Best Practices for Case Finding in DRSi Deepa

Best Practices for Case Finding in DRSi Deepa Raj, M.P.H. Epidemiologist Disease Epidemiology Program U.S. Army Public Health Command Corresponding Authors: Rolando Diaz Susan Varner Lindsey Huse 30 April 2013 UNCLASSIFIED Briefing Outline PURPOSE: To provide examples for preventive medicine (PM) staff to find cases that should be reported into the Disease Reporting System-internet (DRSi). 1. Available Systems and Examples 2. Advantages/Disadvantages

3. Alternative and Supplemental Options Name/Office Symbol/email address UNCLASSIFIED 2 Composite Health Care System CHCS: serves as the foundation for the Department of Defenses electronic health record (AHLTA) Adhocs can be created in CHCS to pull reports based on tests run and positive results: RDIB: Reportable Disease Bacteriology Flat File NNMC Used to identify bacterial cultures

RDIC: Reportable Disease Chem Flat File NNMC Used to identify chemical presence/absence and cut-off values for labs for a select group of communicable diseases Name/Office Symbol/email address UNCLASSIFIED 3 Composite Health Care System Lab Cultures for RBIC Name/Office Symbol/email address Lab Chemistries for RDIC UNCLASSIFIED

4 ESSENTRIS ESSENTRIS: used in inpatient hospital settings to provide point-ofcare data capture at the patients bedside for medical devices and patient care machines. Shares data with AHLTA and VistA, and includes HL7 inbound ADT Every MTF that has some form of admission ward should have ESSENTRIS. Name/Office Symbol/email address UNCLASSIFIED 5

ESSENTRIS ESSENTRIS access may be read-only, but it is a means to stay in connection with a patient of interest regarding: Diagnosis Medical management (treatment/isolation levels) Final outcome/transfer to a higher level of care at another facility Name/Office Symbol/email address UNCLASSIFIED 6 SharePoint

SharePoint is a Microsoft platform that can be used as a providerbased reporting tool for providers at any one MTF. Name/Office Symbol/email address UNCLASSIFIED 7 SharePoint SharePoints reporting tool allows clinicians assigned to one MTF to report suspected and/or confirmed cases to Public Health Nurses.

In some cases, diseases that require specific testing necessitate coordination with local health departments Name/Office Symbol/email address UNCLASSIFIED 8 Inpatient Admissions and ER Visits Similar to monitoring ESSENTRIS, looking at inpatient admissions and ER visits allows PM staff to be alerted to potential cases ahead of time

Going through all the ER visits on a daily basis allows for capture of clinically-diagnosed RMEs, like chicken pox or heat illness. Name/Office Symbol/email address UNCLASSIFIED 9 Inpatient Admissions and ER Visits Monitoring ER visits is also useful for picking up on small clusters, both family and community-based

Notable disadvantage is that often, one clinic will not have good visibility for outlying clinics Name/Office Symbol/email address UNCLASSIFIED 10 Alternative Options ESSENCE: syndromic, sometimes unreliable, potential lags in ingest. Build strong relationships and collaborating with local/county health department officials.

If health departments find military cases, they are more likely to report back. Rely on Infection Control staff at hospitals. Often, PM staff not located on hospital campuses so IC staff can be eyes on the ground Have lab personnel keep a list of both state/DoD RMEs posted on walls so they are always aware of which cases should be reported to PM staff on a daily basis. Name/Office Symbol/email address UNCLASSIFIED

11 Questions? Army: Navy: Air Force: Contact your MAJCOM PH or USAFSAM/PHR PHR / Epidemiology Consult Service Wright-Patterson AFB, Ohio Comm: (937) 938-3207 DSN: 798-3207

[email protected] USAPHC Disease Epidemiology Program Aberdeen Proving Ground MD Comm: (410) 436-7605 DSN: 584-7605 [email protected] Contact your cognizant NEPMU NEPMU2: COMM: (757) 950-6600; DSN: (312) 377-6600 Email: [email protected] NEPMU5: COMM: (619) 556-7070; DSN (312) 526-7070 Email: [email protected] NEPMU6: COMM: (808) 471-0237; DSN: (315) 471-0237 Email: [email protected] USAFSAM /

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