Key Objectives:
- What are the public health program policy concerns with electronic case reports (eCR) containing unexpected, sensitive information such as mental health diagnoses, co-morbidities, and sensitive procedures?
- Data confidentiality is responsibility of sender; but what if your sender sends “too much” –what can be done?
- Who is responsible and at what point in case submission should non-notifiable information be removed?
- When and how should eCR be triggered to include all information (including treatments) without generating duplicate or excess reports?
Brief Summary:
Under the CDC STD Surveillance Network (SSuN) Part B grant, WA DOH is testing electronic case reporting (eCR) of sexually transmitted infections (STI) using CCDs shared by Planned Parenthood of the Great Northwest and Hawaiian Islands (PPGNHI). We reviewed a batch of 62 encounter and longitudinal CCDs and evaluated presence and absence of sensitive information falling into three categories: present and expected (HIV status), missing and needed (partner gender preference) and present and unexpected (mental health diagnoses, co-morbidities, sensitive procedures). Non-notifiable information included 3/18 people with data submitted including medication histories indicative of specific mental health diagnoses, 3/18 people with co-morbidities or procedures listed unrelated to STIs (lupus, diabetes, abortion).Two cases with longer histories and representative findings were selected for discussion. In addition, initial triggering targets and timeframes were identified to ensure that all required information would be included in eCR. Files were analyzed for presence of national diagnostic trigger codes and were compared with paper case reports. Program policies for handling electronic case reports, sensitivity, and ease of disposal of files were compared between paper and electronic case reports. eCR triggering options were reviewed for which would produce the most complete eCR including STI treatments. Treatment data is added to the EHR record shortly after STI diagnosis code when positive test results are received. There are programmatic, legal, and ethical considerations when using a CCD for eCR. It is possible that the “best” case report may be obtained by generating a report 24 hours after the entry of a diagnosis trigger code, which would result in a single report that would also capture treatment for STI. Further study is needed to examine methods of selectively redacting some types of information in a CCD.