BACKGROUND: Occupational lead exposure accounts for 94% of adult elevated blood lead levels (BLLs) nationally. In 2014, the New Jersey Department of Health (NJDOH) incorporated electronic laboratory reporting (ELR) from clinical laboratories for lead into its online Communicable Disease Reporting and Surveillance System (CDRSS), facilitating automated adult lead case identification. We sought to evaluate the sensitivity of using CDRSS in adult lead surveillance and if CDRSS improves timeliness of case identification.
METHODS: For a qualitative evaluation, we interviewed staff in lead surveillance and CDRSS. Sensitivity and positive predictive value (PPV) were calculated by using ELR counts meeting CDRSS case definition, from August 1, 2015 to July 31, 2016. ELRs considered “true positive” met the following: aged ≥16 years old and an elevated BLL (≥10µg/dL) reported from 1 of 3 defined acceptable laboratory tests.
RESULTS: Timely and efficient, 85% of ELRs (n=17,633) were uploaded and electronically sorted within 5 days of specimen collection. Sensitivity was 59% and PPV was 95% with a total of 716 “true positives” after staff sorted 1,241 ELRs. System limitations include redundancies in CDRSS case creation and inability to identify occupational risk factors. Staff must review these discrepancies and interview patients to determine occupational risks, which is time consuming.
CONCLUSIONS: CDRSS is user-friendly and capable of handling high ELR volumes and changing algorithms in a timely manner by using predefined laboratory values and a defined age. CDRSS’s sensitivity can be improved by updating its accepted ELR criteria. Public health departments might find that incorporating lead surveillance into a data management system that uses ELRs can improve timeliness in sorting and identifying cases, allowing faster response in implementation of control and prevention measures.