Automating Case Reporting of Chlamydia and Gonorrhea to Public Health Authorities in Illinois Clinics: Implementation and Evaluation of Findings (Preprint)

Abstract

BACKGROUND Chlamydia and gonorrhea cases continue to rise in Illinois, increasing by 16.4% and 70.9%, respectively, in 2019 compared to 2015. Providers are required to report both chlamydia and gonorrhea, mandated by public health laws. Manual reporting remains a huge burden; 90-93% of cases were reported to Illinois Department of Public Health (IDPH) via Electronic Laboratory Reporting (ELR), and the remaining were reported through web-based data entry platforms, faxes, and phone calls. However, cases reported via ELRs only contain information available to a laboratory facility and do not contain additional data needed for public health. Such data are typically found in an Electronic Health Record (EHR). Electronic Case Reports (eCR) were developed and automated the generation of case reports from EHRs to be reported to public health agencies. OBJECTIVE Prior studies consolidated ‘trigger’ criteria for eCRs and compared eCR reporting with manual reporting and found it to be more complete. The goal of this project was to increase the adoption of standards-based eCR of chlamydia and gonorrhea and in this study, we evaluated the throughput, completeness and timeliness of eCR compared to ELR, and the implementation experience at a large health center-controlled network in Illinois. METHODS For this study, we selected 8 clinics located on the north, west, and south sides of Chicago to implement the eCR; these cases were reported to IDPH. The study period was 52 days. The centralized EHR used by these clinics leveraged two of the three case detection scenarios, which were previously defined as the ‘trigger’ to generate an eCR. These messages were successfully transmitted via Health Level 7 (HL7) Electronic Initial Case Report standard. Upon receipt by IDPH, these eCR were parsed and housed in a staging database. RESULTS During the study period, 183 eCRs representing 135 unique patients were received by IDPH. eCR reported 95% (113 cases) of all the chlamydia cases and 97% (70 cases) of all the gonorrhea cases reported from the participating clinical sites. eCR found additional 14 (19%) cases of gonorrhea that were not reported via ELR. However, ELR reported additional six cases of chlamydia and two cases of gonorrhea that were not reported via eCR. ELR reported 100% of chlamydia cases but only 81% of gonorrhea cases. While key elements such as patient and provider names were complete in both eCR and ELR, eCR was found to report additional clinical data including history of present illness, reason for visit, symptoms, diagnosis, and medications. CONCLUSIONS eCR successfully identified and created automated reports for chlamydia and gonorrhea cases in the implementing clinics in Illinois. eCR demonstrated a more complete case report and represents a promising future of reducing provider burden for reporting cases while achieving greater semantic interoperability between healthcare systems and public health.