Impact of electronic laboratory reporting on completeness of reporting for Syphilis in Houston, TX

Public health surveillance programs strive to balance timeliness and completeness of reporting. Although required by law, providers sometimes delay reporting because the process can be tedious and time consuming. In Texas, both positive and negative confirmatory syphilis test results are reportable. Blood banks, due to the volume of tests conducted, can be especially challenged by reporting in a timely manner. In 2013, the Houston Department of Health and Human Services (HDHHS) collaborated with a large regional blood bank to implement electronic laboratory reporting (ELR).  This study aims to describe the process of ELR implementation and demonstrate its effectiveness to improve data completeness.

For the ELR implementation, we underwent four stages including unit, integrative, volume and parallel testing. For the evaluation, we compared the syphilis lab reports received via two methods. Automatic importation into the Houston electronic disease surveillance system (HEDSS) was evaluated against manual data entry into the Sexually Transmitted Disease Management Information System (STD*MIS). The two-month study period was between October and December 2013.

During the evaluation period, HEDSS received 70 ELRs from the blood bank. Among them, 19 had reactive test results to Treponema Pallidum antibodies. Of the 19 reactive results, 15 (79%) did not have a match in STD*MIS. Out of the 51 non-reactive results, 50 (98%) did not have a match in STD*MIS. Using ELR data as the gold standard, the sensitivity and precision of the traditional manual data entry reporting method regardless of test results was 7% and 100%, respectively. For positive results, the sensitivity increased to 21% and for negative results it decreased to 2%.

In conclusion, the ELR implementation enhanced syphilis reporting completeness, especially for non-reactive results. In addition, reporting via ELR increased the sensitivity of a surveillance system. Local health departments should consider implementing ELR to increase the completeness of surveillance systems.