Public Health Reporting
- Julia Skapik (Deactivated)
- Mindy Hangsleben
State and Local reporting requirements alignment w/CDC
State and local variations may be significant
Routine workflow: From clinical care to state/local public health organizations and that flows to the CDC
Public health emergency: Reporting of COVID-19 case reporting as a communicable disease comes from clinical organizations to state/local public health agencies → CDC/HHS but may also report to CDC
Hospitals report directly to CDC NHSN
Initial WH task force/CMS requested spreadsheet data directly from clinical organizations-- unclear if this workflow is still in play
Testing organizations: provide electronic laboratory reporting
Syndromic surveillance activities
One FQHC workflow: via fax individual case report--required to document the following at a minimum: name, date of birth, gender, race, ethnicity, full address, phone number
In process of implementing eCR
In Utah: using eCR to report to the state-- HIE group for Intermountain provides reporting across the clinical members
Also able to gather external test data from the health information network (HIN) but don’t report on external tests
How does the system know that a patient is a unique patient versus reporting at the test level
CDC receives deidentified data
State has patient-identified data but how this coordinates with local data may be an issue
Example: Philly data May 2 on deaths exceeded the state count
eCR Tool Demo and Discussion (John Loonsk) - (45 min)
Laboratory reporting workflow is well-described but level of data specificity was often inadequate
New HHS guidance requires labs to achieve new minimum level of data
Electronic approach is relatively newer (eLR)
Focused on transmitting the data locally then to the state
State trying to gather deidentified eLR data for CDC reporting-- may not be perfectly deduplicated
In Lyme, reviews show it is only reported in 10% of cases
Lab reporting did not include the expanded data newly required to represent health disparities-- this is rapidly being amended
Public Health Reporting Workflow;
Arizona:
Healthy Arizona: 14 CHCs on third party pop health tool-- integrating risk management
Data is getting sent to state public health agency
ValleyWise Health: County safety net for Maricopa Co
AZ has critical mass of patients in and outpatient now
Tracking lab results, ICU admissions, ventilators, PPE,
Epic shop-- uses Epic data
State-wide database provides current disease burden including admissions and testing
Offers mobile testing sites, 12 clinics, rapid testing
State epidemiologists can be involved with specific cases but do not have the bandwidth for typical cases
Reporting occurs at state level-- Arizona Dept of Health Services
That data is aggregated at state level-- data can be filtered at the county level
Electronic submission of data using a template-- can use EMR to obtain some but not all so additional formatting is needed
State sends data to CDC for national reporting
Local public health agency has helped to obtain PPE and test kits
Recently added HIE (HealthCurrent) feed to find ADT events and pull in COVID-related data
Clinicians can sometimes use HIE to find external COVID information about patients
Challenges:
Data is often fragmented and not comprehensive-- if data isn’t in HIE it may need to be tracked down
Clinical organizations do not have other public health resources and have to fill in gaps
maybe 5% of data and patients require manual adjustments or workarounds
Need for above data is critical to operational response but teams have had 100+ days to set up and now have a functional framework of sorts
Collaboration has some interesting components-- individual organizations still have their own bottom line, resources and data
More than 11 EHRs participate in this network
Andrew Dunnigan-- main role to set up virtual care coordination-- use doxy.me for lightweight implementation
Not prioritized integration with separate EMR
Goal to maintain high level of virtual care moving forward (external constraints assuming)
State working at 90% capacity but right now highly effective thanks to the strategic and data approach to date
Working on a Redcap solution in AZ-- using it for epi and research purpose
State reporting to CDC is deidentified
Subset of the original data to the state
Deidentified
Redcap working group has been demonstrating state/local electronic data capture solutions from implementing eCR and supply chain tracking-- will follow up with the group @Julia Skapik (Deactivated) via Eric Manders
Here's the case report form that shows the info that public health agencies report to CDC: https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf
Link for info on electronic case reporting, including an app that can facilitate reporting called eCR Now: https://ecr.aimsplatform.org/
Critical functionality assumed: lab reporting and case reporting data should be collated and de-duplicated at the state/local level
Whether this is occurring (for whatever reason) is variable depending on: comprehensiveness of data provided, infrastructure for deduplication, ability to link both reports due to timing, etc-- can lead to double-counting
Spot testing is likely to be missed due to lack of electronic lab systems and clinical system entry
eCR was being implemented in a few sites prior to COVID-19
Since the start of COVID-19 has been advancing with some states (CA) and EHRs (Epic) faster than others
eCR Now FHIR App is now available in Cerner
Can be used at the EHR level or locally installed
At this point every public health agency except one is able to recieve the eCR data or in testing
eCR included demographic information required by HHS
From 4 pilot sites there are now 2000
eCR Now App allows systems without EHR eCR capacity to implement electronic case reporting
Part of goal of eCR is to standardize across states the reporting requirements-- almost all states are able to use these shared requirements and take in this data
eCR Aims platform approach: https://ecr.aimsplatform.org/ecr-overview
Triggers eCR action in the record → confirms it is reportable using cloud-based platform with eRDS (Electronic Reporting and Surveillance Distribution System) and CSTE/CDC Decision Support Engine (RCKMS) → builds the report and sends it
RCKMS is a partnership with ASTHO to develop algorithms to determine reporting approach
Based on HL7 standards for reporting
Platform designed around common data element standards with goal of alignment to the EHR and clinical data elements
Challenges around clinician conformance to documentation requirements and lab data standardization
See eCR Infrastructure diagram-- use eHealthExchange/Carequality Trust Framework with or without DirectTrust
Includes an email address for interest in participation-- eCR-Info@aimsplatform.org
Deployment team can support pilot sites – no charge
Funding cuts to public health agencies has had a significant impact on the readiness of public health reporting and local prevention and mitigation efforts
Funding has been released and many organizations are filling in gaps and updating systems
Public health agency surveillance systems are functioning with adequate capacity when populated appropriately
Recent articles:
Traditional Barriers to eCR
Data Methodology and Quality in COVID-19
Copy John Loonsk: john.loonsk@jhu.edu
C19 Contact Tracing Meeting Notes 6/26/20:
Google/Apple – COVID specific and customers opt in and uses temporary Bluetooth keys. Key server is separate from the verification system this feeds a public health api
Partners in Health – Massachusetts contact tracing system that reaches out to people who have been in contact with others that were tested positive they have been working with IT vendors but sounds like it is more of a contact tracer reaching out and working with positive patients to identify people who have been in contact with them.
Mitre – Sara Alert – web based tool aims public health platform hosting, enrolls exposed or sick into the system and pings them every day for 14 days to see if symptoms arise. https://saraalert.org/
Rakhee Palekar – Contact Tracing Workgroup lead
https://www.research.ox.ac.uk/Article/2020-06-25-the-duke-of-cambridge-visits-oxford-vaccine-centre