Online system aids disease reporting

Until recently, Los Angeles County's network of private and public laboratories, hospitals, doctors' offices and clinics routinely faxed and sometimes phoned in reports of communicable diseases to the county's health department. Often late and full of errors, such information was manually retyped into separate government systems.

But things are changing. The health department recently unveiled a new system — Visual Confidential Morbidity Report (Visual CMR) — that is enhancing accuracy and accelerating the collection of reported information. The department received federal funds six years ago to help it develop the system.

"There was very little quality control in the old system," said Dr. David Dassey, deputy director of the county's Acute Communicable Disease Control (ACDC) Unit, which is responsible for tracking communicable disease cases and outbreaks.

ACDC collects data on 85 communicable diseases, except AIDS, sexually transmitted diseases and tuberculosis, which have their own federal funding sources and are reported separately.

Before Visual CMR, "there was a lot of duplication particularly for chronic diseases that people get tested for on multiple occasions," Dassey said. "No one was looking to see whether or not this was good data."

But this summer, employees at Kaiser Permanente Regional Reference Laboratories in Southern California became the first to use Visual CMR. Instead of typing reports and faxing them to the health department, employees logged on to a secure Web portal to fill out forms online and submitted individual case reports with the touch of a button.

A few months before, Kaiser Permanente became the first in the county to send electronic reports of test results, using national health standards, from its servers to the county's database within the required 24 hours.

With about a half-dozen hospitals and many satellite clinics within Los Angeles County, Kaiser Permanente provides anywhere from 30 percent to 40 percent of the 15,000 to 20,000 reports the county receives annually. In addition, the public health department has connected at least six hospitals and plans to add more facilities to Visual CMR.

According to several health officials, Visual CMR will help the government get better data more quickly, making it easier to spot health anomalies.

"You don't have to worry about clerical transcription errors, and it's a great advantage" for the county, said Dr. Ann Vannier, director of microbiology for Kaiser Permanente's labs in Southern California. "Now that they have it all computerized, they can sort the data [and] look at it a different way, whereas before they always had to call up and ask us to sort the data out on our end."

Bioterrorism Concerns

Los Angeles officials started working on the problem of sharing health data well before last fall's anthrax attacks, but national concerns about bioterrorism are pushing local municipalities to beef up their public health detection capabilities.

Quick and accurate reporting on communicable diseases could tip off public health experts to such attacks and possibly stave off wider dispersion of deadly pathogens through the use of rapid containment measures.

With additional federal bioterrorism funds awarded to Los Angeles earlier this year, county officials are planning further enhancements to the system, which is a "very solid foundation" to build on, Dassey said.

"So we have the potential of receiving at least lab information very rapidly, and the question becomes, of course, will that help us identify the usual situations such as outbreaks that previously were not detected or the potential for a bioterrorism event," he said.

"Certainly, those are theoretically possible," he continued. "Outbreaks do happen, and in fact...our system does integrate outbreak management with individual disease case management as well as a system we have for public complaints about food-borne illness."

Vannier said detecting possible bioterrorist acts wasn't the main objective of the project, but it is a benefit.

"And actually, with our national Kaiser task force on bioterrorism, we're looking at various systems," she said, "and this certainly enhances our ability to use this or other systems for reporting to maybe even a more central location than just the county."

Out With the Old

Visual CMR was actually unveiled about two years ago, but it was linked to the arcane and rigid Automated Vital Statistics System (AVSS) that is still used in several counties in California to collect birth and death data. All historical data was uploaded to Visual CMR so the department could still view public health trends.

"So we called that old system 'decentralized' because there was not one central reporting facility. Everything was done on different sites," said Irene Culver, project manager for the Enhanced Surveillance Project for the county's Department of Health Services.

The department's 12 district sites collected information from a network of health professionals and entered it into the system. But district workers could only view their data and not the entire system.

"Now once that information was downloaded to the health center or to the health services mainframe computer, then the [ACDC] unit would get that information and see if they could locate it in that AVSS system," Culver said. "If they couldn't, they had to re-enter the case. Sometimes that resulted in duplicates. If one letter was missed, the system couldn't pick it up."

Under AVSS, Dassey said, it took an average of 30 days between the date a diagnosis was made or a test was run and the date the county received the information.

The county contracted with Woodland Hills, Calif.-based Atlas Development Corp., a software and consulting firm that specializes in developing health applications, to design Visual CMR (see box).

The project cost slightly more than $1 million, including combined funds from the Centers for Disease Control and Prevention and the county, Dassey said.

With limited funds, resources and expertise, he said it would be impossible to securely connect every doctor and clinic to the system, but getting the major hospitals and laboratories on board would be a big boost. Plans are under way to link the county's six hospitals, five comprehensive clinics and public health laboratory to the system.

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