Progress Toward a Reportable Conditions Knowledge Management System (RCKMS)

BACKGROUND: Reporting of conditions of public health importance is a cornerstone of public health surveillance.  Currently, the process is labor-intensive, largely manual, and inconsistent.  Authorized individuals in each public health jurisdiction create rules defining reportable conditions for that jurisdiction, within what time frame, to whom, and by what method.  These definitions are written at differing levels of specificity, and are typically available only in human-readable form, on a web site or poster. Reporters have great difficulty finding and implementing these rules, coping with variation among jurisdictions, and keeping up with changes.  Translating rules written for humans into criteria that can be implemented by an information system is a difficult and time-consuming process that requires scarce specialized expertise.  Requiring that this process be replicated by every reporter and laboratory information system (LIS) and electronic health record system (EHR) vendor in the nation is wasteful, and greatly increases the likelihood of error.

The RCKMS is a collaborative effort among the CDC, CSTE, and APHL, including input from public health stakeholders who create and manage reporting specifications and public health reporters who use that information. The RCKMS is focused on providing a current, authoritative source of information about what is reportable, and when and how, by clinicians, laboratories, hospitals and other public health reporters, in each U.S. jurisdiction. The RCKMS supports the Meaningful Use Stage 1 Reportable Laboratory Results objective, as well as the PH case reporting objective anticipated for Meaningful Use Stage 3.

METHODS: The RCKMS pilot project models reporting specifications for three conditions (blood lead, pertussis, tuberculosis) across seven jurisdictions (NY, NYC, DE, CO, UT, WA, San Diego County), and provides both human-readable and machine-processable output for public health reporters.  This presentation describes the progress made, with an emphasis on lessons learned and next steps.

RESULTS: The pilot project uncovered opportunities for reducing variability across jurisdictions, and identified areas in which existing interoperability standards need to be extended.  It also created a forum for stakeholders to bring together their differing perspectives, and for the public health community to envision the long-term potential of the RCKMS.

CONCLUSIONS: The RCKMS pilot project has moved the PH community closer to the goal of providing in one place the interoperability standards needed to enable electronic reporting.  Challenges remain, and development and testing continues.