Impact of Electronic Laboratory Reporting on Immediately Reportable Conditions: Is Public Health Still Receiving Phone Calls from Laboratories?

BACKGROUND: Electronic laboratory results (ELR) are becoming increasingly more common place in the landscape of public health surveillance.  Evaluation of these records to support initial case reporting of immediately reportable diseases to the local county health department (CHD) has not been conducted.  ELRs are received by the Florida Department of Health (FDOH) on a daily basis.  Laboratory results which meet the criteria for public health reportable disease surveillance are then immediately available in the state’s reportable disease surveillance system, Merlin, for local disease investigators.  However, some conditions are “immediately reportable,” requiring immediate phone reporting by laboratories.

METHODS: Merlin is FDOH’s secure web-based disease reporting and epidemiologic analysis system, operating in all 67 counties.  Modifications were made to Merlin to capture how the case is initially identified by the local county health department.  Cases associated with reportable conditions including those designated as immediately reportable were analyzed to determine how the case was initially reported to local public health. 

RESULTS: In 2005, Merlin received approximately 3,000 ELRs for all reportable conditions.  The number of ELRs received in Merlin associated with reportable condition findings has steadily risen to over 241,000 laboratory results in 2012.  Along with the overall number of ELRs processed, the proportion of cases where the initial case identification occurred via electronic laboratory reporting has increased.  The percentage of first identification by disease showed variation in how the CHD was first notified of the possible case.  Of immediately reportable conditions, 20% of cases in 2012 with known notification information were initially reported to public health via ELR and variation was present by disease.  For example, 10.6% of meningococcal cases, 33.3% of brucellosis cases, and 51.6% of hepatitis A cases were initially identified by CHDs through receipt of an ELR and were not reported initially via  telephone reporting as required by Florida law.

CONCLUSIONS: Participation in electronic laboratory reporting does not nullify the laboratory’s or the practitioner’s responsibility to report immediately reportable conditions via phone.  Some immediately reportable conditions were consistently first reported to public health via receipt of an ELR.  Further evaluation to determine if all conditions traditionally designated as telephone immediately by laboratories should remain as such given electronic laboratory reporting.  This assessment can be used to further evaluate if changes to state regulations are necessary to align actionable public health intent.  Additional refinement of conditions requiring telephone immediate reporting may lead to improved adherence to reporting requirements.