Improving Population Health Through Enhanced Targeted Regional Decision Support

Surveillance is the cornerstone of public health practice. However, health departments rely on hospital, laboratory, and clinic staff to initiate case reports. Clinical providers often underreport reportable diseases, or their reporting is incomplete, inaccurate, or delayed due to: 1) a lack of knowledge on requirements and process, 2) a lack of resources to facilitate reporting, and 3) a perceived lack of value. Under and incomplete reporting can lead to inaccurate community disease burden assessments, which can hinder interventions and preventive care. As clinical data is increasingly captured in electronic form, the potential for automated electronic reporting exists. Health information exchanges (HIEs) are an emerging source of healthcare and clinical data that can be used to improve public health surveillance practices and data quality.

This project leveraged an existing, robust HIE network in primary care clinics and implemented a decision support (CDS) intervention to facilitate awareness that a notifiable disease should be reported to a local public health agency. The research team developed a standard notifiable condition case reporting form to serve as a CDS tool. Clinic staff received reporting forms pre-populated with patient demographic data and pertinent case management information through an HIE application. A clinical messaging system delivered the forms, allowing seamless integration into healthcare providers' workflow.

The specific aims of the project were as follows:

• Evaluate the deployment of an advanced technical framework that enhances management of notifiable condition reporting and communication between providers and population heath stakeholders. 
• Evaluate the quality of existing healthcare data and the capacity for the technical framework to enhance data quality by measuring data quality statistics. 
• Identify and assess facilitators and barriers associated with the implementation and utilization of a technical framework within an HIE. 

Researchers evaluated the use of the CDS tool over 1-year post implementation. Quantitative measures focused on the change in provider reporting rates, completeness of the information in submitted case reports, and timeliness with which forms were submitted to local public health authorities. Interviews with clinic staff examined the burden of case reporting, perceptions of the CDS intervention, and motivations for using the pre-populated forms as compared to the traditional paper-based forms provided by the health department.

Reporting rates in the intervention clinics significantly improved when compared to baseline rates. The completeness of information in the submitted forms also improved, but timeliness was not affected. Feedback from both clinic staff and public health workers were positive, suggesting that decision support tools can facilitate improvements in case reporting without creating additional work. Continued awareness and bidirectional communication between public health officials and their clinical partners is necessary to monitor and improve data quality over time.