Direct Laboratory Notification of Communicable Diseases

5.1 EpiSurv messaging system

The Direct Laboratory Notification Advisory Group, convened by the Ministry of Health, approved a proposal from the Institute for Environmental Science and Research (ESR) to use the existing national notifiable disease database, EpiSurv, to receive notifications from laboratories and pass these on to Medical Officers of Health.
ESR recently invested in an enhanced, robust and secure information management platform known as SurvINZ. It is on this platform that ESR has integrated (and continues to integrate) its surveillance systems and activities to drive greater efficiency and deliver more integrated and timely information to its stakeholders and end users for the benefit of public health.
EpiSurv7, a new web-based real-time version of the national notifiable disease surveillance system, was deployed in April 2007. In May 2007 ESR developed and deployed a prototype contact-tracing module for use with EpiSurv7 for Exercise Cruickshank. EpiSurv7 is currently used by 20 PHUs throughout New Zealand, with 150 registered users. The system is extensible and scaleable.
ESR is able to receive electronic laboratory notifications in HL7 format from external laboratories. ESR can process the messages to appear in EpiSurv so that local PHU staff can use EpiSurv to check whether the case already exists and then update or create a new case if required. The results can be appended to the appropriate case record and viewed as required.
The fact that the routing of messages from laboratories to a medical officer of health happens in real time ensures that the legislative obligation for laboratories to report immediately is met.
As mentioned above, the development and implementation of the national electronic system for direct laboratory notifications requires a phased approach that allows the implementation of electronic notification to be co-ordinated with other IT projects involving laboratories. This will ensure the efficient and effective use of IT resources and systems, and will help minimise compliance costs for parties.
There is also a need to phase the implementation of additional functionality at the PHU user end. The plan is to implement additional EpiSurv functionality for PHU users using the two phases outlined below.

Phase 1

1. Laboratory results from an external Laboratory Information System (LIS) sent electronically using agreed HL7 standards will be automatically stored in the EpiSurv system, eliminating the need for users to manually enter data relating to the notification. When an electronic message from an external LIS is received, users of the central system will be able to view and process the notification.

2. Where appropriate, details from the electronic notification will be mapped into a case report form, avoiding the need for manual data entry.

3. PHUs will be able to extract all data generated for their PHU for use in their local systems used to support their notifiable disease case management, contact tracing and management, and outbreak and emergency response needs. They would also be able to use accumulated data for medium- and long-term surveillance purposes at a local level.

Phase II

The central system will accept ‘notification update’ files or messages from local PHU systems (with this capability) that modify, close and delete cases, etc when standards for data interchange have been developed and agreed. This is to ensure the national system, as the master source of the core data for notifiable diseases, accurately reflects any change in status and avoids the need to manually update the central system (reducing the chances of an error being made).

5.2 ESR contacts

For further information about the requirements for sending electronic notifications, please contact the ESR helpdesk in the first instance:

ESR Service Desk: 04 914 0784

or one of the following ESR electronic reporting and eLab notifications project staff:
Carol Kliem

Senior Information Analyst

Institute of Environmental Science and Research Ltd (ESR)

Tel: [phone]

E-mail: [e-mail]
Ruth Pirie

Senior Advisor (Public Health Information)

Institute of Environmental Science and Research Ltd (ESR)

Tel: [phone]

E-mail: [e-mail]

5.3 Links with other IT projects

There are a number of Ministry-led initiatives relating to laboratories being conducted over the 2007–2009 period. The Ministry is co-ordinating work internally to ensure:

• 
  obvious synergies between initiatives are captured
  
• 
  duplication and avoidable costs are identified and removed.
  

The projects involved are:

• 
  electronic reporting of cervical screening results to the National Screening Unit
  
• 
  direct laboratory notification of notifiable diseases
  
• 
  Health Information Strategy, Action Zone 5 (eLabs)
  
• 
  electronic reporting to the Cancer Registry.
  

The Ministry will be working with the laboratory sector over the next few months to develop a plan to ensure there is effective co-ordination across these projects.

6 IT Specifications

6.1 Information requirements

Currently, laboratories receive  but do not enter  some patient-specific information into their information systems (eg, the patient’s address). Because the test results are sent back to the requesting clinician, who already has the patient’s details, there is no requirement to hold such information.
From 18 December 2007, when laboratories are required by law to notify the Medical Officer of Health, a subset of the ideal data set of patient details will be mandatory. The absolute minimum information required by the Medical Officer of Health to ensure public health action can be initiated following notification (by contacting the clinician) is:

1. 
   patient name
   
2. 
   date of birth or age
   
3. 
   name of referring practitioner
   
4. 
   diagnosis / test results
   
5. 
   laboratory name / sample reference number.
   

Other information that should be sent where available is:

6. 
   patient’s or clinician’s contact details
   
7. 
   name of appropriate public health unit (PHU) (the reporting authority is the PHU in the health district where the case was staying at the time of illness; if this is not known, refer the notification to your local PHU).
   

Due to privacy requirements laboratories must send only the test results pertaining to the notifiable disease in question.  PHUs may require some negative results to enable de-notification of a previous clinician notification.  This is particularly important for some diseases which are likely to have been notified by a clinician on suspicion (eg, invasive meningococcal disease).

Ideally, additional information would be available at initial notification (see the list below). This will need to be collected from secondary sources (ie, they still require clinician notification or information from other hospital or laboratory information systems):

• 
  NHI number
  
• 
  date of birth (if not provided as part of the minimum data set above)
  
• 
  sex
  
• 
  ethnicity
  
• 
  occupation
  
• 
  address details (house number, street name, suburb, town/city, postcode)
  
• 
  phone numbers (home, business, mobile)
  
• 
  diagnosis
  
• 
  test results (if not provided as part of the minimum data set above)
  
• 
  unique order number
  
• 
  symptoms
  
• 
  date of onset.
  

It is envisaged that a rich data set sent directly from laboratories to PHUs, including most or all of the information outlined above, will become a reality in the near future following developments such as electronic ordering of laboratory investigations.