Automatic electronic laboratory-based reporting of notifiable infectious diseases at a large health system

Abstract

Electronic laboratory-based reporting, developed by the UPMC Health System, Pittsburgh, Pennsylvania, was evaluated to determine if it could be integrated into the conventional paper-based reporting system. We reviewed reports of 10 infectious diseases from 8 UPMC hospitals that reported to the Allegheny County Health Department in southwestern Pennsylvania during January 1-November 26, 2000. Electronic reports were received a median of 4 days earlier than conventional reports. The completeness of reporting was 74% (95% confidence interval [CI] 66% to 81%) for the electronic laboratory-based reporting and 65% (95% CI 57% to 73%) for the conventional paper-based reporting system (p>0.05). Most reports (88%) missed by electronic laboratory-based reporting were caused by using free text. Automatic reporting was more rapid and as complete as conventional reporting. Using standardized coding and minimizing free text usage will increase the completeness of electronic laboratory-based reporting.

Figure 1

Schematic of information flow for the electronic reporting system of the University of Pittsburgh Medical Center Health System and for the paper-based reporting system to Allegheny County Health Department. NETSS, National Electronic Telecommunications System of Surveillance. ELR is electronic laboratory-based reporting, and CRS is conventional paper-based reporting system.

Figure 2

Capture-recapture methodology (11). C=number of reports received through both electronic laboratory-based reporting and conventional paper-based reporting. n1=number of reports received through conventional paper-based reporting system only. n2=number of reports received through electronic laboratory-based reporting only. X= estimated number of reports missed by both electronic laboratory-based reporting and conventional paper-based reporting system. R=number of reports received through conventional paper-based reporting system. S=number of reports received through electronic laboratory-based reporting. N=estimated total number of reports available by the Chandra Sekar-Deming capture-recapture calculation.

Figure 3

Timeline for reporting notifiable infectious diseases by the University of Pittsburgh Medical Center Health System, Allegheny County, Pennsylvania.

Figure 4

Venn Diagram depicting the number of notifiable disease reports received independently by the electronic laboratory-based reporting of University of Pittsburgh Medical Center electronic system, Allegheny County Health Department paper-based reporting, or both. The estimated true total number of reports available, calculated by the Chandra Sekar-Deming capture-recapture method, is shown in the large, encompassing circle. ELR is electronic laboratory-based reporting, and CRS is conventional paper-based reporting system.