@article{Ward_Hildebrandt_Patel_2017, title={NEDSS Base System (NBS): Electronic Data Exchange and Workflow Decision Support}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7625}, DOI={10.5210/ojphi.v9i1.7625}, abstractNote={<div style="left: 89.1818px; top: 317.842px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.08186);" data-canvas-width="63.1985303030303">Objective</div><div style="left: 104.045px; top: 332.657px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.976123);" data-canvas-width="374.6036030303032">The NEDSS Base System (NBS), an integrated disease surveillance</div><div style="left: 89.1818px; top: 349.172px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.974675);" data-canvas-width="390.94229015151507">system, implemented extensible functionality to support electronic</div><div style="left: 89.1818px; top: 365.688px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.976247);" data-canvas-width="391.4911712121211">data exchange for multiple use cases and public health workflow</div><div style="left: 89.1818px; top: 382.203px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00202);" data-canvas-width="291.6369318181817">management of incoming messages and documents.</div><div style="left: 89.1818px; top: 413.63px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.11811);" data-canvas-width="81.88294696969696">Introduction</div><div style="left: 104.045px; top: 428.445px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.967346);" data-canvas-width="376.53942651515143">The NBS is an integrated disease surveillance system deployed</div><div style="left: 89.1818px; top: 444.96px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.987047);" data-canvas-width="391.8084272727272">in 22 public health jurisdictions to support receipt, investigation,</div><div style="left: 89.1818px; top: 461.475px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03975);" data-canvas-width="393.7175787878787">analysis and reporting, and data exchange for state reportable</div><div style="left: 89.1818px; top: 477.991px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00629);" data-canvas-width="390.1561689393939">conditions. The NBS is governed by the Centers for Disease Control</div><div style="left: 89.1818px; top: 494.506px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.996838);" data-canvas-width="389.79679924242424">and Prevention (CDC) and state, local, and territorial users that make</div><div style="left: 89.1818px; top: 511.021px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.04761);" data-canvas-width="391.28341060606056">up the NBS Community. In the early 2000’s, electronic laboratory</div><div style="left: 89.1818px; top: 527.536px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.975293);" data-canvas-width="391.51503560606045">results reporting (ELR) was implemented in an effort to improve</div><div style="left: 89.1818px; top: 544.051px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.99214);" data-canvas-width="389.49779242424245">timeliness and completeness of disease reporting. As standards-based</div><div style="left: 89.1818px; top: 560.566px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01973);" data-canvas-width="390.7429522727273">electronic health records (EHRs) are adopted and more surveillance</div><div style="left: 89.1818px; top: 577.082px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02635);" data-canvas-width="390.90438787878736">data become available, modern surveillance systems must consume</div><div style="left: 89.1818px; top: 593.597px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02507);" data-canvas-width="390.8917537878787">information in an automated way and provide more functionality to</div><div style="left: 89.1818px; top: 610.112px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00223);" data-canvas-width="207.39562121212126">automate key surveillance processes.</div><div style="left: 89.1818px; top: 641.539px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.07334);" data-canvas-width="57.70971969696969">Methods</div><div style="left: 104.045px; top: 656.354px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.987422);" data-canvas-width="374.6443128787878">Many use cases exist for exchanging data with an integrated public</div><div style="left: 89.1818px; top: 672.869px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00039);" data-canvas-width="389.91892878787877">health surveillance system. These can include exchange of electronic</div><div style="left: 89.1818px; top: 689.385px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.970045);" data-canvas-width="391.4939787878789">case and laboratory reports from healthcare, data sharing between</div><div style="left: 89.1818px; top: 705.9px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01711);" data-canvas-width="392.7236969696969">public health entities, data migration from legacy systems, and</div><div style="left: 89.1818px; top: 722.415px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.972654);" data-canvas-width="389.466909090909">ongoing exchange with other public health systems (e.g. immunization</div><div style="left: 89.1818px; top: 738.93px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.981548);" data-canvas-width="389.478139393939">registries). The NBS implemented an interface specification called the</div><div style="left: 89.1818px; top: 755.445px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.9983);" data-canvas-width="389.83610530303025">Public Health Document Container (PHDC). PHDC is based on HL7</div><div style="left: 89.1818px; top: 771.96px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.992057);" data-canvas-width="389.5806159090909">version 3 Clinical Document Architecture (CDA). It allows import of</div><div style="left: 89.1818px; top: 788.476px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02135);" data-canvas-width="390.76822045454537">patient (cases and contacts), investigation, treatment, interview, and</div><div style="left: 89.1818px; top: 804.991px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03656);" data-canvas-width="390.95492424242434">laboratory information into NBS. CDA was chosen as the building</div><div style="left: 89.1818px; top: 821.506px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.988282);" data-canvas-width="391.7550833333336">block to facilitate data exchange with the healthcare community.</div><div style="left: 89.1818px; top: 838.021px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01349);" data-canvas-width="390.39621666666665">Through use of data integration tools, incoming data can be mapped</div><div style="left: 89.1818px; top: 854.536px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.955991);" data-canvas-width="391.2076060606062">from any format to PHDC and imported into the system. Existing</div><div style="left: 89.1818px; top: 871.051px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.977526);" data-canvas-width="391.4013287878788">services, such as patient, provider, and organization deduplication</div><div style="left: 89.1818px; top: 887.566px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01697);" data-canvas-width="392.8205583333332">are applied. To assist with management of incoming electronic</div><div style="left: 89.1818px; top: 904.082px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03306);" data-canvas-width="393.2866159090909">documents, NBS implemented a functionality called Workflow</div><div style="left: 89.1818px; top: 920.597px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00507);" data-canvas-width="392.51312878787905">Decision Support (WDS). WDS uses configurable algorithms to</div><div style="left: 89.1818px; top: 937.112px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02783);" data-canvas-width="391.0531893939396">automatically process incoming documents (including case reports,</div><div style="left: 89.1818px; top: 953.627px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.04175);" data-canvas-width="391.05459318181806">laboratory reports, etc.) into the public health workflow. Users can</div><div style="left: 89.1818px; top: 970.142px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01137);" data-canvas-width="390.37375606060607">choose to mark an incoming document as reviewed or automatically</div><div style="left: 89.1818px; top: 986.657px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.964464);" data-canvas-width="391.1865492424241">create an investigation and case notification message to CDC (for</div><div style="left: 89.1818px; top: 1003.17px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00671);" data-canvas-width="183.65756818181822">nationally notifiable conditions).</div><div style="left: 89.1818px; top: 1034.6px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.08498);" data-canvas-width="50.70481818181818">Results</div><div style="left: 104.045px; top: 1049.41px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.992632);" data-canvas-width="374.78469166666656">Through PHDC, NBS is able to receive data from healthcare using</div><div style="left: 89.1818px; top: 1065.93px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.958052);" data-canvas-width="391.172511363636">national standards, such as the HL7 Electronic Initial Case Report</div><div style="left: 89.1818px; top: 1082.45px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.998855);" data-canvas-width="389.8697962121212">(eICR). Three NBS partners are currently collaborating to pilot eICR</div><div style="left: 89.1818px; top: 1098.96px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00513);" data-canvas-width="389.9891181818182">functionality. PHDC was successfully used to migrate large volumes</div><div style="left: 89.1818px; top: 1115.48px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.04159);" data-canvas-width="391.0138833333333">of data from a legacy surveillance system into the NBS. Two NBS</div><div style="left: 89.1818px; top: 1131.99px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.997664);" data-canvas-width="389.82066363636363">states are using PHDC to implement ongoing data exchange between</div><div style="left: 89.1818px; top: 1148.51px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.98137);" data-canvas-width="389.4402371212121">separate surveillance systems within their jurisdiction. In several NBS</div><div style="left: 89.1818px; top: 1165.02px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00249);" data-canvas-width="389.98350303030304">jurisdictions, WDS is used to automatically create investigations and</div><div style="left: 89.1818px; top: 1181.54px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.969503);" data-canvas-width="390.9521166666666">case notifications for high-morbidity conditions such as gonorrhea</div><div style="left: 505.364px; top: 316.142px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.967345);" data-canvas-width="391.6778749999998">and chlamydia. In other jurisdictions, WDS is used to assist with</div><div style="left: 505.364px; top: 332.657px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00189);" data-canvas-width="299.8490909090909">managing high volumes of Hepatitis B and C reports.</div><div style="left: 505.364px; top: 364.085px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.10288);" data-canvas-width="84.24131060606061">Conclusions</div><div style="left: 520.227px; top: 378.9px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.988988);" data-canvas-width="374.6120257575757">CDA-based PHDC does require that public health have knowledge</div><div style="left: 505.364px; top: 395.415px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.971324);" data-canvas-width="391.6217234848482">of standards and data integration resources to transform incoming</div><div style="left: 505.364px; top: 411.93px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.04174);" data-canvas-width="391.0517856060598">messages to the PHDC interface; however, the flexibility provided</div><div style="left: 505.364px; top: 428.445px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00707);" data-canvas-width="392.908996969697">by this approach ensures the system is able to respond to new</div><div style="left: 505.364px; top: 444.96px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00293);" data-canvas-width="392.31379090909076">and changing standards without system development. Additional</div><div style="left: 505.364px; top: 461.475px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.974272);" data-canvas-width="389.2703787878784">enhancements are needed to support data exchange with immunization</div><div style="left: 505.364px; top: 477.991px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.963628);" data-canvas-width="391.265161363636">registries. WDS functionality does reduce burden on public health</div><div style="left: 505.364px; top: 494.506px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.994394);" data-canvas-width="392.18885378787866">staff, especially when dealing with high-volume diseases. Future</div><div style="left: 505.364px; top: 511.021px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.0056);" data-canvas-width="390.03684696969697">functionalities include the ability to define more criteria (such as age</div><div style="left: 505.364px; top: 527.536px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.973816);" data-canvas-width="386.54001136363615">or gender) to drive the actions taken on an incoming lab or case report.</div>}, number={1}, journal={Online Journal of Public Health Informatics}, author={Ward, Jennifer and Hildebrandt, Christi and Patel, Akshar}, year={2017}, month={May} }