Electronic Support for Public Health: Validated Case Finding and Reporting for Notifiable Diseases Using Electronic Medical Data

Abstract

Health care providers are legally obliged to report cases of specified diseases to public health authorities, but existing manual, provider-initiated reporting systems generally result in incomplete, error-prone, and tardy information flow. Automated laboratory-based reports are more likely accurate and timely, but lack clinical information and treatment details. Here, we describe the Electronic Support for Public Health (ESP) application, a robust, automated, secure, portable public health detection and messaging system for cases of notifiable diseases. The ESP application applies disease specific logic to any complete source of electronic medical data in a fully automated process, and supports an optional case management workflow system for case notification control. All relevant clinical, laboratory and demographic details are securely transferred to the local health authority as an HL7 message. The ESP application has operated continuously in production mode since January 2007, applying rigorously validated case identification logic to ambulatory EMR data from more than 600,000 patients. Source code for this highly interoperable application is freely available under an approved open-source license at http://esphealth.org.

Uses of Electronic Health Records for Public Health Surveillance to Advance Public Health

“…The ACA does not directly support the development of EHRs in health care settings. (29,32). The system is in use in four large ambulatory care practices in Massachusetts and Ohio, serving almost two million people in conjunction with their respective state health departments.…”

Public Health Surveillance Systems: Recent Advances in Their Use and Evaluation

“…Investigators interested in early recognition and management of chronic diseases have improved diabetes case detection timeliness and sensitivity by developing and validating an automated, real-time diabetes case-finding algorithm using data extracted from a comprehensive electronic health record (53). Similar algorithms are being developed and used for electronic case reporting of notifiable infectious diseases in some jurisdictions to increase surveillance timeliness and the sensitivity of case detection (9,49). Syndromic surveillance systems originally developed to support early detection of public health events are designed to alert at very low thresholds, which often results in high false-positive rates (i.e., low positive predictive value).…”

Evaluation of Surveillance Methods for Staphylococcal Toxic Shock Syndrome

“…With increasing use of automated electronic reporting for disease surveillance (11), querying hospital discharge data for the TSS-specifi c ICD-9 code is a feasible adjunct to passive surveillance to detect TSS trends over time. Consequently, it is imperative that clinicians and coders are thorough to ensure that ICD-9 codes are accurate.…”