1. 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

2. 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

4. 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

5. 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)

6. 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”

7. 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

8. 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

9. MINNESOTA DEPARTMENT OF HEALTH COMMUNICABLE DISEASE REPORTING FORM
Disease Name: ________________________ Onset date:____/____/____ Report date:____/____/____
DEMOGRAPHIC INFORMATION
LABORATORY AND FACILITY INFORMATION
Name
Last: ___________________________ First: ______________ MI: _________
Reporter
Name: _______________________________ Phone: _____________________
DOB:____/____/____ Age:_____ Days Months Years
Gender: Male Female Transgender Unknown
Medical record #: ___________________________________________
Preferred language: English Other:________________________
Country of birth: U.S Other:______________ Unknown
Address:___________________________________________________
Unknown Homeless
City:______________________ State:____ Zip:_____
County:________________
Phone 1st:___________________ Phone 2nd:_____________________
Occupation:_______________ Parent/Guardian:_______________
Institution/Clinic: ______________________________
City: _________________________________________
Ordering provider:_____________________________
Phone:_______________________________________
Primary care provider: _________________________
Lab Name:_____________________________________
Phone:_________________________________________
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
Hospital name: _________________________________________________
Admit date: ____/____/____ Discharge date: ____/____/____
Died? Yes No Unknown If yes, date of death: ____/____/____
Ethnicity:
Hispanic/Latino
Non-Hispanic/ Non-Latino
Unknown
Race (check all that apply):
American Indian/Alaskan Native Asian
Black/African American White
Native Hawaiian/Pacific Islander 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

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

11. 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

12. 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

13. 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)
Well Folks,
it has been a long time coming but today is an exciting day.  A big milestone in our process of automated disease reporting.
We have just sent the first test/sample file to the state.  This test file processed through all steps of the new process from rules evaluation, flagging, tagging, Clarity extracting, HL7 formatting to secure data transmission.  I am just waiting for confirmation back from the state that the file has arrived.
Our next big focus is to validate the readiness for test/result codes to be automated.  To that end we have a detailed testing session setup on Friday September 10th with specific focus on test codes / result evaluation.  This is to determine which of our test codes will be ready (approved) for actual activation on the automated process.
This brings us to the threshold of seeing this become reality.
Amazing what a small group of people can do!
Thank you all!
-Matt

14. 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
4. Transfer of file to MDH
Rhapsody
5. Upload of data into MEDSS
6. IP staff at regions have access to add additional information manually

15. DEPARTMENT Infection Prevention Microbiology LIS IT 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

16. 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

17. 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

18. 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

19. Solution #2 – Process, cont.
Team was not formed
Facility IP coordinated development of SafetySurveillor reports
IP coordinated IT assistance as needed at the facility

20. Solution #2 – Implementation
Premier
1. Reports run by HCMC staff in the Premier system
.csv
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

21. 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

22. 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

23. 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

24. 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

25. 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.

26. 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

27. Questions and Contact Information
Asa Schmidt, Project Manager
Kathryn Como-Sabetti, Epidemiologist