Using FHIR to Augment Electronic Case Reporting

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The nonprofit Public Health Informatics Institute (PHII) is coordinating a pilot project of the PACER (Public Health Automated Case Event Reporting) model, a system that augments electronic laboratory reporting using FHIR.

The PACER model supports targeted queries from public health to the appropriate healthcare system to collect relevant data to support public health case investigation and follow-up. By using FHIR, PHII notes that PACER provides compatibility with a wide array of commercial EHR vendors and aligns to emerging data modernization initiatives.

PHII’s website explains the use case: Electronic case reporting (eCR) involves automatically sending data on reportable conditions from the clinical provider to the public health authority. “Traditionally, healthcare providers have submitted case reports for STIs using largely manual methods, such as faxing. However, manual case report submission processes are burdensome for both the provider and for public health and allow many opportunities for data errors and unreported cases,” PHII notes. Much of the data needed for an individual case report exists in a patient’s electronic health record (EHR). Automating the building and sending of case reports directly from EHRs promises to reduce the burden of reporting while improving data accuracy, timeliness and completeness.”

Working with CDC, PHII assembled guidance into the an eCR for STI Toolkit, an actionable set of resources that detail case detection logic and the core set of case report data elements for EHR-based electronic case reporting (eCR) of chlamydia and gonorrhea. The toolkit assimilates best practices as gathered from healthcare professionals, public health practitioners and informaticians to define how EHRs should help primary care providers automatically detect and report STI cases. 

The pilot sites, which include the Georgia Department of Public Health and the Houston Health Department, are implementing the PACER architecture in the public health and clinical settings to test how the FHIR-based querying capabilities can be used to improve data collection on sexually transmitted infection (STI) cases, and ultimately aid in public health case investigation and follow-up of gonorrhea and chlamydia cases.

This pilot builds on a proof-of-concept project with the Medical University of South Carolina.

According to an article published in the Journal of Medical Internet Research, “electronic lab reporting 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.”

During the 8-week study period, the researchers identified 117 positive test results for chlamydia, and PACER successfully created an electronic case report for all 117 patients.

They concluded that “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.”

 

 



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