Best Practices for Case Finding in DRSi Deepa Raj, M.P.H. Epidemiologist Disease Epidemiology Program U.S. Army Public Health Command Corresponding Authors: Rolando Diaz Susan Varner Lindsey Huse 30 April 2013 UNCLASSIFIED

Briefing Outline PURPOSE: To provide examples for preventive medicine (PM) staff to find cases that should be reported into the Disease Reporting System-internet (DRSi). Available Systems and Examples Advantages/Disadvantages Alternative and Supplemental Options Name/Office Symbol/email address UNCLASSIFIED

Composite Health Care System CHCS: serves as the foundation for the Department of Defense’s electronic health record (AHLTA) Adhocs can be created in CHCS to pull reports based on tests run and positive results: RDIB: Reportable Disease Bacteriology Flat File NNMC Used to identify bacterial cultures RDIC: Reportable Disease Chem Flat File NNMC Used to identify chemical presence/absence and cut-off values for labs for a select group of communicable diseases -CHCS allows DoD providers to document patient’s health information and (perhaps medically-relevant) history, electronically order laboratory and radiology tests/services, retrieve test results, and order and prescribe medications. Name/Office Symbol/email address UNCLASSIFIED

Composite Health Care System Lab Cultures for RBIC Lab Chemistries for RDIC -Here are examples of the cultures and chemistries that can be searched for in CHCS by creating specific adhocs. Running these adhocs is time-consuming and use considerable resources, so if possible, they should be run at off-peak hours…but this adhoc can be created once and run every day. Name/Office Symbol/email address UNCLASSIFIED

ESSENTRIS ESSENTRIS: used in inpatient hospital settings to provide point-of-care data capture at the patient’s bedside for medical devices and patient care machines. Shares data with AHLTA and VistA, and includes HL7 inbound ADT Every MTF that has some form of admission ward should have ESSENTRIS. --Allows real-time monitoring of heart, fetal, and other critical data --ESSENTRIS allows worldwide documentation of inpatient records for all Service Members and beneficiaries. -ADT = ADMISSION, DISCHARGE, TRANSFER. --Admission ward examples: (Med/ICU/Peds/Surgery/OB/mental health) Name/Office Symbol/email address UNCLASSIFIED

ESSENTRIS ESSENTRIS access may be read-only, but it is a means to stay in connection with a patient of interest regarding: Diagnosis Medical management (treatment/isolation levels) Final outcome/transfer to a higher level of care at another facility -http://dhims.health.mil/products/garrison/chcs.aspxuld be reviewed daily for admissions to inpatient wards. --ESSENTRIS is advantageous because it allows staff to communicate effectively and in a timely fashion with POCs at MTFs (PM staff?) or county health department, and allows for standardization of process and sharing of documentation across DoD and VA treatment facilities --Disadvantage: unlike AHLTA, Essentris records at one MTF are not available to another MTF; even within the same region. Name/Office Symbol/email address UNCLASSIFIED

SharePoint SharePoint is a Microsoft platform that can be used as a provider-based reporting tool for providers at any one MTF. --Here’s an example of Ft Belvoir Community Hospital’s SharePoint page from their intranet. --All MTFs can get access to this platform, and the tool can be set up to intake data from any source (ER, lab-based, clinical, etc.). --Because access is intranet-based, not recommended for storing PHI. --Disadvantage: data CANNOT be shared amongst MTFs. Ex: though everyone with access at FBCH can see data stored in SharePoint, no one from Kirk AHC can see Belvoir’s reported data. Name/Office Symbol/email address UNCLASSIFIED

SharePoint SharePoint’s reporting tool allows clinicians assigned to one MTF to report suspected and/or confirmed cases to Public Health Nurses. In some cases, diseases that require specific testing necessitate coordination with local health departments --We can work with our local county/state collogues is beneficial because it allows an MTF to determine if the suspect case meets the case definition for a true suspect case, and if it does it helps to get a handle on any potential clusters in the population.   Name/Office Symbol/email address UNCLASSIFIED

Inpatient Admissions and ER Visits Similar to monitoring ESSENTRIS, looking at inpatient admissions and ER visits allows PM staff to be alerted to potential cases ahead of time Going through all the ER visits on a daily basis allows for capture of clinically-diagnosed RMEs, like chicken pox or heat illness.   Name/Office Symbol/email address UNCLASSIFIED

Inpatient Admissions and ER Visits Monitoring ER visits is also useful for picking up on small clusters, both family and community-based Notable disadvantage is that often, one clinic will not have good visibility for outlying clinics --clusters: IE, a family that all comes in with vomiting and diarrhea --Disadvantage: so, if other clinics diagnose cases clinically and without a lab AND no one calls main clinic to inform main clinic, then main clinic will miss that RME. Name/Office Symbol/email address UNCLASSIFIED

Alternative Options ESSENCE: syndromic, sometimes unreliable, potential lags in ingest. Build strong relationships and collaborating with local/county health department officials. If health departments find military cases, they are more likely to report back. Rely on Infection Control staff at hospitals. Often, PM staff not located on hospital campuses so IC staff can be “eyes on the ground” Have lab personnel keep a list of both state/DoD RMEs posted on walls so they are always aware of which cases should be reported to PM staff on a daily basis.  --Health depts: if for example a SM chooses to go to a local HD rather than drive over to a DOD MTF…building good relationships with HD staff ensures they will be more likely to defer to Army PM staff for reporting, investigation, etc. --Inf Control staff: If they find a case, they will call PM POC (and likewise, if PM staff see a surgical infection pop up on an ER report they call it to them because that's something THEY have to report…mutually beneficial relationship). Name/Office Symbol/email address UNCLASSIFIED

Questions? Army: USAPHC – Disease Epidemiology Program Aberdeen Proving Ground – MD Comm: (410) 436-7605   DSN:  584-7605 usarmy.apg.medcom-phc.mbx.disease-epidemiologyprogram13@mail.mil Navy: Contact your cognizant NEPMU NEPMU2: COMM: (757) 950-6600; DSN: (312) 377-6600 Email: NEPMU2NorfolkThreatAssessment@med.navy.mil NEPMU5: COMM: (619) 556-7070; DSN (312) 526-7070 Email: ThreatAssessment@med.navy.mil NEPMU6: COMM: (808) 471-0237; DSN: (315) 471-0237 Email: NEPMU6ThreatAssessment@med.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 episervices@wpafb.af.mil