APHL and partners know the answer is "yes." Definitive data about where microbes are enable authorities to pinpoint interventions to keep them from spreading. The problem is getting the data.
Although all states have lists of reportable conditions—communicable diseases that healthcare providers are asked, or are mandated, to report to health authorities—the rate of reporting has always been low. As low as 30%, according to some estimates. That means up to 70% of the most threatening bugs (from a public health perspective) are off the radar—bugs like HIV, hepatitis, pertussis, gonorrhea, influenza and Zika virus.
Fortunately, in the Digital Age this is a problem that can be solved. And APHL has already developed a key piece of the solution, in partnership with CDC, the Association of State and Territorial Health Officials (ASTHO), the Council of State and Territorial Epidemiologists (CSTE) and other collaborators: a software application for electronic case reporting (eCR). Here’s how it works:
A physician records a diagnosis or presumptive diagnosis in a patient’s electronic health record.
If the diagnosis code signifies a priority public health condition, it triggers the creation of an electronic message that is automatically forwarded to the Public Health Community Platform—a national, electronic platform funded with CDC seed money and currently managed by ASTHO.
Certain eCR software applications (developed by APHL and CSTE) running on the platform determine whether or not the condition is reportable in the jurisdiction where it was diagnosed.
If the condition is reportable, the software generates an initial case report, populated with the available information, and forwards it to the appropriate public health authorities.
At the same time, the software generates and transmits a message back to the provider’s office, notifying staff that (a) the condition is reportable, (b) a preliminary case report has already been sent to the appropriate public health agency and (c) a follow-up case report with detailed information is now required.
The beauty of the system is two-fold. First, Steps 2 through 5 occur automatically, without any human intervention at all. Second, as reporting rules change — and the circumstances under which a condition is reportable do change fairly frequently — only one site has to be updated, the centralized eCR software (as opposed to the electronic health record software in every physician’s office).
APHL is now working with CSTE and ASTHO to conduct the first test cases and expects to have the system operational in four jurisdictions, with a limited set of reportable conditions, by the end of June.
Once the system is implemented nationwide, it promises to revolutionize disease surveillance and control within the United States. Not only will health authorities be able to monitor cases of reportable conditions as they are diagnosed, but they will also have information about the treatment modalities listed in the final case reports—information that will reveal what drugs are most adept at killing specific strains of microbes.
APHL’s eCR software may one day help prevent an outbreak in your own community.
For more information, contact Patina Zarcone, MPH, director, Informatics,