An Assessment of Information Exchange Practices, Challenges, and Opportunities to Support US Disease Surveillance in 3 States.

BACKGROUND: State and local public health agencies collect and use surveillance data to identify outbreaks, track cases, investigate causes, and implement measures to protect the public's health through various surveillance systems and data exchange practices. PURPOSE: The purpose of this assessment was to better understand current practices at state and local public health agencies for collecting, managing, processing, reporting, and exchanging notifiable disease surveillance information. METHODS: Over an 18-month period (January 2014-June 2015), we evaluated the process of data exchange between surveillance systems, reporting burdens, and challenges within 3 states (California, Idaho, and Massachusetts) that were using 3 different reporting systems. RESULTS: All 3 states use a combination of paper-based and electronic information systems for managing and exchanging data on reportable conditions within the state. The flow of data from local jurisdictions to the state health departments varies considerably. When state and local information systems are not interoperable, manual duplicative data entry and other work-arounds are often required. The results of the assessment show the complexity of disease reporting at the state and local levels and the multiple systems, processes, and resources engaged in preparing, processing, and transmitting data that limit interoperability and decrease efficiency. CONCLUSIONS: Through this structured assessment, the Centers for Disease Control and Prevention (CDC) has a better understanding of the complexities for surveillance of using commercial off-the-shelf data systems (California and Massachusetts), and CDC-developed National Electronic Disease Surveillance System Base System. More efficient data exchange and use of data will help facilitate interoperability between National Notifiable Diseases Surveillance Systems.

Characterization of public health alerts and their suitability for alerting in electronic health record systems.

Public health agencies including federal, state, and local governments routinely send out public health advisories and alerts via e-mail and text messages to health care providers to increase awareness of public health events and situations. Agencies must ensure that practitioners have timely and accessible information at the critical point-of-care. Electronic health record (EHR) systems have the potential to alert physicians of emerging health conditions deemed important for public health at the most critical time of need. To understand how public health agencies can leverage existing alerting mechanisms in EHR systems, it is important to understand characteristics of public health alerts to determine their suitability for alerting in EHR systems. Authors conducted a review and analysis of public health alerts for a 3-year period to identify critical data attributes necessary to support public health alerting in EHR systems. The alerts were restricted to those most relevant for clinical care. The results showed that there is an opportunity for disseminating actionable information to clinical practitioners at the point of care to guide care and reporting. Public health alerts in EHR systems can be useful in reporting, recommending specific tests, as well as suggesting secondary prevention.

Disseminating public health practice guidelines in electronic medical record systems.

An evaluation of public health practice guidelines published by CDC was conducted to determine the feasibility of disseminating them through electronic medical record (EMR) systems. Of 1,069 guidelines evaluated, 360 contained at least one recommendation that could be presented as an alert or reminder to the clinician during the patient encounter. These guidelines were in the areas of: HIV (59), sexually transmitted diseases (8), health care associated infections (14), tuberculosis (TB) (25), immunizations/vaccine-preventable diseases (80), other infectious diseases (134), reproductive health diseases (8), cancers (9), diabetes (5), and other chronic diseases (18). Further efforts to disseminate CDC guidelines through EMR systems are in progress.

Emergency implementation of knowledge management system to support a bioterrorism response.

In a public health emergency, it becomes necessary for public health agencies to provide timely, accurate and useful information to the community. During the anthrax attacks, the Public Health Practice Program Office in the Centers for Disease Control and Prevention implemented a knowledge management (KM) system to respond to an increased number of inquiries from public health officials, first responders, and health care professionals as well as the general public. While it is possible to successfully implement a knowledge management system quickly in a crisis situation, additional challenges to sustainability may result from shortchanging the normal decision-making channels.