Developing Automated
Communicable Disease Reporting:
Two Pragmatic Technological
Solutions
Kathryn Como-Sabetti, Asa Schmidt, Dede Ouren,
Kathleen Steinmann, Matt Muscha,
Richard Danila
Minnesota Department of Health, HealthPartners
Inc., Hennepin County Medical Center
Minnesota Communicable Disease
Reporting Rule
• MN statute requires all licensed healthcare
providers and laboratorians to report specific
communicable disease
• 78 pathogens/syndromes are reportable
– 18 immediately reportable by phone
– 60 reportable within 1 working day
• Over 25,000 reportable communicable
diseases received in 2010
Minnesota Communicable Disease
Reporting Rule, cont.
• Centralized communicable disease
reporting
– Case investigation may be performed by local
public health depending on pathogen and
jurisdiction
• Minnesota is part of the Emerging
Infection Program
– Increases the number of reportable diseases
and complexity of reporting
Communicable Disease Reporting
Process – Non Urgent Reports
IP Identifies reportable disease
IP Reviews Chart and Completes CRF
CRF Submitted to MDH
(via fax, mail, phone or web)
CRF Submitted to MDH
(via fax, mail, phone or web)
MDH receives CRF
MDH enters information from
CRF into program database
MDH receives CRF
Repeat multiple times per day
MDH Enters Case
Into Program Database
IP Reviews Chart for
Additional Information
MDH Calls IP for additional
Information (sometimes)
Background
• Communicable disease reporting rule changed
in 2004
– MN-APIC/IPs expressed concern about the burden of
increased reporting
– MDH agreed to look into ways to decrease reporting
burden
• Fall 2006; MN-APIC authored a letter to the
Commissioner of Health regarding the
increasing burden of infectious disease
reporting
• Difficult economic times force all agencies to
“find efficiencies”
ADR vs ELR
• MDH has had a number of labs submitting
communicable disease reports through
electronic laboratory reporting (ELR).
• ELR had limited impact on disease reporting
when ELR has very little case information.
– IPs still required to either complete a case
report form
ADR vs ELR, cont.
• Automated disease reporting (ADR) includes
demographic, contact, laboratory, and
facility information
– Combines ELR with information from the
patient’s electronic health record
– Decreases the number of case reports
completed by IPs
MINNESOTA DEPARTMENT OF HEALTH COMMUNICABLE DISEASE REPORTING FORM
Disease Name: ________________________
Onset date:____/____/____
DEMOGRAPHIC INFORMATION
LABORATORY AND FACILITY INFORMATION
Name
Reporter
Last: ___________________________
First: ______________
DOB:____/____/____ Age:_____ Days
Gender:
Report date:____/____/____
Male Female Transgender
Months
MI: _________
Years
Country of birth:
City: _________________________________________
Ordering provider:_____________________________
English Other:________________________
U.S.
Other:______________
Phone: _____________________
Institution/Clinic: ______________________________
Unknown
Medical record #: ___________________________________________
Preferred language:
Name: _______________________________
Unknown
Phone:_______________________________________
Primary care provider: _________________________
Address:___________________________________________________
Unknown Homeless
Phone:_______________________________________
Lab Name:_____________________________________
City:______________________ State:____ Zip:_____
Phone:_________________________________________
County:________________
Phone 1st:___________________Phone 2nd:_____________________
Occupation:_______________
Parent/Guardian:_______________
MDH contact if additional information needed (choose at least one):
Reporter
Primary care provider
Ordering provider
Lab
Other:_______________________________________________________
Was the patient hospitalized? Yes No Unknown
Ethnicity:
Race (check all that apply):
Hispanic/Latino
American Indian/Alaskan Native
Asian
Hospital name: _________________________________________________
Non-Hispanic/ NonLatino
Black/African American
White
Admit date: ____/____/____
Discharge date: ____/____/____
Native Hawaiian/Pacific Islander
Unknown
Died? Yes No Unknown
If yes, date of death: ____/____/____
Unknown
Other:______________________________
Specimen collection date: _____/_____/_____
Specimen source :______________________________________
Pregnant (if applicable): Yes No Unknown
IF YES, due date: _____/_____/_____
Highlighted fields were identified as those in electronic medical records that could be pulled though
an automated process.
Revised 6/10
Solution #1 - Background
• August 2007 RFA released by MDH for data
mining systems to develop automated
reporting to MDH
– 2 awards approximately $24,000 each
– No applications
• April 2009 RFA released by MDH for health
systems to develop automated reporting to
MDH
– 1 award up to $92,000
– Awarded to HealthPartners/Region’s Hospital
Grant Objectives
• Automate the pull of demographic
information from an electronic medical
record and send an electronic case reports
to MDH
– HealthPartners opted to automate the
identification of reportable diseases
• Develop a roadmap for other institutions to
develop ADR
Solution #1 - Process
• Teams were formed at HealthPartners and
MDH and included experts from the
Laboratory, Epidemiology, Infection
Prevention, and Information Technology (IT)
– IT experts included: project management,
message format, message transport,
translation, and laboratory information
systems
• Kick off meeting
• Monthly project conference calls
Solution #1 – Implementation
• 681 tags of laboratory test/result
combinations identified reportable
diseases
• Once tagged, case reports were
generated using Clarity extracting from
the patient’s medical record (EPIC)
Solution #1 – Implementation
Sunquest
1. Lab results in LIMS (sunquest) triggers the feed
EPIC
2. Information is passed on to the HER (EPIC), for case information
HL7
3. HL7 message is created
PHIN-MS
Rhapsody
4. Transfer of file to MDH
5. Upload of data into MEDSS
6. IP staff at regions have access to add additional information manually
TASK
format HL7 results from LIS
to EHR system
confirm the English Text
Code
tag interpretation
confirm reportable flag
confirm extracted data is
formatted in the proper
sequence
HL7 format has data
elements mapped into
agreed locations
confirm standard encrypted
EDI transmission from RH
to MDH
data communication is
functional
DEPARTMENT
Infection
Prevention
Microbiology
LIS
IT
Solution #2 - Background
• Hennepin County Medical Center (HCMC)
contracted with Premier to implement
SafetySurveillor for healthcare associated
infection surveillance
• Included in the contract was a provision
that SafetySurveillor would develop
reports identifying reportable
communicable diseases
Solution #2 - Process
• 4 reports were developed by HCMC and
Premier to identify cases:
– Communicable disease report to
identify cases by pathogen only
– Communicable disease report to
identify cases by pathogen and
specimen source
– Neonatal sepsis report (pathogen and
patient DOB)
– Invasive MRSA report
Solution #2 – Process, cont.
• Paper reporting by healthcare providers
for STDs continues with ADR reporting to
audit
– Process to identify treatment is not automated
but necessary for STD reports
• MDH approved message format
– Message includes demographic, contact,
laboratory, hospitalization and provider
information
Solution #2 – Process, cont.
• Team was not formed
• Facility IP coordinated development of
SafetySurveillor reports
• IP coordinated IT assistance as needed at
the facility
Solution #2 – Implementation
Premier
.csv
1. Reports run by HCMC staff in the Premier system
3. Flat file is created
PHIN-MS
4. Transfer of file to MDH
Rhapsody
5. Upload of data into MEDSS
6. IP staff at HCMC have access to add additional information manually
Current Status
Solution #1
• MDH receives files daily from HP
– Implementation is going through a validation
step to confirm all data is correct
• Upload into MEDSS will create new disease
events in the system
– De-duplication will try to match to existing
persons and events.
• Disease events will be listed on daily workflows
for epis (routing is based on disease)
• IPs at HP are being trained on MEDSS
Current Status
Solution #2
• MDH receives files twice a week from
HCMC
– MDH staff time saved for reviewing
HCMC charts
• Files are manually routed to disease
program staff
• MEDSS team is currently working on
mapping the message into MEDSS
• Approximate 20% of chlamydia and
gonorrhea was not reported by providers
Lessons learned
• ADR improved disease reporting at HCMC
• Manual process of running ADR reports
resulted in reports not being sent daily
• ADR decreases the burden of infectious
disease reporting on healthcare facility
staff
– Once in MEDSS we expect ADR will decrease
MDH staff time spent entering records
Lessons learned, cont.
• There is no standard. Rules for the what
tests/results to send are unique
– Early discussions about when to send data is
essential
– Lab/IP staff provide the knowledge
• IT/Lab/IP/EPI partnership essential
– Team approach lead to smoother
implementation
• IP provides clinical interpretation
Lessons learned, cont.
• Creating the ADR message was complicated
without a standard to fall back on, we ended up
modifying the HL7 message for ELR reporting
• Standardized coding of tests and results would
make it easier to route to the correct program
areas/epis
• When data is sent from one system to another
information gets lost
– Example: Coded test/results in LIMS were
passed on as text to the EHR system, forcing
us to translate them back after we received it.
Lessons learned, cont.
• A practical focus made it possible
– What data elements can we rely on? If we can’t
trust the data don’t try to get it if its
complicated
– What is our goal? If we want things to be
easier for the IPs and we manage to do an
automated transfer of 80% of the cases, can’t
they then do the rest manually if we give them
the tools?
– If we maintain the process of ‘report
immediately by telephone’ for the conditions
that needs this we got our EPIs to be more
confident in the process
Questions and Contact
Information
• Asa Schmidt, Project Manager
– Asa.schmidt@state.mn.us
• Kathryn Como-Sabetti, Epidemiologist
– Kathy.como-sabetti@state.mn.us
651-201-5414