Implementation of a Hepatitis C Test and Cure Program: Informatics Strategies

Wednesday, June 22, 2016: 10:30 AM
Kahtnu 1, Dena'ina Convention Center
Atar Baer , Public Health - Seattle & King County, Seattle, WA
Elizabeth Barash , Public Health - Seattle & King County, Seattle, WA
Meaghan S. Munn , Public Health - Seattle & King County, Seattle, WA
Curtis Drake , Public Health - Seattle & King County, Seattle, WA
Beth Sohlberg , Public Health - Seattle & King County, Seattle, WA
Shelly McKeirnan , Public Health - Seattle & King County, Seattle, WA
Jeffrey S. Duchin , Public Health - Seattle & King County, Seattle, WA
BACKGROUND:  Public Health – Seattle & King County's (PHSKC) Communicable Disease Database (CDDB) was previously poorly suited for chronic hepatitis C virus (HCV) surveillance: it lacked key laboratory, clinical and demographic data elements for tracking cases longitudinally over multiple medical encounters, and capture of external data sources required resource-intensive manual entry. In addition, some Hepatitis C Test and Cure (HCV-TAC) clinical laboratories were not yet enrolled in the Washington State Department of Health’s (DOH) electronic lab reporting (ELR) system, and participating labs did not report certain critical test values necessary to support hepatitis surveillance efforts.

METHODS:  PHSKC requested the inclusion of additional test values in the ELR program (e.g., HCV RNA negative findings, FibroSURE results) and encouraged routine use of HCV reflex RNA testing by clinical laboratories and healthcare providers. An informatics strategy was developed to integrate: hepatitis electronic lab reports transmitted to PHSKC via XML from WA DOH; XML-based electronic lab and clinic data reported retrospectively (for the period 2013-15) and prospectively to PHSKC by five healthcare organizations; and hepatitis case reports submitted to PHSKC via manual, routine notifiable condition reporting. PHSKC’s CDDB was redesigned to match and de-duplicate records across data sources. A relational database structure was adopted, allowing lab and clinical data elements to be captured longitudinally.  

RESULTS:  We estimate that of the total volume of HCV laboratory records that were previously collected manually, 85% are now captured electronically. Electronic lab reporting provides additional information about confirmatory testing, staging, and treatment response, which were previously unavailable due to the resource demands of manual reporting. Establishing XML reporting of clinic and lab data was more resource-intensive than predicted, but all sites overcame challenges imposed by the reporting requirements.

CONCLUSIONS: Electronic data collection and corresponding modifications to our CDDB is expected to improve timeliness and completeness of HCV surveillance data, facilitate case management and linkage to care, and reduce reliance on resource-intensive manual data collection.