NEDSS Base System (NBS): Electronic Data Exchange and Workflow Decision Support

Abstract

ObjectiveThe NEDSS Base System (NBS), an integrated disease surveillancesystem, implemented extensible functionality to support electronicdata exchange for multiple use cases and public health workflowmanagement of incoming messages and documents.IntroductionThe NBS is an integrated disease surveillance system deployedin 22 public health jurisdictions to support receipt, investigation,analysis and reporting, and data exchange for state reportableconditions. The NBS is governed by the Centers for Disease Controland Prevention (CDC) and state, local, and territorial users that makeup the NBS Community. In the early 2000’s, electronic laboratoryresults reporting (ELR) was implemented in an effort to improvetimeliness and completeness of disease reporting. As standards-basedelectronic health records (EHRs) are adopted and more surveillancedata become available, modern surveillance systems must consumeinformation in an automated way and provide more functionality toautomate key surveillance processes.MethodsMany use cases exist for exchanging data with an integrated publichealth surveillance system. These can include exchange of electroniccase and laboratory reports from healthcare, data sharing betweenpublic health entities, data migration from legacy systems, andongoing exchange with other public health systems (e.g. immunizationregistries). The NBS implemented an interface specification called thePublic Health Document Container (PHDC). PHDC is based on HL7version 3 Clinical Document Architecture (CDA). It allows import ofpatient (cases and contacts), investigation, treatment, interview, andlaboratory information into NBS. CDA was chosen as the buildingblock to facilitate data exchange with the healthcare community.Through use of data integration tools, incoming data can be mappedfrom any format to PHDC and imported into the system. Existingservices, such as patient, provider, and organization deduplicationare applied. To assist with management of incoming electronicdocuments, NBS implemented a functionality called WorkflowDecision Support (WDS). WDS uses configurable algorithms toautomatically process incoming documents (including case reports,laboratory reports, etc.) into the public health workflow. Users canchoose to mark an incoming document as reviewed or automaticallycreate an investigation and case notification message to CDC (fornationally notifiable conditions).ResultsThrough PHDC, NBS is able to receive data from healthcare usingnational standards, such as the HL7 Electronic Initial Case Report(eICR). Three NBS partners are currently collaborating to pilot eICRfunctionality. PHDC was successfully used to migrate large volumesof data from a legacy surveillance system into the NBS. Two NBSstates are using PHDC to implement ongoing data exchange betweenseparate surveillance systems within their jurisdiction. In several NBSjurisdictions, WDS is used to automatically create investigations andcase notifications for high-morbidity conditions such as gonorrheaand chlamydia. In other jurisdictions, WDS is used to assist withmanaging high volumes of Hepatitis B and C reports.ConclusionsCDA-based PHDC does require that public health have knowledgeof standards and data integration resources to transform incomingmessages to the PHDC interface; however, the flexibility providedby this approach ensures the system is able to respond to newand changing standards without system development. Additionalenhancements are needed to support data exchange with immunizationregistries. WDS functionality does reduce burden on public healthstaff, especially when dealing with high-volume diseases. Futurefunctionalities include the ability to define more criteria (such as ageor gender) to drive the actions taken on an incoming lab or case report.