Public Health Automated Case Event Reporting (PACER) Platform for Enhancing Electronic Laboratory Reports with Clinical Data (Preprint)

BACKGROUND Public health reporting is the cornerstone of public health practice that inform the prevention and control strategies. Over the years, public health reporting has advanced to automated electronic methods but have been fraught with complex nuances in clinical and public health workflows, data and messaging standards, and efficient process and technology tools. There is a need to leverage advances made in the past to implement an architecture that facilitates timely and complete public health reporting with relevant case-related information that have previously not easily been available to the public health community. OBJECTIVE Positive test results of notifiable conditions are reported as electronic laboratory report (ELR) from laboratories. ELR is a reliable method for reporting cases to public health authorities but contains very limited data. We have designed Public Health Automated Case Event Reporting (PACER) platform that leverages existing ELR infrastructure. PACER is a Fast Health Interoperability Resources (FHIR) based system that queries the electronic health record (EHR) from where the laboratory test was requested, to extract expanded information about the case such as additional demographics, diagnoses, and treatment data. METHODS Incoming ELR to a public health department were used as the trigger for a FHIR-based query. Predetermined queries were translated to Clinical Quality Language (CQL) logics. Within the PACER environment, these CQL logical statements were managed and evaluated against the providers’ FHIR servers. These predetermined logics were filtered and only data relevant to that episode of the condition were extracted and sent to public health as an electronic case report (eCR). We evaluated this architecture by examining the completeness of additional information in the eCR such as patient demographics, medications, symptoms, and diagnoses. This additional information is crucial in understanding disease epidemiology but existing eCR and ELR architectures do not report them, therefore, we used the completeness of these data fields as the metrics to gauge extent of enriching notifiable condition case reports. RESULTS During an eight-week study period, we identified 117 positive test results of chlamydia. PACER successfully created an eCR for all 117 patients. PACER extracted demographics, medications, syPACER deployed in conjunction with ELRs can enhance public health case reporting with additional relevant data. The architecture is modular in design, allowing it to be used for any reportable condition, including evolving outbreaks. PACER allows for an enhanced and complete case report that contains relevant case information that helps us to better understand the epidemiology of the disease.mptoms, and diagnoses in 99%, 73%, 71%, and 65% of the cases respectively. CONCLUSIONS PACER deployed in conjunction with ELRs can enhance public health case reporting with additional relevant data. The architecture is modular in design, allowing it to be used for any reportable condition, including evolving outbreaks. PACER allows for an enhanced and complete case report that contains relevant case information that helps us to better understand the epidemiology of the disease.