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Dixon BE, Zhang Z, Arno JN, Revere D, Joseph Gibson P, Grannis SJ. Improving Notifiable Disease Case Reporting Through Electronic Information Exchange-Facilitated Decision Support: A Controlled Before-and-After Trial. Public Health Rep 2020; 135:401-410. [PMID: 32250707 DOI: 10.1177/0033354920914318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Outbreak detection and disease control may be improved by simplified, semi-automated reporting of notifiable diseases to public health authorities. The objective of this study was to determine the effect of an electronic, prepopulated notifiable disease report form on case reporting rates by ambulatory care clinics to public health authorities. METHODS We conducted a 2-year (2012-2014) controlled before-and-after trial of a health information exchange (HIE) intervention in Indiana designed to prepopulate notifiable disease reporting forms to providers. We analyzed data collected from electronic prepopulated reports and "usual care" (paper, fax) reports submitted to a local health department for 7 conditions by using a difference-in-differences model. Primary outcomes were changes in reporting rates, completeness, and timeliness between intervention and control clinics. RESULTS Provider reporting rates for chlamydia and gonorrhea in intervention clinics increased significantly from 56.9% and 55.6%, respectively, during the baseline period (2012) to 66.4% and 58.3%, respectively, during the intervention period (2013-2014); they decreased from 28.8% and 27.5%, respectively, to 21.7% and 20.6%, respectively, in control clinics (P < .001). Completeness improved from baseline to intervention for 4 of 15 fields in reports from intervention clinics (P < .001), although mean completeness improved for 11 fields in both intervention and control clinics. Timeliness improved for both intervention and control clinics; however, reports from control clinics were timelier (mean, 7.9 days) than reports from intervention clinics (mean, 9.7 days). CONCLUSIONS Electronic, prepopulated case reporting forms integrated into providers' workflow, enabled by an HIE network, can be effective in increasing notifiable disease reporting rates and completeness of information. However, it was difficult to assess the effect of using the forms for diseases with low prevalence (eg, salmonellosis, histoplasmosis).
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Affiliation(s)
- Brian E Dixon
- 10668 Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.,50826 Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.,12250 Center for Health Information and Communication, Health Services Research & Development Service, Department of Veterans Affairs, Indianapolis, IN, USA
| | - Zuoyi Zhang
- 50826 Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Janet N Arno
- 12250 School of Medicine, Indiana University, Indianapolis, IN, USA.,4059 Marion County Public Health Department, Indianapolis, IN, USA
| | - Debra Revere
- 7284 School of Public Health, University of Washington, Seattle, WA, USA
| | - P Joseph Gibson
- 4059 Marion County Public Health Department, Indianapolis, IN, USA
| | - Shaun J Grannis
- 50826 Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.,12250 School of Medicine, Indiana University, Indianapolis, IN, USA
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Dixon BE, Zhang Z, Lai PTS, Kirbiyik U, Williams J, Hills R, Revere D, Gibson PJ, Grannis SJ. Completeness and timeliness of notifiable disease reporting: a comparison of laboratory and provider reports submitted to a large county health department. BMC Med Inform Decis Mak 2017. [PMID: 28645285 PMCID: PMC5481902 DOI: 10.1186/s12911-017-0491-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Most public health agencies expect reporting of diseases to be initiated by hospital, laboratory or clinic staff even though so-called passive approaches are known to be burdensome for reporters and produce incomplete as well as delayed reports, which can hinder assessment of disease and delay recognition of outbreaks. In this study, we analyze patterns of reporting as well as data completeness and timeliness for traditional, passive reporting of notifiable disease by two distinct sources of information: hospital and clinic staff versus clinical laboratory staff. Reports were submitted via fax machine as well as electronic health information exchange interfaces. Methods Data were extracted from all submitted notifiable disease reports for seven representative diseases. Reporting rates are the proportion of known cases having a corresponding case report from a provider, a faxed laboratory report or an electronic laboratory report. Reporting rates were stratified by disease and compared using McNemar’s test. For key data fields on the reports, completeness was calculated as the proportion of non-blank fields. Timeliness was measured as the difference between date of laboratory confirmed diagnosis and the date the report was received by the health department. Differences in completeness and timeliness by data source were evaluated using a generalized linear model with Pearson’s goodness of fit statistic. Results We assessed 13,269 reports representing 9034 unique cases. Reporting rates varied by disease with overall rates of 19.1% for providers and 84.4% for laboratories (p < 0.001). All but three of 15 data fields in provider reports were more often complete than those fields within laboratory reports (p <0.001). Laboratory reports, whether faxed or electronically sent, were received, on average, 2.2 days after diagnosis versus a week for provider reports (p <0.001). Conclusions Despite growth in the use of electronic methods to enhance notifiable disease reporting, there still exists much room for improvement.
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Affiliation(s)
- Brian E Dixon
- Indiana University, Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 5000, Indianapolis, IN, 46202, USA. .,Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA. .,Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, 1481 W. 10th St, 11H, Indianapolis, IN, USA. .,Department of BioHealth Informatics, School of Informatics and Computing, Indiana University, 535 W Michigan St, Indianapolis, IN, 46202, USA.
| | - Zuoyi Zhang
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA
| | - Patrick T S Lai
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA.,Department of BioHealth Informatics, School of Informatics and Computing, Indiana University, 535 W Michigan St, Indianapolis, IN, 46202, USA
| | - Uzay Kirbiyik
- Indiana University, Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 5000, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA
| | - Jennifer Williams
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA
| | - Rebecca Hills
- University of Washington, School of Public Health, 1107 NE 45th St, Suite 400, Box 354809, Seattle, WA, 98195-4809, USA
| | - Debra Revere
- University of Washington, School of Public Health, 1107 NE 45th St, Suite 400, Box 354809, Seattle, WA, 98195-4809, USA
| | - P Joseph Gibson
- Marion County Public Health Department, 3838 N Rural St, Indianapolis, IN, 46205, USA
| | - Shaun J Grannis
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA.,Indiana University, School of Medicine, 3410 10th St, #6200, Indianapolis, IN, USA
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Bauer NS, Ofner S, Pottenger A, Carroll AE, Downs SM. Follow-up of Mothers with Suspected Postpartum Depression from Pediatrics Clinics. Front Pediatr 2017; 5:212. [PMID: 29043246 PMCID: PMC5632353 DOI: 10.3389/fped.2017.00212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/20/2017] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Pediatric providers are increasingly screening for postpartum depression (PD), yet, it is unknown how often mothers comply with recommendations to seek treatment. The objectives were to describe the rate at which mothers with suspected PD seek treatment and explore factors that predict help-seeking behavior. DESIGN AND METHODS Mothers were recruited from four pediatric clinics after identification using the Child Health Improvement through Computer Automation (CHICA) system. Mothers with a positive screen were invited to participate in a telephone interview between January 2012 and December 2014. Mothers reported if they sought treatment or called a community resource. RESULTS 73 of 133 eligible mothers participated (55% response rate). Fifty women recalled a recommendation to seek help. Only 43.8% (32/73) made a follow-up appointment with an adult provider and even fewer kept the appointment. CONCLUSION A majority of mothers suspected of having PD recalled a referral for further intervention; yet, less than half took action. Further investigation of barriers of help-seeking behavior is warranted.
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Affiliation(s)
- Nerissa S Bauer
- Section of Children's Health Services Research, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
| | - Susan Ofner
- Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Amy Pottenger
- Section of Children's Health Services Research, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Aaron E Carroll
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States.,Section of Pediatric and Adolescent Comparative Effectiveness Research, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Stephen M Downs
- Section of Children's Health Services Research, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
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Kratz A. Electronic reporting of all reference laboratory results: An important step toward a truly all-encompassing, integrated health record. Health Informatics J 2015; 22:496-504. [PMID: 25701555 DOI: 10.1177/1460458215569004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Results from reference laboratories are often not easily available in electronic health records. This article describes a multi-pronged, long-term approach that includes bringing send-out tests in-house, upgrading the laboratory information system, interfacing more send-out tests and more reference laboratories, utilizing the "miscellaneous assay" option offered by some reference laboratories, and scanning all remaining paper reports from reference laboratories for display in the electronic health record. This allowed all laboratory results obtained in association with a patient visit, whether performed in-house or at a reference laboratory, to be available in the integrated electronic health record. This was achieved without manual data entry of reference laboratory results, thereby avoiding the risk of transcription errors. A fully integrated electronic health record that contains all laboratory results can be achieved by maximizing the number of interfaced reference laboratory assays and making all non-interfaced results available as scanned documents.
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Affiliation(s)
- Alexander Kratz
- Department of Pathology and Cell Biology, Columbia University Medical Center, USA
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Dixon BE, Siegel JA, Oemig TV, Grannis SJ. Electronic health information quality challenges and interventions to improve public health surveillance data and practice. Public Health Rep 2013; 128:546-53. [PMID: 24179266 PMCID: PMC3804098 DOI: 10.1177/003335491312800614] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We examined completeness, an attribute of data quality, in the context of electronic laboratory reporting (ELR) of notifiable disease information to public health agencies. METHODS We extracted more than seven million ELR messages from multiple clinical information systems in two states. We calculated and compared the completeness of various data fields within the messages that were identified to be important to public health reporting processes. We compared unaltered, original messages from source systems with similar messages from another state as well as messages enriched by a health information exchange (HIE). Our analysis focused on calculating completeness (i.e., the number of nonmissing values) for fields deemed important for inclusion in notifiable disease case reports. RESULTS The completeness of data fields for laboratory transactions varied across clinical information systems and jurisdictions. Fields identifying the patient and test results were usually complete (97%-100%). Fields containing patient demographics, patient contact information, and provider contact information were suboptimal (6%-89%). Transactions enhanced by the HIE were found to be more complete (increases ranged from 2% to 25%) than the original messages. CONCLUSION ELR data from clinical information systems can be of suboptimal quality. Public health monitoring of data sources and augmentation of ELR message content using HIE services can improve data quality.
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Affiliation(s)
- Brian E. Dixon
- Indiana University, School of Informatics and Computing, Indianapolis, IN
- Regenstrief Institute, Indianapolis, IN
- Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Center of Excellence on Implementing Evidence-Based Practice, Indianapolis, IN
| | | | - Tanya V. Oemig
- Wisconsin Department of Health Services, Wisconsin Electronic Disease Surveillance System, Madison, WI
| | - Shaun J. Grannis
- Regenstrief Institute, Indianapolis, IN
- Indiana University, School of Medicine, Indianapolis, IN
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Anand V, Sheley ME, Xu S, Downs SM. Real time alert system: a disease management system leveraging health information exchange. Online J Public Health Inform 2012; 4:ojphi.v4i3.4303. [PMID: 23569648 PMCID: PMC3615830 DOI: 10.5210/ojphi.v4i3.4303] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Rates of preventive and disease management services can be improved by providing automated alerts and reminders to primary care providers (PCPs) using of health information technology (HIT) tools. METHODS Using Adaptive Turnaround Documents (ATAD), an existing Health Information Exchange (HIE) infrastructure and office fax machines, we developed a Real Time Alert (RTA) system. RTA is a computerized decision support system (CDSS) that is able to deliver alerts to PCPs statewide for recommended services around the time of the patient visit. RTA is also able to capture structured clinical data from providers using existing fax technology. In this study, we evaluate RTA's performance for alerting PCPs when their patients with asthma have an emergency room visit anywhere in the state. RESULTS Our results show that RTA was successfully able to deliver "just in time" patient-relevant alerts to PCPs across the state. Furthermore, of those ATADs faxed back and automatically interpreted by the RTA system, 35% reported finding the provided information helpful. The PCPs who reported finding information helpful also reported making a phone call, sending a letter or seeing the patient for follow up care. CONCLUSIONS We have successfully demonstrated the feasibility of electronically exchanging important patient related information with the PCPs statewide. This is despite a lack of a link with their electronic health records. We have shown that using our ATAD technology, a PCP can be notified quickly of an important event such as a patient's asthma related emergency room admission so further follow up can happen in near real time.
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Affiliation(s)
- Vibha Anand
- Children’s Health Services Research, Indiana University School of Medicine, IN
- Regenstrief Institute for Health Care, Indianapolis, IN
| | - Meena E. Sheley
- Children’s Health Services Research, Indiana University School of Medicine, IN
| | - Shawn Xu
- Children’s Health Services Research, Indiana University School of Medicine, IN
| | - Stephen M. Downs
- Children’s Health Services Research, Indiana University School of Medicine, IN
- Regenstrief Institute for Health Care, Indianapolis, IN
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