Lessons Learned: Implications of a Web-Based Disease Morbidity Reporting System May 9, 2006 National STD Prevention Conference Kathryn E. Macomber, MPH Michigan Department of Community Health

STD Reporting History Former system was dbase (MI developed) Paper case reports sent through local health departments and entered at state PHIN-compliant, web-based disease reporting system implemented July 2004 all communicable diseases STDs integrated January 10, 2005

New Case Entry HTML screens have common variables such as sex, race, date of birth Interacts with pdf disease-specific forms NETSS variables exported from html and pdf

Disease Specific Form: Gonorrhea Corresponding Variables from HTML Screens Interface With Fields on Disease Specific Form Referral Info, Lab Info, Specimen Info, Treatment Info, Concurrent Co-Infection, and local fields on second page

Advantages over Paper-Based System Standard Reports Real-time data Geocoding and Mapping Deduplication Process Both person and disease Improved data quality Additional variables Former system captured only NETSS required variables

MDSS Standard Reports Examples of some of the reports you can do

Map

Easy Access to Coordinate Data Gonorrhea, Chlamydia by School District

Patient De-Duplication

Case De-Duplication MDSS also checks for existing cases for this patient across all LHJs as there may be multiple referrals (e.g., lab and provider) CREATE - Creates a new case with case information and merged patient information. MATCHES EXISTING - Does not create new case for patient. PLACE IN QUEUE – Defers to Administrator

Changes in Data Quality

Completeness-CT and GC Evaluation Year Variable 2003 2005 Sex 100% 99.9% Age 99% County of Residence Zip Code 74% 85%

Completeness-Race Evaluation Year Variable 2003 2005 GC 60% 67% CT 53% 58%

Changes in Timeliness Pre-MDSS we did not collect date of specimen # of days to NETSS transmission could not be calculated (no CSPS indicators) MDSS does collect this variable Complete for 92% of GC/CT cases in 2005 45% of GC/CT transmitted within 30 days 65% of GC/CT transmitted within 60 days

Information Source Old System: “STD Clinic” or “Private Physician/HMO” New System: Drop down menu of complete list

Information Source-GC and CT Evaluation Year Variable 2003 2005 ER - 10.0% Corrections 1.4% School Clinic 1.9% Unknown 3.0% Family Planning/PP 7.0% STD Clinic 22.0% Private MD/HMO 78.0% 31.0%

Obstacles over Paper-Based System Speed Impact of Lab Reporting Jurisdictional Issues Syphilis Labs and Follow-up

Speed MI dbase system had only 11 variables 1 case every 20 seconds MDSS has approximately 50 variables I case every 60 seconds Data entry speed is dependant on number of users on the system Slow processing between case entry Due to deduplication, geocoding, pdf

Impact of Lab Reporting 5 MI laboratories are entering results, either manually or electronically Quest soon to come online (HL7 transfer) Labs do not have patient demographics or treatment information Doctors no longer receive disease reporting form from laboratory Missing link in the reporting system

Jurisdictional Issues 30% of the cases at the Oakland County STD clinic are residents of Detroit Oakland County can enter Detroit morbidity but can not modify or update information once case has been submitted Incomplete information, no follow-up Issue across state Detroit has jurisdiction over several Wayne County cities

What to do with Syphilis? Syphilis electronic labs are transferred into the system But syphilis lab does not mean morbidity Once a lab is staged and determined to be morbidity, cases are re-entered into the system Can’t upload or download labs Still being hand entered into historical record search database

Lessons Learned MDSS was designed for communicable diseases, not for the high morbidity of STDs Local STD programs are currently limited on staffing Electronic lab reports are frequently incomplete Interactive PDF forms complicate entry

Lessons Learned However, we have gained higher quality information And maintained completeness of essential variables Better epidemiological capacity, especially at the local level

Next Steps? How to support local data entry (Detroit, 2005) Need to plan for how to integrate syphilis How do we integrate program module or a CDC released STD PAM?