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Iowa Surveillance Electronic Exchange Team

February 25, 2019

2004

2004 surveillance was labor intensive

  • Surveillance Reports were received by fax or mail
  • Each referral to local public health started with a blank e-mail and consisted of the
  • Patient's name,
  • date of birth,
  • disease,
  • health care provider & phone# (if known).
  • Local investigators completed paper forms and faxed them to CADE
  • CADE staff included: Bureau Chief, State Public Health Vet, 2 in-house epi/nurses, 6 field epis, 1 in-house epi, data manager, EIS Officer, and 1 business analyst
  • The data manager reviewed, statused, and reported the NETSS file to CDC
  • Epi or Epi/Nurses reviewed surveillance data -unless special circumstances- on a weekly basis at the CADE/SHL Thursday meeting

Surveillance Improvements

  • State Hygienic Lab (University Hygienic Lab then) began exporting Excel files of reportable lab results and transmitting these files via Secure File Transport Protocol (SFTP) in December 2004
  • Mail-merging county-specific documents from these Excel files began in early 2005
  • Mail-merged documents were sent through e-mail as attachments
  • Increased efficiency of referrals AND provided significantly more info to local investigators

Reporting Comparison

United Clinical Laboratories 2008 Year vs. 1 week in 2019

2009

Iowa Disease Surveillance System (IDSS)

  • IDSS is rolled out statewide throughout 2009
  • Replaced the NETSS system at IDPH
  • Full investigation information captured inside IDSS
  • Integrated system for CADE, TB, Hepatitis (including maternal/perinatal)
  • Diseases pre-determined before loaded to the system
  • Automatic assignment to investigation jurisdiction (Primary Agency)
  • Automated alerts began October 14, 2009
  • TB Message Mapping Guide (first generation) went live - reporting to CDC

2010

STD & Environmental Health Integration

Electronic Laboratory Reporting (SHL)

  • CDC Announces STD MIS support is going to sunset; IDPH STD Program decides to integrate surveillance into IDSS... goes live January 14, 2010
  • Environmental Health transitions from Excel spreadsheets to IDSS... goes live April 26, 2010 for
  • Arsenic Poisoning
  • Cadmium Poisoning
  • Carbon Monoxide Poisoning
  • Mercury Poisoning
  • Methemoglobinemia
  • Electronic Lab Reporting with SHL goes live March 9, 2010

2014

Statewide ELR Implementation Begins

  • Credentials for Iowa's smartLab are first issued to hospital personnel on January 8, 2014
  • ELR connection with ARUP established July 11, 2014, (2nd ELR partner)
  • UnityPoint (Iowa's first hospital system) goes live October 1, 2014, bringing 22 facilities on-line at once
  • Statewide implementation & implementation with national partners completed within 5 years
  • IDSS enhancements continue

2019

Now: 2019

  • IDSS still used by CADE, Environmental Health, Hepatitis areas (Hep C, Hep B maternal & perinatal), STD, TB
  • Two IDSS applications connect to the same database (~ replacing the wheels on the bus while driving down the road)
  • Lead surveillance uses Healthy Housing and Lead Poisoning Surveillance System (HHLPSS)
  • HIV surveillance uses the Enhanced HIV/AIDS Reporting System (eHARS)
  • ELR Infrastructure ... is moving to the cloud - Amazon Web Services - scheduled the weekend of April 13, 2019
  • Message Mapping Guide (MMG) development:
  • Genv2 went live March 2018 (50 conditions can be reported via Genv2)
  • TB generation 1 live since 2009
  • Hepatitis, Pertussis, Mumps, Foodborne, & TB Gen2 are all in progress

National ELR Partners

Total IDPH Disease Surveillance Traffic 2018

ELR Redirect

Rhapsody module available for all jurisdictions to use at https://www.gggllc.com/

Challenges:

  • Nebraska - HL7 version & Iowa staff access Nebraska's NBS
  • Illinois - seem understaffed & may have limited capacity with BizTalk development to handle in-bound message variation
  • Kansas - low volume exchange now that Quest Lenexa is received via AIMS
  • Minnesota - limited ELR implementation; this would be secondary
  • Missouri - limited ELR implementation; this would be secondary

ISEE Team & ELR Daily Operations

All cross-trained on HL7, ELR operations, and interact with IDSS

Swathi Ramasahayam ~ HL7 Technical Specialist and Electronic Exchange Architect for IDPH since 2008: non-smartLab traffic & error handling within Rhapsody Integration Engine, HL7 Development Projects (MMG, ELR interfaces, electronic Case Reporting, blood lead match)

Sree Vidya Maddali ~ Business Analyst for IDPH ISEE team since June 1, 2018: smartLab, ELR Daily Tracking, Error Handling & overall traffic monitoring, customer service & troubleshooting with partners, special projects, SQL query support for program areas using IDSS

John Satre ~ Informatician (former NEDSS Officer, IDSS Coordinator, ELR Coordinator) with IDPH since 2004 (embedded in CADE September 2004 - January 2014): Plan implementation processes, acquire funding, coordinate electronic exchange projects, assist with operations, coordinate ISEE team activities with surveillance program areas, develop training and communication materials

Brief Demos

if time permits

smartLab

ELR Daily Tracking

Error Handling

Electronic Initial Case Reporting

(eICR)

2021

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