Surfacing actionable insights from electronic case reporting data

Summary

The challenge

To reduce the burden of manual reporting on healthcare providers, the Association of Public Health Laboratories (APHL), the Council of State and Territorial Epidemiologists (CSTE), and the CDC established an automated way to send case report information from electronic health records (EHRs) to public health departments. This process, known as eCR, is intended to make disease reporting faster and easier by replacing manual case reports that are traditionally sent by mail, phone, and fax. It works like this: When data corresponding to a reportable condition (e.g., COVID-19) is entered into a patient’s EHR, a case report is automatically generated and sent to the appropriate public health agencies so they can record, track, and investigate individual cases. This automated approach has the potential to significantly streamline both the case ascertainment and case investigation process.

However, public health departments face barriers to integrating eCR in their existing workflows. When an eCR file arrives at a public health department, it contains more than just information on the reportable condition — it also includes data from a patient’s entire health record, such as demographics, diagnoses, comorbidities, occupation, immunizations, medications, and more. It can feel like getting someone’s entire medical record dropped on your desk. The volume of information makes it difficult for public health staff to figure out why the eCR was sent to them and where it should go next. To add to this challenge, eCR data doesn’t come to public health departments in an easily-readable format. Each eCR file contains pages and pages of data that don’t appear in a consistent order or with consistent formatting. Because of formatting challenges and the overwhelming volume of eCR data, it can take significant time and effort for public health staff to review incoming eCRs.

As one epidemiologist put it:

You can just scroll on forever for some of these eCRs and never find what you’re looking for.

In practice, finding critical information from eCR data can feel like looking for a needle in a haystack. Not only that, because eCR data can be so difficult to sort through, many public health jurisdictions still choose to manually contact healthcare providers for clinical information. This remains a time-consuming and onerous process for both healthcare providers and public health departments. It’s the exact problem that eCR is supposed to solve. To fulfill the promise of eCR, public health staff need to be able to quickly find key information from incoming eCR data so they can take timely public health action.

The solution

Under the umbrella of the CDC and USDS Pandemic-Ready Interoperability Modernization Effort (PRIME), Skylight aimed to make eCR data more usable for public health staff. To do this, we developed the eCR Viewer, an intuitive interface that surfaces a summary of condition-specific information in a more readable format at the top of the eCR file. Using the eCR Viewer, public health staff can easily find data relevant to the reportable condition. The eCR Viewer also orders and organizes data consistently regardless of which electronic medical record system generated the eCR. Because the eCR Viewer makes it easier for public health staff to find clinical information for case investigation, eCR becomes a more useful data source, thereby reducing the need to manually contact healthcare providers.

To date, the Skylight team has undertaken the following work related to the eCR Viewer:

• Conducted generative research with staff at public health departments to understand how eCR fits into case ascertainment and case investigation workflows
• Developed concept designs of the eCR Viewer and gathered feedback from users to develop a lightweight MVP
• Built out the product vision and measurement plan to ensure the eCR Viewer will meet the intended impact for time savings
• Partnered with the General Dynamics Information Technology (GDIT) team to integrate the eCR Viewer into the CDC’s National Electronic Disease Surveillance System (NEDSS) Base System (NBS) with pilot jurisdictions
• Identified pilot jurisdictions to test and validate the eCR Viewer in their public health data workflows; NBS pilot partners include the states of Maine and Tennessee
• Established a separate pilot partnership with the city of Philadelphia to evaluate using the eCR Viewer outside of a surveillance system as a web-based tool hosted by CDC

Initial results from our research efforts have been promising:

It is incredibly challenging to show and teach and get end users to use eCR when you can’t view all the data. This viewer will be absolutely a game changer to get people to understand the value of eCR.

Epidemiologist

We plan to commence pilots with jurisdictions in summer 2024 to test the eCR Viewer in a production data environment and further validate the tool’s downstream public health impact. Our aim is to scale the eCR Viewer with a wide range of jurisdictions to turn eCR into the go-to data source for case ascertainment and investigation.

Importantly, the eCR Viewer isn’t simply a standalone software tool. It works in concert with a wider portfolio of open-source, modular tools developed by Skylight that help solve a range of critical public health data challenges. Together, these tools enable jurisdictions to build flexible, modern, and performant data systems that improve the larger public health data infrastructure of the United States.

The results

• Completed design and development of an eCR Viewer MVP and validated its potential time savings with public health staff
• Based on user testing with a lightweight MVP, the eCR Viewer allows staff to process a singular eCR file for case ascertainment in five clicks rather than twenty-five clicks
• Based on user journey mapping in Maine, the eCR Viewer enables staff to process all eCR files in a queue (over 5,000) in just one week rather than 4.5 months
• Three public health jurisdictions have committed to pilot the eCR Viewer, commencing kickoff in summer 2024