Page 48 - Driving Public Health in the Fast Lane

Appendix A

Core Pillars of Public Health Surveillance

In the United States, the public health surveillance system spans across federal, state, territorial, local, and
tribal jurisdictions to support detection, response, and prevention of public health threats. While public
health surveillance is recognized as an important component to protect the nation from public health
threats, it is under-resourced. Much of the current funding for public health surveillance is reallocated
from Centers for Disease Control and Prevention (CDC) to state, territorial, local, and tribal health
1
departments to strengthen their respective surveillance systems, but gaps remain. The nation’s public
health surveillance system is plagued by data quality and timeliness issues that inhibit the individual data
systems and the public health surveillance system as a whole. To address the challenges facing the public
health surveillance system, an in-depth understanding of each of the individual data systems is necessary.

Electronic Case Reporting (eCR)

Case reporting is a key component of public health, and occurs when reporting entities such as hospitals
and health care providers submit patient disease information to public health authorities pursuant to
jurisdictional laws. An initial case report to public health departments includes health data from the time
of suspected disease onset and pre-disease confirmation, which is then updated with all relevant data
post-disease confirmation. 2

Unlike traditional case reporting, eCR systems can generate and transmit case reports through a semi- or
fully-automated application—known as clinical decision support—that pulls reportable patient data from
3
an electronic health record (EHR) or an intermediary system such as an health information exchange.
The Reportable Condition Knowledge Management System reduces the administrative burden on health
care providers and public health professionals to manually identify and extract reportable disease/
condition data from patient EHRs and manually generate a case report. This automated process mitigates
the risk of data entry, transmission errors, or failures to report at all. With more accurate disease data, eCR
systems can promote more timely notifiable disease reporting and optimize public health surveillance
functionality throughout the system, supporting rapid public health responses and implementation of
control measures.

Today, nearly all case reports continue to be submitted to public health authorities via manual processes
such as faxes, emailed PDFs, and mailed paper forms. However, a few jurisdictions have implemented an
eCR system through participation in the Digital Bridge—a public-private partnership that supports the
electronic and interoperable processes that help modernize the public health surveillance system. 4

1 Office of Public Health Scientific Services. CDC Public Health Surveillance Strategy Report: 2014-2018. cdc.gov. https://www.cdc.gov/surveillance/pdfs/Surveillance-Series-Bookleth.pdf. Published
September, 2018.
2 Hamilton JJ, et al. Electronic Case Reporting (eCR). cste.org. https://cdn.ymaws.com/www.cste.org/resource/resmgr/2016PS/16_SI_02.pdf.
3 Public Health Informatics Institute. Advancing Electronic Case Reporting of Sexually Transmitted Infections. https://www.phii.org/sites/default/files/resource/pdfs/ECRofSTIGuidance_v3%20
%281%29.pdf. Updated March 15, 2018.
4 Current State of Data Exchange. digitalbridge.us. https://digitalbridge.us/infoex/about/.

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