1. 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

2. 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

3. 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

4. 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

5. 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

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

7. Map

8. Easy Access to Coordinate Data Gonorrhea, Chlamydia by School District

9. Patient De-Duplication

10. 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

11. Changes in Data Quality

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

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

14. 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

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

16. 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%

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

18. 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

19. 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

20. 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

21. 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

22. 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

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

24. 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?