2. Navy and Marine Corps Public Health Center

3. Navy and Marine Corps Public Health Center

4. 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:
Register at:
Confirm attendance:
Please enter your full name/ into the DCS chat box to the right or your Service HUB
You will receive a confirmation within 48 hours with your attendance record; if you do not receive this , please contact your Service HUB
Navy and Marine Corps Public Health Center

5. Attention Army DRSi Users and Reportable Medical Event Reporters!
Please fill out the following survey: 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 Please share this survey with others you know who perform medical event reporting.
Navy and Marine Corps Public Health Center

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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Metric Report - Navy
Navy and Marine Corps Public Health Center

14. 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.

15. 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.

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

17. 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

18. Navy and Marine Corps Public Health Center

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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):
Along the left hand side, under “Online Help Documents”, select “CHCS Ad Hoc Samples”
CHCS Ad Hoc on line classes:
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

28. 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

29. 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

30. 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:
Air Force: /Epi/SurveillanceandReporting
Army:
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

31. 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 or via AMRDEC:
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 . If you are part of a line command (ship or in another country) follow-up with phone call given receipt issues
Navy and Marine Corps Public Health Center

32. 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

33. 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

34. HOW TO GET HELP
Navy and Marine Corps Public Health Center

35. Contact your DRSi Helpdesk for questions on DRSi Access and Use
Navy and Coast Guard DRSi users:
Phone:
Army DRSi users:
Phone:
usarmy.apg.medcom-aphc.mbx.disease-
Air Force DRSi users:
for questions:
for DRSi account access: usn.hampton-
Phone for DRSi account access:
NEED TO UPDATE
Navy and Marine Corps Public Health Center

36. Contact your Service Surveillance hub for Guidance and Consultation on Reporting
Army: APHC – Disease Epidemiology Program
Aberdeen Proving Ground – MD
Comm: (410)   DSN:  
Navy: Contact your cognizant NEPMU
NEPMU2: COMM: (757) ; DSN: (312)
usn.hampton-roads.navhospporsva.list.nepmu2norfolk-
NEPMU5: COMM: (619) ; DSN (312)
NEPMU6: COMM: (808) ; DSN: (315)
NEPMU7: COMM (int): (local): ; DSN:
Air Force: Contact your MAJCOM PH or USAFSAM/PHR
USAFSAM / PHR / Epidemiology Consult Service
Wright-Patterson AFB, Ohio
Comm: (937)   DSN:  
NEED TO UPDATE
Navy and Marine Corps Public Health Center

37. Attention Army DRSi Users and Reportable Medical Event Reporters!
Please fill out the following survey: 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 Please share this survey with others you know who perform medical event reporting.
Navy and Marine Corps Public Health Center