BACKGROUND: Disease surveillance benefits from timely information exchange between clinical and public health systems. Automated disease reporting reduces workload. In 2009, the Northern Kentucky Independent District Health Department, in partnership with St. Elizabeth’s Hospital, began using a proprietary system called HealthSiS to support direct disease reporting from the hospital’s electronic health records and laboratory systems to public health. When positive laboratory results are received, the system sends e-mail alerts devoid of protected health information to both hospital infection control staff and district health department staff prompting them to access the system and review new cases. Additionally, the system electronically populates Kentucky’s EPID 200 Reportable Disease Form, reportedly saving 50% of workers’ time compared to paper-based reporting. This paper compares HealthSIS to a paper-based system.
METHODS: The evaluation lasted from May 2016 to August 2016. End-users and the system developers were administered open-ended interview questions which were tailored according to the Centers for Disease Control and Prevention’s (CDC) guidelines for evaluating surveillance systems. Other questions focused on options for interoperability and system integration. Comparisons between the times spent on automated disease reporting, the advantages of the system, ease of utilization and data completeness were made between HealthSIS and the former paper process.
RESULTS: The system abstracted information with 100% accuracy from hospital and laboratory records, but only 50% of the form is populated necessitating further manual data entry. Disease-reporting time was reduced from 15 minutes per case in the paper-based system to about one minute, saving more than 90% reporting time. The alerting function saves time by instantly notifying end-users when cases are available for review. The system provides a template that can be incorporated into the State Health Information Exchange to serve as a statewide surveillance system.
CONCLUSIONS: Automated reporting saves time requiring less manual interaction with reports. Efficiency of surveillance is affected by multiple factors some of which include time of laboratory result transmission from the hospital laboratory information system (LIMS) to the surveillance system, and personnel response time to alerts. More evaluation projects in other jurisdictions will accelerate the pace of implementation of electronic disease reporting. LIMITATIONS: The system which was initially deployed across three health departments is currently in use by one health department. It does not cover all the reportable diseases in Kentucky. The evaluation was carried out only at the site where HealthSIS is currently used between one hospital and one LHD: results may not be generalizable.