Harvesting Clinical Data for Public Health Investigations from Electronic Health Records: Progress Toward Making Electronic Case Reporting through Consolidated Clinical Document Architecture a Reality in Utah

Background:  Electronic laboratory reporting (ELR) for sexually transmitted diseases (STDs) has been successfully implemented in many states, yet some states continue to expend resources on completing public health investigations by manually ascertaining clinical data from medical records.  The use of electronic health records (EHRs) among clinical providers, however, affords the opportunity to enhance investigations as well as contributing toward electronic case reporting (eCR). The goal of this project was to develop informatics solutions needed to electronically receive clinical data from EHRs.  We describe recent progress in receiving single-patient encounter EHR data as consolidated clinical document architecture (C-CDA) messages.

Methods:  Utah Department of Health (UDOH) worked with a clinical partner and their EHR vendor to create an interface at UDOH to receive C-CDAs through a secure file transfer (sFTP). The C-CDA message elements were then parsed and validated with the clinical partner for accuracy.  The validated variables were mapped to UDOH's electronic communicable disease surveillance and case management system (UT-NEDSS). 

Results:  Over 55,000 C-CDAs have been received and the accuracy of these messages has been verified with the provider. In the C-CDAs we identified over 40 key variables within the larger data areas of patient demographics, treatment information, facility details, lab data, and diagnosis codes. These variables can be used to supplement data not consistently captured through ELR to complete case reports and public health investigations. The data from these C-CDAs have been mapped to UT-NEDSS. 

Conclusions:  C-CDAs are a timely and effective way of obtaining clinical information from EHRs to supplement ELR data for cases of chlamydia and gonorrhea. Next steps include: 1) evaluating the quality of the data for completion of case report forms and; 2) creating insertion and integration algorithms to enhance the capacity of UDOH's rules engine to utilize RxNorm and ICD codes to trigger reporting of chlamydia and gonorrhea events.