A State Health Department and Health Information Exchange Partnership: An Effective Collaboration for a Data-Driven Response for COVID-19 Contact Tracing in Maryland

Abstract

Background: Accurate, complete, timely data were essential to effective contact tracing for COVID-19. Maryland Department of Health partnered with Maryland's designated health information exchange, Chesapeake Regional Information System for Our Patients (CRISP), to establish data enhancement processes that provided the foundation for Maryland's successful contact tracing program.

Methods: Hourly, electronic positive COVID-19 test results were routed through CRISP to the contact tracing data platform. The CRISP matched reports against its master patient index to enhance the record with demographic, locating, fatality, vaccination, and hospitalization data. Records were deduplicated and flagged if associated with a congregate setting, select state universities, or recent international travel. χ 2 Tests were used to assess if CRISP-added phone numbers resulted in better contact tracing outcomes.

Results: During June 15, 2020, to September 1, 2021, CRISP pushed 531,094 records to the state's contact tracing data platform within an hour of receipt; of those eligible for investigation, 99% had a phone number. The CRISP matched 521,731 (98%) records to their master patient index, allowing for deduplication and enrichment. The CRISP flagged 15,615 cases in congregate settings and 3304 cases as university students; these records were immediately routed for outbreak investigation. Records with an added phone number were significantly more likely to be successfully reached compared with cases with no added phone number ( P = 0.01).

Conclusions: The CRISP enhanced COVID-19 electronic laboratory reports with a near-instant impact on public health actions. The partnership and data processing workflows can serve as a blueprint for data modernization in public health agencies across the United States.

Figure 1

High-level data flow for contact tracing data in Maryland. COVID-19 ELRs reported to the MDH are received electronically in HL7 format from the majority of providers by a Rhapsody integration engine (1). ELRs are pushed simultaneously to the state communicable disease surveillance database (NEDSS) for further processing and to the CRISP (Maryland's health information exchange) (3). Cases can also be manually entered and are pushed to a confirmed case database (2) which is pushed to CRISP nightly for reconciliation. CRISP enhances the reports and pushes the enhanced reports to the contact tracing data platform (covidLINK) (4) hourly, where a first outreach attempt is made for contact tracing within 24 hours of receiving the data. Once a case has been traced and cleared from isolation, records flow back to NEDSS daily to improve the completeness of case data (5). ELR, electronic laboratory results; NEDSS, National Electronic Disease Surveillance System.

Figure 2

More detailed data flow for contact tracing data in Maryland. This diagram illustrates the same data flow as in Figure 1 but presents additional detail regarding CRISP processing and record enhancements. Data enhancements primarily occur within the black circle. EID, enterprise identifier; MPI, Master Patient Index.

Figure 3

Contact tracing outcomes in Maryland, PCR- and antigen test-positive cases. “Cascades” illustrating contact tracing outcomes for cases and possible contacts entered into the contact tracing data platform as published to the MDH website. The number of cases reflects those pushed to the contact tracing data platform and eligible for investigation. “Successfully reached” means that someone answered the phone (but might not have completed an interview).