BACKGROUND: In 2013, Georgia Department of Public Health (GDPH) implemented electronic submission of laboratory reports (ELR) from public health and clinical laboratories for enteric diseases through a module in its State Electronic Notifiable Diseases Surveillance System (SendSS). These reports can be used to create new cases or can be manually or automatically linked with existing case records. We evaluated the effectiveness of the enteric disease ELR system in terms of its data quality, the timeliness of its reports, and its acceptability to users compared to traditional notifiable disease reporting methods.
METHODS: We interviewed four submitting laboratories and four GDPH employees who use the ELR system by phone or emailed survey. The linking system was examined by comparing linking variables between reports where an electronic report had failed to link to its corresponding case. The accuracy and completeness of the electronic reports were assessed by comparing electronic and paper lab reports from September 2015.
RESULTS: All users of the ELR indicated that electronic reporting provided an improvement in flexibility and reporting time over their traditional methods of reporting. GDPH users indicated that the system centralizes information and makes it easier to find reports, but they expressed concern that clinical laboratories believed they no longer needed to enter cases into SendSS. We found 47 instances of 75 where an electronic report failed to auto-link despite a perfect match to a case report and identified specific coding errors that were responsible. We compared 237 paper lab reports to their electronic equivalents across thirteen variables. Eighteen (7.5%) of the paper reports did not have matching electronic reports. Of the remaining 219, 21 (11%) had discrepant information. Patient phone number, county of residence, and race/ethnicity were on the electronic report but not the paper report 39%, 52%, and 45% of the time, respectively. Completeness of the reports varied by submitting laboratory. Electronic reports were received an average of 5.4 days before their paper counterpart.
CONCLUSIONS: In general, electronic reports are as complete as or more complete than paper reports. Complexities with electronic message coding can cause errors that prevent reports from automatically linking to existing case records. Manual data entry remains a burden on GDPH staff. Users are optimistic about the potential of electronic reporting, but without a way to reliably link or generate case reports automatically from electronic messages, the system offers only modest improvements over paper lab reports.