Background: Due to limitations of many data sources used for STD research, it has been difficult to study access, utilization, quality of STD services or model comprehensive control strategies; to monitor adherence to recommendations for STD testing and management; and to monitor long term adverse outcomes.
Methods: With support from CDC, we integrated multiple data sources, including electronic health records, lab tests, clinical encounters, medical and prescription claims, morbidity and case investigation reports, into a comprehensive STD registry. Records for all individuals tested for chlamydia, gonorrhea, or syphilis between 2003 and 2014 were identified using a health information exchange network. Data were matched across datasets and integrated into de-identified datasets for use in public health practice and research.
Results: A total of 5.1 million tests were identified for 628,137 individuals. Most tests were performed on females (84.6%). The majority of tests (45%) were performed on individuals who self-identified as black, 35% white, and 4.6% Hispanic. In addition to test results, individuals are flagged if they were HIV positive and/or pregnant at the time of STD testing. Beyond testing data, the registry also contains data on 13 million clinical encounters, including visits to public STD clinics, outpatient practices (e.g., OB/GYN, family medicine), and emergency departments, as well as treatment records from STD clinics and community pharmacies.
Conclusions: Comprehensive sources allow for analyses that provide unique insights into STD testing and services. For example, while overall case counts have risen in Indianapolis over the past decade, so has testing resulting in a relatively stable positivity rate. This suggests that incidence is not going up; instead, providers and public health agencies are identifying more cases due to testing and electronic lab reporting. A range of analyses are planned; and many more are possible with resources like an integrated registry.