Advancing Electronic Case Detection and Reporting of Sexually Transmitted Infections

BACKGROUND:  Sexually transmitted infections (STI) are among the most frequently reported infectious conditions reported to state and local public health agencies. While electronic lab reports (ELR) of STI have improved the timeliness of case reports, they often lack important demographic data that is captured in primary care settings and could be used for local interventions like case follow up and partner notification. As primary care clinicians adopt electronic health record (EHR) systems, opportunities to improve STI surveillance through informatics emerge. Two promising informatics practices include automated case detection and electronic case reporting.  Automated case detection entails programming an EHR to scan patient data and apply criteria for determining which disease cases need to be reported to public health. With electronic case reporting, the clinician’s EHR creates an electronic version of the public health case report and transmits it directly to a computerized public health surveillance system. Despite recent advances, challenges with EHR-based STI case detection and reporting result from variations across clinical practices and public health jurisdictions. This presentation details findings from an analysis of EHR-based implementations of case detection and reporting functionality for gonorrhea and chlamydia. 

METHODS:  For this project we compare case detection logic and electronic case reporting criteria gathered from a series of focus groups conducted in settings that have implemented EHR-based case detection logic. A template for STI case detection logic is used to guide focus group discussion toward identifying EHR-based data elements and value sets indicating reportable cases and the content of electronic case reports sent to public health. 

RESULTS:  This presentation will describe findings from the focus group series and detail the clinical vocabularies and coded value sets used in implementations of EHR-based automated case detection, the content and format of electronic STI case reports generated by EHRs, and variations across specific implementations.

CONCLUSIONS:  This project seeks to identify opportunities for reaching harmonized standards for EHR-based case detection and reporting of STIs.  It is designed to complement similar efforts for other public health reportable conditions and inform emerging health information technology standards that can improve public health surveillance. Consensus on how EHRs can best improve case detection and reporting increases the likelihood that standards are developed, widely and uniformly implemented, and result in accurate and comparable information on disease burden across populations.