1. Karla Schmitt, PhD, MPH, ARNP
Alignment of Technology, Policy and Law Result in 200% Increase in Perinatal STI Identification
Stacy Shiver, BA
Karla Schmitt, PhD, MPH, ARNP
Susan O'Bryan, MLS
Adrian Cooksey, MPH
Mary White, (DBA)

2. Historical Framework
1,000s of landmark publications on STIs in pregnancy
Pathogen specific
Treatment efficacy
Laboratory screening, often with specific assays
Cohort often from clinic setting or multiple clinic environments
Scope of data limited by access to medical records and extent of funding resources
Stacy- total 5 slides on the mechanics of how we get information, how we expect to connect for vital stats info, hardware, software....
these slides should address how a new state of the art technology approach/application enhanced our capacity for case identification
    note need to highlight this as a programmatice structural response to create an environment that supports program operations and reduces disease transmission
    note what was planned, what succeeded, what failed, what was partial success, and obstancles to get to this point
    note the practical pathway.....
Karla- total 5 slides on: a) background (historical underpinings of our disease process understanding, b) primary desired outcome (new standards of care, better understanding of disease processes) and c) data gathered to date if we are very lucky a logistic regression statement about association....
    note critical elements that have been gathered, believd observed, and what is missing in evidence base; frame historical knowledge on difference in new technology, capacity to control more variables; historical bias versus recent evidence
And We will need a  concluding slide on implications for HC delivery systems in FL  and potential policy directives to evolve

3. Darwinian Framework Evolutionary trajectory……Opportunities to explore
During 2005, 3% of all infants born in Fl were delivered to women who had an STD during pregnancy or at delivery
Evolutionary trajectory……Opportunities to explore
Broader community and population based surveillance analyses
Automated linked data sets from diverse source applications
Expanded capacity to control variable bias
Update knowledge and document “evidence”
Revise standards of care and drive policy
Identify economic advantage to process improvement
Reduce STD associated stigma
And if we are very lucky….improve perinatal health outcomes….the critical impetus for a change in our posture

4. New Law, New Code
Re-wrote the Florida Statute section on blood testing of pregnant women
broadened testing other than blood
required that practitioner inform the woman of the testing that would take place
And, retained authority of department to specify conditions.
Law Points:
Code Points:

5. Florida Administrative Code 64D-3 Revised the relevant sections
clarified requirements in 1st & 3rd trimesters, postpartum
made routine CT, GC, Hep B, HIV, syphilis
notify the woman of the testing that would take place, and her rights
direct ED refer women not yet in care after the 12th week to county health departments
required documentation on birth, fetal death certificates of infection and treatment events

6. Pre-Computer Period Pre-Network Period
Interview Record
Provider Reports
Medical Record
Field Record
Congenital Record
Lab Reports
Pre-Network Period
Interview Record
Provider Reports
STD
NETSS
Medical Record
Field Record
MIS
Computers/Software
Congenital Record
Lab Reports

7. Modern Networks and Computers/Software
Hospitals
Lab Repository
PHIN MS
Laboratory
Vital Stats
Providers
CDC
Clinics

8. HISTORICAL IMPLEMENTATION OF CHANGE MODERN IMPLEMENTATION OF CHANGE
More paper
More Duties for Workforce
More Dedicated Work Hours
MODERN IMPLEMENTATION OF CHANGE
Information Management
Application of Automation
Minimize Impacts to Workforce

9. Florida’s Application of Technology for STD
Full Integration of ELR into PRISM
Integration of HARS into PRISM
PRISM searches of Florida’s Vital Statistics Database – automated.
Bidirectional Communication between PRISM and clinical systems.
Access to critical information systems combined with key automation to reduce workloads and improve information management.

10. Post Modernization Pre Modernization
During 2005, 1.3% of all infants born in Fl were delivered to women who had an STD reported during pregnancy or at delivery
3,500 case reports in pregnancy
Post Modernization
During 2007, 5.5% of all infants born in Fl were delivered to women who had an STD reported during pregnancy or at delivery
13,114 case reports in pregnancy
Broader range of infections
From one to six
Case definitions established
Scope of condition details expanded
Partner treatment status
Baby’s status at end of pregnancy
Prenatal care components
Prenatal care components:
number of visits, first visit, last visit
prenatal care provider
trimester of testing
treatment date
interview date
morbidity created
gestational age
Baby details:
status at birth
DOB
birth weight
Partner details:
date of treatment
linkage to cluster, network
co-morbidity risk

11. Observations of Interest
Majority of infections identified later in pregnancy than anticipated: 34.5% in 2nd trimester, 35.3% in 3rd trimester
No surprise: chlamydia comprised 65% of infections identified in group and 17.5%; early latent comprised 20% of infections identified in group and chlamydia 50%
Prenatal care status known on 47.2%: of those 84% received appropriate treatment
Ethnicity distribution remained consistent over time
Race distribution both shifted, and reported with higher % “unknown”
Prenatal care components:
number of visits, first visit, last visit
prenatal care provider
trimester of testing
treatment date
interview date
morbidity created
gestational age
Baby details:
status at birth
DOB
birth weight
Partner details:
date of treatment
linkage to cluster, network
co-morbidity risk

12. Observations of Interest
Baby status known on 92%
83.4% experienced a live birth
2.2% experienced a live birth, followed with death
Small number, ¾ among untreated partners
Small number, ¾ associated with syphilis
38% identified as serofast, likely serofast, previously adequately treated; uncertain if followed adequately per protocol
unknown significance
Prenatal care components:
number of visits, first visit, last visit
prenatal care provider
trimester of testing
treatment date
interview date
morbidity created
gestational age
Baby details:
status at birth
DOB
birth weight
Partner details:
date of treatment
linkage to cluster, network
co-morbidity risk

13. Policy implications Training specific to perinatal infections for DIS
Modules in development for certification curricula
Revised processes to increase treatment completion within acceptable intervals
Processes to assure partner treatment
Law change for partner expedited treatment
Law change to assure partner treatment
Processes to assure standardized follow-up during prenatal care for repeat testing as indicated (and measurement)
KEY POINT: much more work remains to
clean and link data, understand how staff
entered data, revamp surveillance activities to
capture potential of data
Prenatal care components:
number of visits, first visit, last visit
prenatal care provider
trimester of testing
treatment date
interview date
morbidity created
gestational age
Baby details:
status at birth
DOB
birth weight
Partner details:
date of treatment
linkage to cluster, network
co-morbidity risk
Enhanced case identification highlighted significant prevalence during pregnancy

14. Questions? Contact: Stacy Shiver Sr. Management Analyst Supervisor
Bureau of STD Prevention and Control,
Division of Disease Control
(850)