Navy and Marine Corps Public Health Center

Navy and Marine Corps Public Health Center

ANNOUNCEMENT To Register for the Monthly Disease Surveillance Trainings: Contact your Service Surveillance HUB to receive monthly updates and reminders Log-on or Request log-on ID/password: https://tiny.army.mil/r/zB8A/CME Register at: https://tiny.army.mil/r/MEHsS/EpiTechFY18 Confirm attendance: Please enter your full name/email into the DCS chat box to the right or email your Service HUB You will receive a confirmation email within 48 hours with your attendance record; if you do not receive this email, please contact your Service HUB Navy and Marine Corps Public Health Center

Attention Army DRSi Users and Reportable Medical Event Reporters! Please fill out the following survey: https://usaphcapps.amedd.army.mil/Survey/se/251137455FFEF2A5 NOTE: Once you exit the survey, you cannot re-enter that same survey to complete it, and only completed surveys will be included in the aggregate analysis for Army Public Health Center. The survey has been extended to close Tuesday, 5 March 2018. Please share this survey with others you know who perform medical event reporting. Navy and Marine Corps Public Health Center

Improving Your Medical Event Reporting Process Asha Riegodedios, Staff Epidemiologist Navy and Marine Corps Public Health Center 27 February 2018

Outline Ways to measure your reporting performance Potential barriers to reporting Solutions to address those barriers

What makes a good disease reporting program? Command instruction or SOP: process in place that is enduring and encompasses all aspects of surveillance and reporting Completeness of Reporting: good, time efficient case finding strategy Build relationships: Have a feedback loop to engage your partners and leaders Lab Civilian counterparts Command suite or ESC Know your baseline: Know your population and the baseline expected occurrence of disease Navy and Marine Corps Public Health Center

What makes a good case report? Timeliness: Report on time according to Service regulations Navy: routine events (7 days); urgent events (24 hours) Air Force: urgent events (24 hours) Army: routine events (48 hours); urgent events (24 hours) Accuracy: Services monitor for accuracy for specific events Completeness: Fill in all fields in the DRSi screen and add useful information in the comments section A good report allows all of us to fulfill our respective roles at all levels of public health action. Timeliness: - Allows for timely action - File a preliminary report for urgently reportable events and update it as more information is collected Accuracy Report correctly according to Service regulations and the case definitions in the Armed Forces Guide DRSi disease screens: each disease has different lab and event related questions Ensure your answers to these are accurate; If you don’t know the answer, then don’t fill out that question If you are unsure how to fill out the report with the information you have collected, then call your Service hub/NEPMU Services monitor for accuracy for specific events Completeness Fill in all fields in the DRSi screen for that disease: lab results, event related questions Add useful information in the comments section of the DRSi disease screen; this depends on the disease Exposure circumstances, case investigation details, preventive measures put into place

How can you measure your reporting performance? Metrics Reports: Navy MTFs: NMCPHC Quarterly MTF Case Finding Report provides your % completeness of reporting Air Force MTFs: USAFSAM AFDRSi Quarterly Completeness of Reporting Metrics sent to MAJCOMs Army MTFs: Army Public Health Management System contains metrics for timeliness of DRSi reporting; completeness metrics are conducted by APHC Conduct a program assessment based on the command reporting instruction do a quick periodic assessment Use tools like DRSi CF module to find missed reportable events There is no single fool proof way to measure how well your department is doing and it isn’t easy to ensure you are at 100% performance either. The methods available to you are USAFSAM AFDRSi Quarterly Completeness of Reporting Metrics are completed for each installation and released to MAJCOMs about 45 days after every quarter Navy and Marine Corps Public Health Center

Metric Reports Navy: NMCPHC creates a quarterly report comparing lab results to reported events helps identify MTFs that may benefit from process improvement A completeness of reporting below 70% prompts our attention Army: APHC metric that measures timeliness of reporting DRSi entry: % of RMEs entered within 48 hrs of diagnosis date All RMEs are monitored to identify whether cases are reported within 48 hrs of diagnosis date AF: USAFSAM releases a quarterly report comparing confirmed lab results to reported events Five quarters available Plans to add additional metrics as the report evolves APHC has an established metric, tracked as part of the Public Health Management System Metric Dashboard, that measures timeliness of reporting. DRSi entry: % of RMEs entered within 48 hrs of diagnosis date (tracked monthly) All RMEs are monitored to identify whether cases are reported within 48 hrs of diagnosis date USAFSAM releases a quarterly metric comparing confirmed lab results to events reported in AFDRSi Although a newer report, five quarters of data are available for tracking reporting completeness at the local level USAFSAM will be adding additional metrics as the report evolves Navy and Marine Corps Public Health Center

Metric Report - Navy The Navy has developed a completeness metric utilizing lab results data from local CHCS. This report has helped tremendously: (1) increasing our knowledge of local business process and CHCS data and (2) enabling MTFs to focus time on improving their processes. Navy and Marine Corps Public Health Center

Metric Report - Navy Navy and Marine Corps Public Health Center

Metric Report - Army This is a display of an MTF’s performance regarding the 48-hour DRSi metric. Green means the MTF reported over 95% of cases within 48 hours, yellow means that 90-95% of cases were reported within 48 hours, and red means that less than 90% of cases were reported with 48 hours. The graph is tracked by month.

Metric Report - Army This is a display of an MTF’s performance regarding the 48-hour DRSi metric. Green means the MTF reported over 95% of cases within 48 hours, yellow means that 90-95% of cases were reported within 48 hours, and red means that less than 90% of cases were reported with 48 hours. The graph is tracked by month.

Metric Report – Air Force Navy and Marine Corps Public Health Center

Program Assessment DRSi Case Finding module Records from your local CHCS host 3-4 day delay as opposed to CHCS ad hocs that are much more timely Identify records that haven’t been reported as yet Focus on “positive” case finding records: these represent labs that are likely indicative of a reportable event Navy and Marine Corps Public Health Center

Navy and Marine Corps Public Health Center

Program Assessment Summary Reports in DRSi When you log into DRSi, Summary Reports is one of the three tabs available to you from the main screen. There are a whole slew of summary report capabilities in DRSi. We didn’t intend to make it so plentiful, but each report is there to fulfill the needs of each Service’s needs. You may not ever use some of these, but these are here to allow you to run some quick stats on your data using just a few mouse clicks rather than Navy and Marine Corps Public Health Center

Summary Reports If you click on the SHOW REPORT DESCRIPTIONS, you will see a list of what each of these reports might do for you. I’ll highlight only a few of these that I think might be the most useful to you. Navy and Marine Corps Public Health Center

Summary Reports – Monthly Facility Report Monthly Facility Report: Count of All MER-Cases entered for a facility for a specified date-range, if provided otherwise all data. The Monthly Facility Report allows you to quickly see the total number of MERs in the DRSi database for your unit for a given month or year. As a user, you can use it to see if your tracking numbers match what is in DRSi. As an MTF PM department head, you can use it to see whether the units under you are reporting as expected. You would need to have a good understanding of what to expect. The system allows you to compare months. Navy and Marine Corps Public Health Center

The Monthly Facility Report allows you to quickly see the total number of MERs in the DRSi database for your unit for a given month or year. As a user, you can use it to see if your tracking numbers match what is in DRSi. As an MTF PM department head, you can use it to see whether the units under you are reporting as expected. You would need to have a good understanding of what to expect. The system allows you to compare months. Navy and Marine Corps Public Health Center

Summary Reports – Completion Status Report Completion Status Report: List of all Preliminary MER-Cases (MER Status = "Preliminary") for a facility. The Completion Status Report allows you to print a list of pending MERs for your unit. As a user, you can use it to identify MERs that have not been finalized over a period of time, go back and complete them, and ensure you haven’t missed anything. Do you need to improve your follow-up and completion process? As an MTF PM department head, you can use it to see whether your follow-up and completion processes need to be improved because MERs should not remain in pending status. It can help you target any improvements. NEPMUs might use this report to identify which MTFs might benefit from an assist phone call. Navy and Marine Corps Public Health Center

Summary Reports – Submission Overview Report The Submission Overview Report allows you to quickly see the total number of MERs in the DRSi database for your unit and the date of the last reported MER. As a user, you can use to see if the MERs you are submitting are really getting into the system. As an MTF PM department head, you can use it to see whether the units under you are reporting as expected – when is the last time NMC SD and each of its clinics reported. It can help you target any improvements. NEPMUs might use this report to identify which MTFs might benefit from an assist phone call. This view shows only the NMC SD UIC. If you have purview over several reporting units, for example, if you were at NMC SD and had access to the child clinic as well, you could select all your units from the “Select Reporting Unit” drop down and you’d see a table showing stats for each reporting unit, child and parent units. Navy and Marine Corps Public Health Center

Barriers to Reporting Providers do not report CHCS ad hocs/spool reports do not capture everything Laboratory tests are sent out for testing (mail outs) Staff turnover Getting a DRSi account is too hard Lack of Command Leadership Support New Medical Record requires new processes to be put in to place (MHS Genesis) Providers do not report. NOTE: this is subject to Service regulations. In the Navy, for example, it is the provider that is required to report, but in the Air Force that is not the case. Still, they are a resource for finding out about cases that need to be reported. Navy and Marine Corps Public Health Center

What can I do when providers don’t report? Use CHCS ad hoc/spool reports regularly Encourage your lab to report/notify PM Review sick call logs and lab results Command disease reporting instruction = provider reporting Use the DRSi Case Finding module and the ESSENCE RME module Develop a targeted provider outreach and education strategy One-on-one Group (e.g. AF monthly ProStaff meetings) Hang up list of reportable events in provider offices Communicate with your PHEO Use CHCS ad hoc/spool reports regularly Encourage your lab to report/notify PM about specific events Review sick call logs and lab results/chits Ensure the responsibility of provider reporting is written in the command disease reporting instruction Use the DRSi Case Finding module and the ESSENCE RME module Develop a targeted provider outreach and education strategy including one-on-one and group outreach (the AF has monthly ProStaff meetings where this is supposed to happen.) Hang up list of reportable events in provider offices Communicate with your PHEO to ensure two-way dialogue Navy and Marine Corps Public Health Center

What can I do when CHCS ad hoc/spool reports do not capture everything or if I am not allowed access? Contact your supporting regional Medical Center for consultation on updating the ad hoc code Visit the CHCS support staff at your local MTF Sample CHCS codes (AF MTFs): https://bdqas.afms.mil/data_metrics/ Along the left hand side, under “Online Help Documents”, select “CHCS Ad Hoc Samples” CHCS Ad Hoc on line classes: http://jko.jten.mil Geared towards IT personnel Lab System Support Center/Imaging Support (LSSC/IS): Support lab/rad needs Use DRSi Case Finding module Use ESSENCE RME module We provide a wide variety of Laboratory System support request like maintaining the Lab Files and Tables by adding New Lab Tests, Setting up the Lab Instrument Files, Updating CPT Code Files, Cleaning Up Old Pending Accessions, assisting with Lab Interoperability Issues, CHCS Lab User Training, and Special Request for Adhoc Reports Navy and Marine Corps Public Health Center

What can I do when lab tests are sent out as mail-outs? Visit your lab Know what is tested in-house Know what is sent out Work with your lab to ensure return test results are seen in CHCS ad hoc/spool reports and DRSi case finding module Use AHLTA to gather information for the Medical Event Report I need to update this slide Navy and Marine Corps Public Health Center

What can I do when there is staff turnover and everyone is new? Contact previous staff members and interview them Visit your lab Know what is tested in house Know what is sent out For lab mail-outs work out who will take the responsibility for reporting Get access to CHCS ad hoc/spool reports and assess them Know your population How they get their healthcare Work with op units to identify who will take responsibility for reporting Assess how well you are finding your cases EXPLAIN the op units bullet – make sure listeners know this applies to only some clinics who have operational units that have their own embedded clinical capability but use the MTF ancillary services. Navy and Marine Corps Public Health Center

What can I do when there is staff turnover and everyone is new? Establish SOPs that are cited by a command instruction Know the reporting requirements and processes Navy: NMCPHC Medical Event Reporting webpage: http://go.usa.gov/3KdE5 Air Force: https://kx2.afms.mil/kj/kx7/PublicHealth/Pages/content.aspx#/Comm /Epi/SurveillanceandReporting Army: http://phc.amedd.army.mil/topics/healthsurv/de/Pages/default.aspx Conduct regular training Contact your reach back support with any unanswered questions and for training on DRSi and Reporting Navy and Marine Corps Public Health Center

How can I get a DRSi account easily and quickly? Fill out the SAAR form– ensure you are using the right form (from DRSi website) Include HIPAA training date AND reporting unit Have your supervisor digitally sign the SAAR form (can be written) Submit the form to the DRSi HelpDesk Two Helpdesks: Navy/AF helpdesk and Army helpdesk Via email or via AMRDEC: https://safe.amrdec.army.mil Do not send form encrypted (since SSN is not required) Most accounts are granted within hours if it’s a working day If you do not get a response from the DRSi HelpDesk within two days, call them Fill out SAAR form (one-pager) - get the form from the DRSi website. Some people have old forms but those don't have all of the required fields and also has a fax number on it for a fax that is not in use. Have your supervisor digitally sign the SAAR form (can be written). Highly encourage users to fill and sign forms electronically with CAC credentials. As opposed to printing filling/signing and scanning to PDF. Expedites creation of account much quicker Via email. If you are part of a line command (ship or in another country) follow-up with phone call given email receipt issues Navy and Marine Corps Public Health Center

How can I get the support of my command leadership? Establish a command reporting instruction Utilize a formal process to conduct an assessment The Joint Commission accreditation Lean six sigma Command assessment program Service metric reports Contact your reach back support for advice and assistance NEPMU APHC USAFSAM Navy and Marine Corps Public Health Center

How can I address the challenges with MHS Genesis? Loss of CHCS ad hoc reports Know when MHS Genesis will be rolling out to your MTF Ensure PM is part of the MTF’s roll out meetings with Cerner Users need to have the correct access keys Users need access to the correct reports Ensure PM is providing feedback through the routine MTF roll out meetings New Lab results report MHS Genesis roll outs are designed to be iterative, each MTF roll out benefits from the previous roll out Engage IOC sites to learn from their experiences UPDATE THIS Navy and Marine Corps Public Health Center

HOW TO GET HELP Navy and Marine Corps Public Health Center

Contact your DRSi Helpdesk for questions on DRSi Access and Use Navy and Coast Guard DRSi users: Phone: 757-953-0954 E-mail: usn.hampton-roads.navmcpubhlthcenpors.list.nmcphc-ndrs@mail.mil Army DRSi users: Phone: 410-417-2377 Email: usarmy.apg.medcom-aphc.mbx.disease- epidemiologyprogram13@mail.mil Air Force DRSi users: Email for questions: afdrsi@us.af.mil Email for DRSi account access: usn.hampton- roads.navmcpubhlthcenpors.list.nmcphc-ndrs@mail.mil Phone for DRSi account access: 757-953-0954 NEED TO UPDATE Navy and Marine Corps Public Health Center

Contact your Service Surveillance hub for Guidance and Consultation on Reporting Army: APHC – Disease Epidemiology Program Aberdeen Proving Ground – MD Comm: (410) 436-7605   DSN:  584-7605 usarmy.apg.medcom-aphc.mbx.disease-epidemiologyprogram13@mail.mil Navy: Contact your cognizant NEPMU NEPMU2: COMM: (757) 950-6600; DSN: (312) 377-6600 Email: usn.hampton-roads.navhospporsva.list.nepmu2norfolk- threatassess@mail.mil NEPMU5: COMM: (619) 556-7070; DSN (312) 526-7070 Email: usn.san-diego.navenpvntmedufive.list.nepmu5-health-surveillance@mail.mil NEPMU6: COMM: (808) 471-0237; DSN: (315) 471-0237 Email: usn.jbphh.navenpvntmedusixhi.list.nepmu6@mail.mil NEPMU7: COMM (int): 011-34-956-82-2230 (local): 727-2230; DSN: 94-314-727-2230 Email: NEPMU7@eu.navy.mil Air Force: Contact your MAJCOM PH or USAFSAM/PHR USAFSAM / PHR / Epidemiology Consult Service Wright-Patterson AFB, Ohio Comm: (937) 938-3207   DSN:  798-3207 usafsam.phrepiservic@us.af.mil NEED TO UPDATE Navy and Marine Corps Public Health Center

Attention Army DRSi Users and Reportable Medical Event Reporters! Please fill out the following survey: https://usaphcapps.amedd.army.mil/Survey/se/251137455FFEF2A5 NOTE: Once you exit the survey, you cannot re-enter that same survey to complete it, and only completed surveys will be included in the aggregate analysis for Army Public Health Center. The survey has been extended to close Tuesday, 5 March 2018. Please share this survey with others you know who perform medical event reporting. Navy and Marine Corps Public Health Center