BACKGROUND: From June 2010 through December 2012, carbapenem-resistant Klebsiella pneumoniae (CRKP) was made laboratory reportable to Los Angeles County Department of Public Health (LACDPH). Cases were reported via paper, web interface, and electronic laboratory reporting (ELR). Our objective was to assess the impact of ELR on the timeliness, completeness, and specificity of CRKP reports.
METHODS: We reviewed all CRKP cases reported to LACDPH from 2010-2012. We compared lag time (days from diagnosis to upload into LACDPH database), and completeness of key report fields across the three reporting methods: paper, web interface, and ELR. To assess whether ELR led to more complete reporting, we compared incidence (CRKP reports per 10,000 patient days) for ELR hospitals and two non-ELR hospitals matched by facility size and teaching status. Based on LACDPH review of surveillance and supplemental data, reported cases were classified as confirmed or false cases.
RESULTS: Nine hospitals reported CRKP cases using ELR for all or part of the surveillance period; 100 facilities reported using other methods. Of 2,555 cases reported, 7.4% were via ELR, 10.1% via web interface, and 82.5% via paper. ELR had significantly shorter lag than web and paper reports (medians = 3, 5 and 148 days, respectively). Patient identifying information (date of birth and address) was more complete for ELR than other report types (p=.03). ELR significantly more often included laboratory information, such as specimen source (p<.0001), but patient demographic information was less complete for ELR (p<.0001). CRKP incidence at ELR and matched non-ELR hospitals were similar. Ultimately, 67.7% of ELR reports were confirmed cases, compared with 86.0% for paper and 69.4% for web interface.
CONCLUSIONS: ELR is increasingly used for communicable disease surveillance. Our results suggest advantages in timeliness and completeness of some data, which likely can be generalized from CRKP to other conditions. Improved timeliness was a function both of quicker reporting to LACDPH and absence of data entry delays which occurred with paper forms. Missing data and lower specificity have implications for staff workload and should be addressed.