A Modified Public Health Automated Case Event Reporting Platform for Enhancing Electronic Laboratory Reports With Clinical Data: Design and Implementation Study

Abstract

Background: Public health reporting is the cornerstone of public health practices that inform prevention and control strategies. There is a need to leverage advances made in the past to implement an architecture that facilitates the timely and complete public health reporting of relevant case-related information that has previously not easily been available to the public health community. Electronic laboratory reporting (ELR) is a reliable method for reporting cases to public health authorities but contains very limited data. In an earlier pilot study, we designed the Public Health Automated Case Event Reporting (PACER) platform, which leverages existing ELR infrastructure as the trigger for creating an electronic case report. PACER is a FHIR (Fast Health Interoperability Resources)-based system that queries the electronic health record from where the laboratory test was requested to extract expanded additional information about a case.

Objective: This study aims to analyze the pilot implementation of a modified PACER system for electronic case reporting and describe how this FHIR-based, open-source, and interoperable system allows health systems to conduct public health reporting while maintaining the appropriate governance of the clinical data.

Methods: ELR to a simulated public health department was used as the trigger for a FHIR-based query. Predetermined queries were translated into Clinical Quality Language logics. Within the PACER environment, these Clinical Quality Language logical statements were managed and evaluated against the providers' FHIR servers. These predetermined logics were filtered, and only data relevant to that episode of the condition were extracted and sent to simulated public health agencies as an electronic case report. Design and testing were conducted at the Georgia Tech Research Institute, and the pilot was deployed at the Medical University of South Carolina. We evaluated this architecture by examining the completeness of additional information in the electronic case report, such as patient demographics, medications, symptoms, and diagnoses. This additional information is crucial for understanding disease epidemiology, but existing electronic case reporting and ELR architectures do not report them. Therefore, we used the completeness of these data fields as the metrics for enriching electronic case reports.

Results: During the 8-week study period, we identified 117 positive test results for chlamydia. PACER successfully created an electronic case report for all 117 patients. PACER extracted demographics, medications, symptoms, and diagnoses from 99.1% (116/117), 72.6% (85/117), 70.9% (83/117), and 65% (76/117) of the cases, respectively.

Conclusions: PACER deployed in conjunction with electronic laboratory reports can enhance public health case reporting with additional relevant data. The architecture is modular in design, thereby allowing it to be used for any reportable condition, including evolving outbreaks. PACER allows for the creation of an enhanced and more complete case report that contains relevant case information that helps us to better understand the epidemiology of a disease.

Keywords: EHR; chlamydia; electronic case reporting; electronic health records; electronic laboratory reporting; fast healthcare interoperability resources; gonorrhea; health information interoperability; public health surveillance; sexually transmitted diseases.

Figure 1

Electronic laboratory reports sent from laboratories are ingested by health departments and serve as the trigger for PACER electronic case reports. CSTE: Council for State and Territorial Epidemiologists; CQL: Clinical Quality Language; eCR: electronic case report; ELR: electronic laboratory reporting; HL7: health level 7; MLLP: Minimum Lower Level Protocol; PACER: Public Health Automated Case Event Reporting.

Figure 2

Detailed architecture of PACER. API: application programming interface; CQL: Clinical Quality Language; eCR: electronic case report; EHR: electronic health record; ELR: electronic laboratory reporting; FHIR: Fast Health Interoperability Resources; HL7: health level 7; OAuth2: OAuth 2.0 Authorization Framework; PACER: Public Health Automated Case Event Reporting.

Figure 3

High-level architecture of PACER. ELR: electronic laboratory reporting; FHIR: Fast Health Interoperability Resources; PACER: Public Health Automated Case Event Reporting.

Figure 4

Laboratory, public health agency, and health care provider workflow to generate case reports using Public Health Automated Case Event Reporting. CQL: Clinical Quality Language; eCR: electronic case report; EHR: electronic health record; ELR: electronic laboratory reporting; FHIR: Fast Health Interoperability Resources.