For hepatitis C surveillance, only acute hepatitis C is reportable in Texas. The Houston Health Department (HHD) receives about 3,000 electronic laboratory reports of positive HCV infection annually. However, these lab reports do not contain clinical information needed to differentiate acute from chronic infections. They also don't provide sufficient information for cases to meet state reporting requirements. Currently, clinical information is received from providers via paper case reports. These reports require manual data entry into the disease registry. Thus, the current surveillance system is labor-intensive for both the HHD and healthcare providers, resulting in under- and delayed- reporting. To resolve this issue, the HHD is implementing the "Streamlining Hepatitis C Automatic Reporting Project (SHARP)." The purpose is to modify the Houston Electronic Disease Surveillance System (HEDSS) so that it can accommodate incoming electronic health records. This data will allow the HHD to (1) replace paper-based case reporting of acute hepatitis C and (2) better monitor the acute hepatitis C burden (incidence, prevalence, risk factors, and comorbidities).
METHODS:
The HHD established an EHR reporting route with a local safety net hospital to receive ADT messages. The messages contain (1) data required to differentiate acute from chronic infection which can also be used for acute hepatitis C case reporting (i.e., symptoms and/or ICD codes of acute hepatitis C), and (2) characteristics of those acutely infected (e.g., risk factors and demographics). The HHD has incorporated an ICD code lookup table in its interface engine (Rhapsody). Any message containing ICD codes of acute hepatitis C symptoms is matched to HEDSS by a patient's name and date of birth. If this person has a positive HCV test results within 6 months in HEDSS, this person will be considered having acute hepatitis C, and subsequently will be linked to care.
RESULTS:
The updated surveillance system will result in (1) an increased number of acute hepatitis C case reporting; (2) a more accurate reflection of true incidence and prevalence, and better characterization of risk factors and comorbidities of those acutely infected; (3) an increased number of individuals who are linked to care; and (4) a more robust disease surveillance system with improved timeliness, accuracy, and completeness of reporting.
CONCLUSIONS:
The updated surveillance system is expected to be associated with improved surveillance of acute hepatitis C in Houston. The updated surveillance system can be used for surveillance of other diseases besides acute hepatitis C.