Influenza data exchange in Houston: Comparison of electronic laboratory reporting with paper reporting

Reports of notifiable diseases are largely received by Houston Department of Health and Human Services through FAX, mail, telephone and manually imputed into Houston's Electronic Disease Surveillance System (MAVEN). This causes reporting delays, slows down emergency response efforts and incurs huge amounts of resources. After the H1N1 influenza pandemic, Houston's Electronic Laboratory Reporting (ELR) project was initiated in phases, to improve the timeliness and completeness of all notifiable disease reports sent from Houston's Public Health Reference Laboratory (PHRL) to MAVEN.

Phase 1 is completed and Houston's PHRL is currently reporting all influenza and varicella cases by ELR. Reports are sent real-time to MAVEN through an integration engine, where Health Level 7 messages and local test codes are converted using industry standards. MAVEN picks up processed messages hourly from a designated folder, de-duplicates and creates cases. All influenza reports received from July 14 to November 12 2010 were reviewed.

A total of 148 influenza reports (74 unique PCR results and 74 culture result updates) were received by ELR and paper-reporting. Houston's PHRL does PCR and culture testing on every influenza specimen received. A comparison showed that while 100% of both PCR results and culture updates were received by ELR, only 68% of unique PCR results and 50% of culture updates were received by paper-reporting. Furthermore, complete PCR and culture results were received an average of 4.35 days earlier through ELR compared to an average of 2 weeks by paper-reporting.

The results show that ELR eliminated duplicates, decreased the reporting lag time by 10 days and increased influenza PCR and culture reports by 32% and 50% respectively. This suggests that ELR has the potential to make a large impact on the timeliness and completeness of notifiable disease reporting, ultimately facilitating more rapid disease outbreak investigation and institution of disease control measures.