Development of an Implementation Guide to Enable Public Health Case Reporting of Electronic Medical Record (EMR) data in HL7 Clinical Document Architecture (CDA) format

Background

Reportable conditions are diseases considered to be of great public health importance. Local, state, and national agencies require that such diseases be reported when they are diagnosed by clinicians or laboratories. First in the process is occurrence of the condition itself. The case reporting workflow is triggered by identification of a reportable condition by a health care worker. The event is then reported to the local or state public health system to prompt an investigation.

This presentation provides an overview in the development of a standard message format to send a CDA (Reporting) document, created by the healthcare facility or provider, to state and local public health agencies.

Methods

The CDA Public Health Case Reporting project followed the Presidential Initiative White House E-gov Consolidated Health Informatics (CHI) standards adopted by CDC's Public Health Information Network (PHIN). The guidelines were used in the review of data elements (N=259) to identify the appropriate codes. Pre-defined heuristics (Question and Answers vs Assertion style) were taken into account.

Results

The assignment of codes, along with the application of heuristics, for each data element resulted in 1) a reduction in the number of data elements from the original list; 2) reassessment in the utility of data elements to support case reporting (vs. case investigation); and 3) recommendations for inclusion of additional data elements to support the intended use case of the IG.

Conclusion

The CDA for Public Health Case Reporting project will constrain CDA to meet the requirements of disease-specific case reports (e.g., Anthrax, Hepatitis B, Tuberculosis and Tularemia). The foundation of this effort will be a set of modular definitions (templates) reusable across forms for other conditions and conformant with design patterns established for EMRs and interoperable data exchange.