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Lessons Learned: Implications of a Web-Based Disease Morbidity Reporting System

In 2004, Michigan transitioned from a paper-based STD reporting system to a PHIN-compliant web-based platform, enhancing data quality and timeliness. This system captures a wide range of variables, facilitating improved case management and geographic mapping of disease spread. Key findings highlight the necessity for complete data entry, improved lab reporting processes, and better integration of multiple jurisdictions. While the system faced obstacles such as staffing limitations and incomplete electronic lab reports, it ultimately resulted in higher quality epidemiological insights.

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Lessons Learned: Implications of a Web-Based Disease Morbidity Reporting System

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  1. Lessons Learned: Implications of a Web-Based Disease Morbidity Reporting System May 9, 2006National STD Prevention Conference Kathryn E. Macomber,MPH Michigan Department of Community Health

  2. STD Reporting History • Former system was dbase (MI developed) • Paper case reports sent through local health departments and entered at state • PHIN-compliant, web-based disease reporting system implemented July 2004 • all communicable diseases • STDs integrated January 10, 2005

  3. New Case Entry • HTML screens have common variables such as sex, race, date of birth • Interacts with pdf disease-specific forms • NETSS variables exported from html and pdf

  4. Disease Specific Form: Gonorrhea Corresponding Variables from HTML Screens Interface With Fields on Disease Specific Form Referral Info, Lab Info, Specimen Info, Treatment Info, Concurrent Co-Infection, and local fields on second page

  5. Advantages over Paper-Based System • Standard Reports • Real-time data • Geocoding and Mapping • Deduplication Process • Both person and disease • Improved data quality • Additional variables • Former system captured only NETSS required variables

  6. MDSS Standard Reports

  7. Map

  8. Easy Access to Coordinate DataGonorrhea, Chlamydia by School District

  9. Patient De-Duplication

  10. Case De-Duplication MDSS also checks for existing cases for this patient across all LHJs as there may be multiple referrals (e.g., lab and provider) CREATE - Creates a new case with case information and merged patient information. MATCHES EXISTING - Does not create new case for patient. PLACE IN QUEUE – Defers to Administrator

  11. Changes in Data Quality

  12. Completeness-CT and GC

  13. Completeness-Race

  14. Changes in Timeliness • Pre-MDSS we did not collect date of specimen • # of days to NETSS transmission could not be calculated (no CSPS indicators) • MDSS does collect this variable • Complete for 92% of GC/CT cases in 2005 • 45% of GC/CT transmitted within 30 days • 65% of GC/CT transmitted within 60 days

  15. Information Source • Old System: “STD Clinic” or “Private Physician/HMO” • New System: Drop down menu of complete list

  16. Information Source-GC and CT

  17. Obstacles over Paper-Based System • Speed • Impact of Lab Reporting • Jurisdictional Issues • Syphilis Labs and Follow-up

  18. Speed • MI dbase system had only 11 variables • 1 case every 20 seconds • MDSS has approximately 50 variables • I case every 60 seconds • Data entry speed is dependant on number of users on the system • Slow processing between case entry • Due to deduplication, geocoding, pdf

  19. Impact of Lab Reporting • 5 MI laboratories are entering results, either manually or electronically • Quest soon to come online (HL7 transfer) • Labs do not have patient demographics or treatment information • Doctors no longer receive disease reporting form from laboratory • Missing link in the reporting system

  20. Jurisdictional Issues • 30% of the cases at the Oakland County STD clinic are residents of Detroit • Oakland County can enter Detroit morbidity but can not modify or update information once case has been submitted • Incomplete information, no follow-up • Issue across state • Detroit has jurisdiction over several Wayne County cities

  21. What to do with Syphilis? • Syphilis electronic labs are transferred into the system • But syphilis lab does not mean morbidity • Once a lab is staged and determined to be morbidity, cases are re-entered into the system • Can’t upload or download labs • Still being hand entered into historical record search database

  22. Lessons Learned • MDSS was designed for communicable diseases, not for the high morbidity of STDs • Local STD programs are currently limited on staffing • Electronic lab reports are frequently incomplete • Interactive PDF forms complicate entry

  23. Lessons Learned • However, we have gained higher quality information • And maintained completeness of essential variables • Better epidemiological capacity, especially at the local level

  24. Next Steps? • How to support local data entry (Detroit, 2005) • Need to plan for how to integrate syphilis • How do we integrate program module or a CDC released STD PAM?

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