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Note that this page is still actively under construction!!!

Overview

The tracking of communicable diseases by Public Health domain is a complex and ever-changing landscape, but one that should be of interest to and accessible to all members of the larger community. The COVID-19 pandemic has dramatically raised the awareness of role of Public Health in understanding and combating communicable diseases.

To help people better navigate their way through an understanding of what Public Health is and why it's so important to track and respond to communicable diseases like COVID-19, we have put together this resource to demystify some of the terminology and alphabet soup. Please keep in mind that this is an informal page and not meant to be an official description of any programs or projects (please refer to the links provided for more official descriptions).

We will be working hard to keep it accurate and up to date, but please leave comments if you think additions or corrections are warranted. We especially welcome pointers to other programs across the globe.

Typical Flow of Data

As a cohort of patients progress through the life cycle of infection with a communicable disease, the data related may flow through a series Public Health systems performing different aspects of the organized response including event detection, outbreak management and response. Typically, a patient will be seen at a healthcare facility that is set up to report, electronically or manually, to a variety of Public Health systems within the jurisdiction (state or metropolitan area) the facility operates. The Syndromic Surveillance System operating in the jurisdiction will often be the first system aware of a potential communicable disease as it collects real-time data regarding chief complaints for emergency and urgent care visits. As more data is collected on the patient by the healthcare providers, the jurisdictional Disease Surveillance/Outbreak Management System will receive patient-specific hospital, physician and laboratory reported regarding the potential communicable disease for epidemiologists to follow up on and to track and manage the spread of infectious disease. Often jurisdictional Public Health laboratories will be called upon to perform specific diagnostic testing for the patient with the results flowing back to the Disease Surveillance/Outbreak Management System. If a vaccine is available for the communicable disease, then the jurisdiction's Immunization Information System (IIS) will receive vaccine administration data as individuals in the population are vaccinated as part of the outbreak management response. If ultimately, the infection proves fatal to an individual, the jurisdictional Electronic Death Registration System (EDRS) will receive data regarding the decedent and possible causes of death. Further information on these individual systems and the interoperability standards used to exchange data electronically are provided below.

While data is typically collected first at the jurisdictional level, data is often shared with a national Public Health agency (such as the Centers for Disease Control and Prevention in the United States). 

Example data flow in the United States.

Common Terms

Case ReportingThe generation and transmission of information of individual observations of communicable diseases from clinical care providers to public health agencies for review and action.

Contact Tracing - The identification and monitoring of people in close contact with someone who is infected

Public Health Systems

Disease Surveillance/Outbreak Management Systems

Collects hospital, physician and laboratory reported and patient specific communicable disease information for epidemiologists to follow up on patient specific cases to track and manage the spread of infectious disease.

Relevant HL7 Standards:

Abbreviations and Terms:

  • ECR - Electronic Case Reporting
    • The automated generation and transmission of case reports from electronic health records to public health agencies for review and action.
  • eICR - Electronic Initial Case Report
    • The initial set of data on reportable conditions sent from clinical care providers to Public Health
  • RR - Reportability Response
    • Data returned from Public Health to clinical care serving several functions, including to Provide suggested or required clinical follow-up activities from the responsible Public Health Agency (PHA), including any additional reporting needs or infection control activities and to provide access to clinical support resources suggested by the responsible PHA for identified reportable conditions

  • ELR - Electronic Laboratory Reporting
    • Electronic transmission from laboratories to public health of laboratory reports which identify reportable conditions

Electronic Death Registration Systems (EDRS)

Collects death certification information from hospitals, physicians, funeral homes and medical examiners making data available for reporting and analysis for public health surveillance.

Relevant HL7 Standards:

Immunization Information Systems (IIS)

Collects patient specific information on vaccines administered, tracks inventory and supply of vaccines. Provides personalized vaccination recommendations for patients.

Relevant HL7 Standards:

Public Health Laboratory Information Systems

Receives laboratory test orders to be performed by the jurisdictional lab and sends results responding to novel strains of disease, natural disasters, chemical spills, food-borne outbreaks and other health emergencies.

Relevant HL7 Standards:

Syndromic Surveillance Systems

Collects real-time data (ADT chief complaints) from Emergency Department and Urgent Care visits to assist epidemiologists to identify early and monitor potential outbreaks.

Relevant HL7 Standards:

Other Standards in Use

Specialized standards are also used within healthcare and Public Health communities in response to particular diseases and crises. For example, several COVID-19 specific standard are being developed for use by healthcare organizations, and state and federal agencies.

Additional COVID-19 Standards

SANER - http://build.fhir.org/ig/HL7/fhir-saner/index.html

The Situational Awareness for Novel Epidemic Response Implementation Guide enables transmission of high level situational awareness information from inpatient facilities to centralized data repositories to support the treatment of novel influenza-like illness.

COVID-19 FHIR IG - https://covid-19-ig.logicahealth.org/index.html

A collection or library of data elements that relate to COVID19.  Submission of data needed in public health electronic case reporting (required by state laws/regulations) to jurisdictional public health agencies you must use “HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 1.1 - US Realm”

Additional Resources

CDC guidance on certifying deaths due to COVID-19 - https://emergency.cdc.gov/coca/calls/2020/callinfo_041620.asp

Common Programs

International

World Health Organization (WHO)

WHO works worldwide to promote health, keep the world safe, and serve the vulnerable.

United States

National Center for Health Statistics (NCHS)/National Vital Statistics System (NVSS)

The National Vital Statistics System is the oldest and most successful example of inter-governmental data sharing in Public Health and the shared relationships, standards, and procedures form the mechanism by which NCHS collects and disseminates the registration of vital events – births, deaths, marriages, divorces, and fetal deaths. 

National Healthcare Safety Network (NHSN)

HSN provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare-associated infections.

National Notifiable Diseases Surveillance System (NNDSS) 

The National Notifiable Diseases Surveillance System (NNDSS) helps public health monitor, control, and prevent about 120 diseases. These diseases are important to monitor nationwide and include infectious diseases such as Zika, foodborne outbreaks such as E. coli, and noninfectious conditions such as lead poisoning. NNDSS is a multifaceted program that includes the surveillance system for collection, analysis, and sharing of health data. It also includes policies, laws, electronic messaging standards, people, partners, information systems, processes, and resources at the local, state, territorial, and national levels

National Syndromic Surveillance Program (NSSP)

NSSP is a collaboration among CDC, federal partners, local and state health departments, and academic and private sector partners. They collect, analyze, and share electronic patient encounter data received from emergency departments, urgent and ambulatory care centers, inpatient healthcare settings, and laboratories. The electronic health data are integrated through a shared platform—the BioSense Platform.

Public Health Information Network (PHIN)

PHIN tools and resources are provided below to help increase the capacity of public health agencies to electronically exchange health data and information.

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