Electronic Laboratory Reporting May Help Speed Case Reporting of Notifiable Diseases

Laurie Barclay, MD

December 15, 2008

December 15, 2008 — Electronic laboratory reporting (ELR) may potentially speed case reporting of notifiable disease and facilitate disease control activities, according to an analysis of Florida reporting from 2002 to 2006 published in the December 12 issue of Morbidity and Mortality Weekly Report. This analysis determined that improvements in timeliness in reporting would be highly disease specific and would be greatest for salmonellosis and shigellosis.

"[ELR] potentially can improve the timeliness of notifiable disease case reporting and subsequent disease control activities, but the extent of this improvement and the resulting effects on the workload of state or local surveillance teams are unknown," write A. Kite-Powell, MS, and colleagues. "To estimate those effects, investigators from the Florida Department of Health (FDOH) evaluated the timeliness of reporting for four notifiable diseases of varying incubation periods: salmonellosis, shigellosis, meningococcal disease, and hepatitis A."

Assuming that ELR could reduce to 1 day the time from completion of a diagnostic laboratory test to notification of the county health department (CHD) of the result, the investigators calculated the potential improvement associated with ELR. Using Merlin, the FDOH Web-based reportable disease surveillance database, the researchers found that ELR would reduce the total time from symptom onset to CHD notification of a case by nearly half for salmonellosis (from 12 days to 7 days) and for shigellosis (from 10 days to 6 days). However, there would be no change for meningococcal disease (4 days) and minimal improvement for hepatitis A (from 13 days to 10 days).

Both timeliness and completeness of reporting dates should improve for all conditions reported with ELR, approaching 100% for laboratory reporting and CHD notification dates. However, the date of symptom onset and any time interval using this date rely on patient recall.

An accompanying editorial note indicates at least 3 limitations regarding these findings: 1% to 33% of key dates are missing from the Merlin database, the varying interpretation and application of date field definitions by those entering data into Merlin, and an inability to record times in less than 1-day increments.

Although this analysis did not directly evaluate the potential effect of ELR on the workload of CHD communicable disease investigators in Florida, an increase in reported cases of salmonellosis, shigellosis, and hepatitis A is expected with ELR, because all positive cultures and immunoglobulin results will be transmitted electronically. Implementation of ELR may increase the number of preliminary reports requiring investigation, and therefore workload, without a corresponding increase in the number of confirmed cases.

Because ELR in Florida is being introduced in a stepwise fashion, CHDs can evaluate the effects of ELR on workflow and human resource requirements for various reportable diseases.

"The analysis in this report suggests the effects of ELR will be disease specific, with differing limitations and challenges for each condition," the editorial note states. "Under a newly implemented ELR system, local and state public health officials should be able to 1) monitor timeliness and completeness of reporting, 2) assess workload and workflow, 3) ensure that reporting of high-priority conditions is not adversely affected by ELR, and 4) interact with clinicians in a manner that fosters respect for the clinician-patient relationship and compliance with state-mandated reporting requirements. If the number of reported cases increases substantially when ELR is implemented, jurisdictions will need to establish priorities for investigation and follow-up of laboratory reports received."

Morb Mortal Wkly Rep. 2008;57:1325–1328.

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