Tests to Evaluate Public Disease Reporting Systems in Local Public Health Agencies


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The primary objectives of disease surveillance are: Protecting the health of the public; To determine the extent of morbidity within the community; To evaluate risk of transmission; To intervene rapidly when appropriate. Delay or failure to report: Delay or failure to report communicable diseases has contributed to secondary transmission in the past. Each day the violation is continued is a separate offense. Contact Information. Public Health Programs.

Disease Reporting

We refer readers to the many articles and reviews written on this subject. This systematic review shows that a minority of notification systems meet either predefined, standardized or disease specific timeframes. Systems which include laboratory reporting, either combined with reporting by physicians, are more often associated with timely notification.

Electronic reporting systems are not associated with sufficient timeliness of notifications, while they need a considerable investment. And, even when fully implemented, they will only reduce a part of the notification chain, excluding D1-D2. Therefore, during outbreak threats, patient, doctors and laboratory testing delays need to be reduced to achieve timely detection and notification. Conventional reporting methods, like phone calls, and mobile phone texting, still can play an important role, besides alerting potential patients, physicians, and provision of appropriate laboratory test.

Tests to Evaluate Public Health Disease Reporting Systems in Local Public Health Agencies | RAND

Public health authorities should be aware of these aspects and incorporate contingency systems for enhanced notification in their preparedness plans. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Introduction Timely notification of infectious diseases is crucial for prompt response by public health services. Methodology Articles reviewing timeliness of notifications published between and were searched in Pubmed and Scopus. Results 48 articles were identified. Conclusion A minority of notification systems meets either predefined, standardized or disease specific timeframes.

Funding: The authors received no specific funding for this work. Introduction Monitoring infectious diseases is essential for detecting outbreaks that demand public health response and control measures. Download: PPT. Data extraction Information extracted included the country or region of the study setting, year of publication, infectious disease s , general or disease specific reporting system, study design comparison study where two or more reporting methodologies were compared, or evaluation study when one system was evaluated , level of reporting and methodology of reporting, legislation mandatory or voluntary reporting , reporting delay studied, predefined timeframe for reporting and the outcomes of the reporting delay s.

Method of reporting: - conventional reporting postal mail, fax, telephone or e- mail ; - electronic reporting including web-based reporting systems, as electronic laboratory reporting ELR , electronic automated laboratory reporting EALR. For each selected study, one researcher extracted the relevant data. Timeframes and classification of study outcomes WHO defines reporting timeliness as the proportion of all expected reports in a reporting system received by a given date [ 17 ]. We evaluated the timeliness results of the notification system of each study according the following timeframes: The predefined timeframe: the timeliness criteria designated by the study itself.

These are defined through legislation, local rules or by the authors of that specific study. The disease specific timeframe: as timely intervention to prevent or control an outbreak is disease specific, we defined disease specific median reporting delays between onset of disease and notification at the local health department D1.

Results An overview of the search process is depicted in the flowchart in Fig 3. Timeliness Out of 48 studies, 39 provided a predefined timeframe. Fig 4. Overview scores according predefined and standardized timeframes. Comparison and intervention studies In 13 studies timeliness of electronic systems was compared with conventional systems. Discussion To our knowledge, this is the first systematic review assessing timeliness of notification systems.

Although this was not the primary aim of the study, we identified the following facilitators and barriers related to timeliness outcomes of notification systems: 1. Concerning reporters physicians, laboratories : facilitating factors: motivation, communication between public health services and reporters , awareness raising, acceptance and simplicity of procedures and clinical guidelines, knowledge, training, phone call reminders, regular feedback [ 3 , 9 , 16 , 25 , 31 , 32 , 36 , 38 , 45 , 54 ].

Barriers were lack of knowledge, lack of communication, uncertainty towards notification procedures [ 39 , 45 ]. Available resources: availability of staff, technical facilities fe fax and rapid laboratory transport [ 25 , 27 , 42 ]. Barriers were different laboratory software among laboratories and using out-of-state laboratory facilities [ 38 , 53 , 57 ]. Notification procedures: unification of reporting times, legal adjustments of notification time, f. Barriers were administrative procedures and high volume of cases [ 39 ].


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Others: higher number of notifiable cases during an epidemic was reported as barrier [ 28 ], but considered facilitating factor in others as extra supportive staff was made available. Limitations Studies used different parameters to calculate timeliness of their notification systems. Conclusion This systematic review shows that a minority of notification systems meet either predefined, standardized or disease specific timeframes. Supporting information. S1 Table. S2 Table. Prisma checklist.

Acknowledgments The authors thank Dr. References 1. Measuring underreporting and under-ascertainment in infectious disease datasets: a comparison of methods. BMC Public Health. Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. Evaluation of reporting timeliness of public health surveillance systems for infectious diseases. Quantifying reporting timeliness to improve outbreak control. Emerg Infect Dis. International Health Regulations Wurtz R, Cameron BJ.

Electronic laboratory reporting for the infectious diseases physician and clinical microbiologist. Clin Infect Dis. Statewide system of electronic notifiable disease reporting from clinical laboratories: comparing automated reporting with conventional methods. Timeliness of case reporting in the Swedish statutory surveillance of communicable diseases — Scandinavian journal of infectious diseases. Electronic reporting improves timeliness and completeness of infectious disease notification, The Netherlands, View Article Google Scholar A comparison of the completeness and timeliness of automated electronic laboratory reporting and spontaneous reporting of notifiable conditions.

American journal of public health. Drivers of earlier infectious disease outbreak detection: a systematic literature review. Int J Infect Dis. Automatic electronic laboratory-based reporting of notifiable infectious diseases at a large health system. Joint External Evaluation Tool. Evaluation of the timeliness and completeness of a Web-based notifiable disease reporting system by a local health department. J Public Health Manag Pract. Timeliness of national notifiable diseases surveillance system in Korea: a cross-sectional study.

Changes in Clinical Diagnostics and Tracking Infectious Diseases

Timeliness of surveillance during outbreak of Shiga Toxin-producing Escherichia coli infection, Germany, Gram-positive rod surveillance for early anthrax detection. Evaluation of the SIMI system, an experimental computerised network for the surveillance of communicable diseases in Italy. European journal of epidemiology. Timely measles surveillance in the Republic of Korea, — Impact of sentinel laboratory surveillance. Journal of medical virology.

Completeness and timeliness of tuberculosis case reporting.

Electronic Laboratory Reporting

A multistate study. Am J Prev Med. Day F, Sutton G. General practitioner notifications of gastroenteritis and food poisoning: cause for concern. Journal of public health. Evaluation of a national microbiological surveillance system to inform automated outbreak detection. Journal of Infection. Evaluation of the timeliness and completeness of communicable disease reporting: Surveillance in The Cuban Hospital, Qatar. Qatar medical journal. Active influenza surveillance at the local level: a model for local health agencies. Acta Paul Enferm ;29 3 — Evaluation of'Campylobacter'Infection Surveillance in Victoria.

PloS one. Enhancing surveillance for hepatitis C through public health informatics. In 3 studies, conventional reporting method was as fast as, or faster than electronic systems [ 26 , 32 , 50 ]. Six studies analyzed a variety of interventions in the notification systems: increased frequency daily reporting[ 18 ] , sentinel lab surveillance [ 21 ], legal adjustments [ 24 ], training [ 25 ] and better facilities fax , SMS text messages [ 43 ] and systematic monitoring delayed reports conventional reporting [ 51 ].

In all studies timeliness improved range several days , however, none of the interventions resulted in sufficient timeliness for predefined or standardized timeframes. To our knowledge, this is the first systematic review assessing timeliness of notification systems. Thirty-nine out of 48 identified studies from 17 different countries provided quantitative data including a predefined timeframe. Timeliness of almost one third of the systems was sufficient, one third insufficient and the others partly sufficient, both for the predefined as the standardized timeframes.

Reporting delay by laboratories, either combined with by physicians, was timelier than other delays in the notification chain in both timeframes. Outcomes were not related to notification systems. The disease specific timeframe for optimal outbreak control was not met by any study. Nevertheless, differences in predefined timeframes do exist; therefore we introduced in this review a standardized timeframe per delay in order to compare notification timeliness between studies.

We choose for standardized timeframes delays that were achievable. Eight studies had no timeframe. In our opinion, the outcomes of applying a standardized timeframes are most representative in the appraisal of timeliness of a notification system. It is remarkable that studies provide little background explanation about the designated timeframes, except when incubation periods are used, which are considered to be related to communicability and therefore critical when considering control measures [ 3 , 46 ], or when timeframes related to measures such as post exposure prophylaxis are used [ 37 ].

Timely notification for this purpose is disease specific, as we have demonstrated earlier [ 4 ]. Therefore timely notification will mainly prevent tertiary, and further, cases. In none of the 8 studies in this review that provided relevant information regarding D1 medians for these 6 diseases, the notification system was timely for effective outbreak control. This might be one of the reasons why infectious diseases such as measles are difficult to control and still are endemic in many industrialized countries. Timeliness outcomes for these delays were less sufficient than for D1-D2 in the standardized system.

This review shows that many notification systems therefore can be improved to minimize delays D3 and D This is certainly indicated in situations of increased threats. In such situations, also temporary conventional notification methods as telephone calls to the local health departments have an added value. Therefore decisions on investments in notifications systems should take into consideration the reduction in timeliness in D3, D4-D5 compared to potential reduction of D1-D2 and D3 telephone in case of specific health threats.

Although this was not the primary aim of the study, we identified the following facilitators and barriers related to timeliness outcomes of notification systems:. Although we cannot come to conclusions to which extent these barriers and facilitators influence the timeliness of notification systems, it is obvious that addressing these aspects contribute to optimized functionality of the system.

Over the last two decades, several studies demonstrated the value of electronic reporting systems reducing notification delays [ 7 ]. However, over the last years, implementation of ER also revealed challenges. Gluskin et al. Besides increased volumes of incomplete notifications, coding of infectious diseases can be a challenge for laboratories when adjusting diagnostic tests, and for public health authorities whose computer systems have to keep up with de ELR codes.

Also considerable information technology infrastructure, expertise and workforce need to be available for a good operating system, requiring substantial financial investments. The next step forward would be notifications through Electronic Medical Records EMR , also requiring technical and financial investments, but addressing the physician reporting delay D3P , which had the lowest scores in timeliness in our review.

This system also can combine clinical systems and several laboratory tests resulting in notifications complying with case definitions which will reduce the workload for both public health services and physicians considerably. The studies of Quan et al and Rosewell et al showed that mobile phone reporting using SMS, shortened reporting time compared with conventional paper-based reporting and follow up from 37 to 7 days medians and from 84 to 2.

This methodology is simple, user friendly, reliable, and technically feasible in rural areas. It might be interesting to consider the use of mobile phone texting in addition to existing sophisticated notification systems in situations of newly emerging diseases or enhanced surveillance in high income countries as well. Studies used different parameters to calculate timeliness of their notification systems.

In case the median, percentiles or means were used, we had to classify the score according to the percentage of notifications within timeframes. Also the opinion of the authors of the study reflected in the paper was used to come to a score. Some studies used the delay between specimen collection at the laboratory and notification at the local health departments. These delays were included as D2 as well, even though the test result was not yet available, in order to limit the number of different delays used in this study.

It is noteworthy that 8 studies, while presenting the delays of their notification system, did not include a predefined timeframe, either mandatory or chosen by the authors of the study. Also in several studies there was a difference between the mandatory timeframe and the timeframe chosen by the authors, without explanation. A realistic mandatory timeframe should be developed.


  • JMIR Publications.
  • Passive Disease Surveillance.
  • Disease Reporting | Georgia Department of Public Health?
  • It might be good to add a standardized timeframe, at least for D3 and D, mostly affected by the notification system, in the Joint External Evaluation tool by the WHO. The cut-offs in the scoring and delays in the standardized timeframe have been chosen on the above described grounds, but still are based on the opinions of the authors of this study.

    Therefore we comply with the WHO standard.

    Language selection

    In several articles, different notification systems were mentioned, both conventional and electronic, without clarifying which notifying organization used which system. Therefore, with the limited number of selected articles, this review might not have shown an existing difference between conventional and electronic systems.

    Lastly, we did not include completeness of notifications percentage notified diseases or completeness of information provided in the notification. We are aware that certain aspects of notification systems facilitate completeness, for example ELR towards notification completeness, and physician reporting to completeness of information provided. We refer readers to the many articles and reviews written on this subject.

    This systematic review shows that a minority of notification systems meet either predefined, standardized or disease specific timeframes. Systems which include laboratory reporting, either combined with reporting by physicians, are more often associated with timely notification. Electronic reporting systems are not associated with sufficient timeliness of notifications, while they need a considerable investment.

    And, even when fully implemented, they will only reduce a part of the notification chain, excluding D1-D2. Therefore, during outbreak threats, patient, doctors and laboratory testing delays need to be reduced to achieve timely detection and notification. Conventional reporting methods, like phone calls, and mobile phone texting, still can play an important role, besides alerting potential patients, physicians, and provision of appropriate laboratory test. Public health authorities should be aware of these aspects and incorporate contingency systems for enhanced notification in their preparedness plans.

    Public health

    Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Introduction Timely notification of infectious diseases is crucial for prompt response by public health services. Methodology Articles reviewing timeliness of notifications published between and were searched in Pubmed and Scopus.

    Results 48 articles were identified. Conclusion A minority of notification systems meets either predefined, standardized or disease specific timeframes. Funding: The authors received no specific funding for this work. Introduction Monitoring infectious diseases is essential for detecting outbreaks that demand public health response and control measures.

    Download: PPT. Data extraction Information extracted included the country or region of the study setting, year of publication, infectious disease s , general or disease specific reporting system, study design comparison study where two or more reporting methodologies were compared, or evaluation study when one system was evaluated , level of reporting and methodology of reporting, legislation mandatory or voluntary reporting , reporting delay studied, predefined timeframe for reporting and the outcomes of the reporting delay s.

    Method of reporting: - conventional reporting postal mail, fax, telephone or e- mail ; - electronic reporting including web-based reporting systems, as electronic laboratory reporting ELR , electronic automated laboratory reporting EALR. For each selected study, one researcher extracted the relevant data. Timeframes and classification of study outcomes WHO defines reporting timeliness as the proportion of all expected reports in a reporting system received by a given date [ 17 ].

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    We evaluated the timeliness results of the notification system of each study according the following timeframes: The predefined timeframe: the timeliness criteria designated by the study itself. These are defined through legislation, local rules or by the authors of that specific study. The disease specific timeframe: as timely intervention to prevent or control an outbreak is disease specific, we defined disease specific median reporting delays between onset of disease and notification at the local health department D1.

    Results An overview of the search process is depicted in the flowchart in Fig 3. Timeliness Out of 48 studies, 39 provided a predefined timeframe. Fig 4. Overview scores according predefined and standardized timeframes. Comparison and intervention studies In 13 studies timeliness of electronic systems was compared with conventional systems.

    Discussion To our knowledge, this is the first systematic review assessing timeliness of notification systems. Although this was not the primary aim of the study, we identified the following facilitators and barriers related to timeliness outcomes of notification systems: 1. Concerning reporters physicians, laboratories : facilitating factors: motivation, communication between public health services and reporters , awareness raising, acceptance and simplicity of procedures and clinical guidelines, knowledge, training, phone call reminders, regular feedback [ 3 , 9 , 16 , 25 , 31 , 32 , 36 , 38 , 45 , 54 ].

    Barriers were lack of knowledge, lack of communication, uncertainty towards notification procedures [ 39 , 45 ]. Available resources: availability of staff, technical facilities fe fax and rapid laboratory transport [ 25 , 27 , 42 ]. Barriers were different laboratory software among laboratories and using out-of-state laboratory facilities [ 38 , 53 , 57 ]. Notification procedures: unification of reporting times, legal adjustments of notification time, f. Barriers were administrative procedures and high volume of cases [ 39 ]. Others: higher number of notifiable cases during an epidemic was reported as barrier [ 28 ], but considered facilitating factor in others as extra supportive staff was made available.

    Limitations Studies used different parameters to calculate timeliness of their notification systems. Conclusion This systematic review shows that a minority of notification systems meet either predefined, standardized or disease specific timeframes. Supporting information.

    Tests to Evaluate Public Disease Reporting Systems in Local Public Health Agencies Tests to Evaluate Public Disease Reporting Systems in Local Public Health Agencies
    Tests to Evaluate Public Disease Reporting Systems in Local Public Health Agencies Tests to Evaluate Public Disease Reporting Systems in Local Public Health Agencies
    Tests to Evaluate Public Disease Reporting Systems in Local Public Health Agencies Tests to Evaluate Public Disease Reporting Systems in Local Public Health Agencies
    Tests to Evaluate Public Disease Reporting Systems in Local Public Health Agencies Tests to Evaluate Public Disease Reporting Systems in Local Public Health Agencies
    Tests to Evaluate Public Disease Reporting Systems in Local Public Health Agencies Tests to Evaluate Public Disease Reporting Systems in Local Public Health Agencies

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