Sexually Transmitted Diseases (STD) Clinic Electronic Messaging and Laboratory Reporting

State: CO Type: Model Practice Year: 2008

Primary Goal: Improve clinical productivity and patient care by eliminating paper forms and laboratory reports through electronic data transmission. Objectives: 1. Develop electronic reporting to eliminate the need for clinicians and clerical staff to fill out paper-based state morbidity reporting forms and treatment information. 2. Develop electronic reporting to eliminate the need for clinicians to fill out paper-based state HIV Program Evaluation Monitoring System (PEMS) forms. 3. Develop electronic reporting of state laboratory test results so that paper-based results do not need to be printed, transported, and manually entered into the electronic medical record.
The bi-directional electronic reporting addressed several Denver Public Health department concerns: (1) clinician productivity in completing several forms where the data were already collected electronically; (2) the inability to electronically communicate with other public health partners through PHIN standards and messaging expectations; (3) responsiveness and accuracy in communicating information to and from the state health department. In early 2005, an electronic medical record was implemented, eliminating all internal data collection forms within the STD Clinic. However, the requirement to complete the state health department's paper forms still existed. Significant time was being spent completing forms to order tests performed at the state lab, reporting demographic and risk information, and reporting morbidity data. Even though the electronic medical record contained most of this information, there was neither a mechanism to extract the information onto the form nor a mechanism at the state to receive it in electronic format. Through this new process, paper forms were eliminated and data are sent electronically on a daily basis. Data are formatted in a standardized, PHIN-compliant message format for both transmission and receipt of the data. Since data come from source systems, rather than being written on forms and re-entered into a second system, the data accuracy is improved and data are uploaded into systems more quickly.
Agency Community RolesThe development of the bi-directional electronic reporting system was a partnership among the DPH STD Clinic, the DPH Informatics department, the Information Systems department within the Denver Health organization (the parent organization of DPH), the Colorado Department of Public Health and Environment (CDPHE), and the EMC consulting group. DPH, a local health department, took the lead in identifying the opportunities for improvement and engaging other partners in the implementation of the electronic reporting. Project leadership and project management was coordinated through the DPH Informatics department. Consultation was frequently made with the STD Clinic management to discuss its processes and determine which improvements would be the most beneficial. Denver Health was also a key partner throughout the entire process by providing technical support and resources from the Information Services department. The Denver Health Information Services department was instrumental in developing the process to transmit data securely between DPH and CDPHE. Another major partner in this project was the EMC Corporation. It provided the expertise and resources to develop processes to extract and format the data from the DPH clinical information systems, along with developing the interface for posting the state laboratory test results into the DPH systems. Finally, an essential key partner was CDPHE. Each phase of the project required detailed interaction with CDPHE to discuss formats, interact with the departments receiving the data, and support testing and troubleshooting. The state personnel were very supportive in developing this new technology and implementing these new processes and programs. This partnership has resulted in both organizations, DPH and CDPHE, being able to reduce significant labor costs for processing data, form completion, data entry, and report printing. It has also lead to better teamwork, communication, and PHIN compliance. Costs and ExpendituresThe initial development and implementation for this electronic reporting system was approximately $130,000 over the span of about 2.5 years. These costs included the development of automated data extraction routines, building of an HL-7 laboratory data interface with the STD Clinic information system, in-kind support for testing and validation, and technical expertise for updating applications and providing secure data transmissions. ImplementationImplementation of bi-directional electronic messaging and reporting was performed in three phases. Phase 1 implemented morbidity reporting, phase 2 implemented HIV test reporting, and phase 3 implemented the state health department laboratory test result reporting. Each phase was considered essential toward achieving the overarching goal of eliminating unnecessary forms and reports, bi-directional reporting, and improving productivity at both the local and state health departments. Phase 1: Morbidity reporting, leveraged data already captured in the STD Clinic’s electronic medical record. Morbidity reporting was the first automated electronic messaging effort with the state health department. Data required for reportable disease messaging consisted of patient demographics, test results, and treatment information. Programs were written to extract these data elements for positive tests, mark the records of data being transmitted, configure the data in a standardized format, and securely transmit the data to the state health department. Discussions were held with the state’s information technology staff to agree on an acceptable format, perform testing, and develop new processes for the transmission and receipt of these data. This phase began in October 2005 and went into production in July 2006. The process provided a great learning experience and resulted in immediate process improvements for both agencies. Phase 2: Electronic reporting of HIV Program Evaluation Monitoring System (PEMS), is required data (demographic, risk, and prior test history) for each HIV test given within the STD Clinic. Although captured electronically for all STD Clinic patients, some information was not electronically available for all Counseling, Testing, and Referral Services (CTRS) clients. To address this, a new abbreviated electronic form was implemented in the electronic medical record system. In addition, implementation efforts were placed on hold while the state finalized revisions to its form. Using lessons learned from the morbidity reporting, programs were developed to format and transmit the data electronically to the state health department. Parallel reporting, both paper and electronic, was conducted for about three months until it was ensured that the accuracy of the electronic system was as good, if not better, in providing these data. Development began in November 2006 and was completely implemented in October 2007. The final phase was to implement electronic laboratory test result reporting from the state health department to the STD Clinic. This was the first opportunity to accept electronic data from the state health department. For PHIN compliancy, the interfaces were set up to accept HL-7 formatted test results. This phase required the most programming effort in order to ensure proper formatting and record matching between state and local data systems. Similar to previous phases, system validation required parallel processing and then final implementation. Development began in July 2007 and was implemented in February 2008.
Implementation of the electronic reporting has: (1) eliminated data entry of state laboratory test results; (2) eliminated printing of test results at the state health department; (3) eliminated all paper forms mandated by the state health department within the STD Clinic; (4) improved productivity of clinicians and clerical staff due to the elimination of paper forms; (5) reduced the labor costs of clerical functions within the clinic; (6) improved accuracy of test results in the STD Clinic’s clinical information system; (7) improved accuracy of data in state health department data systems; (8) improved the turnaround time in the availability of test results; (9) reduced the time for morbidity reporting to the state health department; and (10) eliminated the need for state health department to manually enter the morbidity data and the HIV PEMS data into its data systems.
The bi-directional electronic reporting is fully automated and requires minimal support to maintain the system. Once each day the error logs are checked to see if there are any anomalous data that were not uploaded. Any non-matching lab results, which are rare, are reviewed and addressed. The implementation of these processes has greatly enhanced the productivity and accuracy of the systems, enabling the clinicians to focus more on patient care and less on paperwork. Future changes to the system to accommodate new lab tests and new data requirements can be managed mostly by the DPH Informatics department, Denver Health Information Systems department, and the CDPHE information systems staff. Any funding needed to implement additional features or functionality will be supported through department infrastructure funds. CDPHE, after viewing the successful implementation of electronic reporting with DPH, has pursued similar implementations with other local health departments within Colorado. CDPHE and our other partners are very supportive in continuing the electronic reporting because the savings are so readily apparent.