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Hepatitis B and C are the most commonly reported infectious diseases in NYC; in part because both are highly prevalent and patients are tested repeatedly over time. Annually, for each infection, the NYC Department of Health and Mental Hygiene (DOHMH) receives over 90,000 reports, representing over 40,000 persons, of whom about 10,000 are newly reported. Laboratory electronic reporting has been mandatory since 2006 and has created many data management challenges. These include ensuring completeness of laboratory reporting, improving standardization of test types and test results, interpreting complex test methodologies, and matching multiple reports for a given patient. We present our solutions to these challenges.
Although both laboratories and providers are required to report, 93% of all hepatitis reports submitted to DOHMH are from laboratories. With limited resources, focusing on complete laboratory reporting is our highest priority. To identify gaps in laboratory reporting, we review all hepatitis B core IgM (HBcIgM) events that were reported by providers, but not by laboratories; we follow-up with the laboratory to resolve reporting barriers. Because reporting is done by over 100 laboratories and is not standardized, we developed a web application that electronically standardizes three variables: test type, test result and specimen source. Only standardized data is imported into our surveillance database. Reporting hepatitis test results is complex, especially for hepatitis B surface antigen (HBsAg) and hepatitis C antibody. HBsAg positive must be confirmed by the laboratory; hepatitis C antibody signal to cut off (s/co) ratio must be high to be reported to the NYC DOHMH. We track each laboratory’s HBsAg confirmation method and hepatitis C s/co threshold to ensure we import only reportable positive tests. Lastly, with multiple reports for the same patient, matching persons is a key concern; automated algorithms minimize the number of possible matches requiring manual review. With highly prevalent conditions like hepatitis B and C, if the algorithm is too sensitive, persons with common names may be called matches when they are not. In NYC, this is especially true with our hepatitis B surveillance database, half of whom are East Asians. East Asian names are especially prone to being misclassified as duplicates because of differences in character transliteration and shortness of names. To reduce these problems, in partnership with our vendor, we developed a special matching program for East Asian names.
NYC DOHMH’s experience may be useful for other health departments facing similar challenges.