Joe Jackson Utah Department of Health Twitter: #AMIA2018

1. Electronic Case Reporting in Utah Joe Jackson Utah Department of Health Twitter: #AMIA2018

2. Utah eCR Experience 2018 HIMSS, Digital Bridge Go Live? 2017 HIMSS, Digital Bridge Implementation, Poison Control, EpiTrax 2016 PHCP, SSuN Go Live, Digital Bridge Planning 2015 eCR for STIs 2013 ELR, SSuN Coming together is a beginning.Keeping together is progress.Working together is success. -Henry Ford 2012 EMSA 2009 TriSano 2007 RTCEND

3. SSuN Impact • Infrastructure Enhancements • Demonstrated capability to receive and process eCR directly from provider • Knowledge • Benefits of centralized reporting rules and standardized triggering • Benefits to providers • Challenges identified • Magnitude of task to manage case information once it is received

4. Challenges • Legal • Message structure • Data are similar to ELR • Data are different from ELR • Message Processing Enhancements • Surveillance System Enhancements • Validation • Investigator process changes • Provider buy-in • Organizational capabilities • People • Technology • Politics • Funding

5. Code 26-6 Communicable Disease Control Act “The department has authority to investigate and control the causes of epidemic infections and communicable disease, and shall provide for the detection, reporting, prevention, and control of communicable diseases and epidemic infections or any other health hazard which may affect the public health.” “The department may designate those diseases which are communicable, of concern to the public health, and reportable; and establish rules for the detection, reporting, investigation, prevention, and control of communicable diseases, epidemic infections, and other health hazards that affect the public health.”

6. R386-702 Communicable Disease Rule R386-702-2(9)(j) "Electronic case reporting" is defined as the transmission of clinical, diagnostic, laboratory, and treatment related data from reporting entities to the Department in a structured, computer-readable format that reflects comparable content to HL7 CDA(reg trademark) R2 Implementation Guide: Public Health Case Report, Release 2 - US Realm - the Electronic Initial Case Report (eICR). Electronic Initial Case Reporting is a form of electronic reporting. R386-702-2 (9)(m) "Encounter" is defined as an instance of an individual presenting to a health care facility. R386-702-2(9)(l) "Electronic reporting" is defined as the transmission of laboratory or health related data from reporting entities to the Department in a structured, computer-readable format that reflects comparable content to HL7 messaging.

7. R386-702-6 Reporting Criteria R386-702-6 (2)(b)(ii) Electronic case reporting is an authorized method of reporting to the Department. For additional information on this process, contact the Division of Disease Control and Prevention Informatics Program Considering: Entities reporting via electronic case reporting may send all clinical information for an encounter that meets criteria for reporting to public health.

8. Digital Bridge eCR Workflow

9. Manage Case Information The Public Health Agency receives the electronic initial case report. The case report is an input into the "Manage Case Information" process (which includes a broad range of activities including: classifying case reports, correlating case reports with ELRs, de-duplicating case reports, deleting erroneous case reports, append additional or supplemental information, etc.). Task 21 - eCR Process Notes (Refined 1/19/17)

10. Manage Case Information eCRMessage EMSA Integration Engine SystemMessages Split on triggers EpiTrax API Pre-Processed Message EpiTraxXML Rules Holding EpiTrax Discard

11. Manage Case Information eCRMessage EMSA Integration Engine EpiTrax API Pre-Processed Message EpiTrax Discard

12. Automation is Recommended

13. Provider Time-Motion Study >160 hours saved annually across 8 clinics Longer consultations Targeted investigations Less interruptions to clinic flow Reduced reporting burden Timeliness Improvements Data Exchange/eCR • Data received sooner ~48 hours after ELR • Paper reporting = a week or more • Clinical data exported nightly • Cases updated when data is new or different

14. Street Unit number City Zip code Area code Phone number Ethnicity Race Birth sex Medical record number Completeness Improvements • Pregnancy status • Treatment name • Treatment dosage • Treatment quantity • Treatment start date • Treatment stop date • Clinician name • Clinician area code • Clinician phone number

15. Lessons Learned • Provider – Public Health relationship is critical • Find solutions that reduce reporting burden and don’t require clinical process changes • Understand EHR usage • More technical challenges than anticipated • Reusing existing ELR system was a good decision • Be prepared for setbacks and challenges • Don’t let the perfect be the enemy of the good