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Volume 21, Number 10—October 2015

Electronic Public Health Registry of Extensively Drug-Resistant Organisms, Illinois, USA

William E. TrickComments to Author , Michael Y. Lin, Robynn Cheng-Leidig, Mary Driscoll, Angela S. Tang, Wei Gao, Erica Runningdeer, M. Allison Arwady, and Robert A. Weinstein
Author affiliations: Rush University Medical Center, Chicago (W.E. Trick, M.Y. Lin, R.A. Weinstein); Cook County Health and Hospitals System, Chicago, Illinois, USA (W.E. Trick, W. Gao, R.A. Weinstein); Illinois Department of Public Health, Springfield, Illinois, USA (R. Cheng-Leidig, M. Driscoll, A.S. Tang, E. Runningdeer, M.A. Arwady)

Main Article

Table 2

Selected challenges encountered and solutions offered during development of a statewide XDRO registry, Illinois, USA

Challenge Solution
Legal and regulatory: sharing patient CRE information without explicit informed consent
Public health rule written to authorize reporting/sharing of CRE information, as allowed under HIPAA 45 CFR 164.512(b)
Technical, security
Securely maintain username/password permissions IDPH maintains permissions through existing portal infrastructure in parallel with the I-NEDSS application. User table synchronized with XDRO registry permissions.
Electronic laboratory reporting of CRE results
Not implemented; standardized values not defined for all CRE criteria. Custom codes need to be created. Reconciliation between electronic and manual reports will require development.
Data accuracy
Susceptibility criterion exclusive to Klebsiella pneumoniae and Escherichia coli. Selected inappropriately for other organisms To prevent users from including other species for this “susceptibility criterion,” this criterion could not be selected unless K. pneumoniae or E. coli were chosen as the organism.
No master patient identifier available Combinations of patient last name, first name, and date of birth used as an identifier (Figure 3). Disclaimer to hospital staff to confirm matched patient queries.
No universal health care facility identifier available We use existing IDPH facility codes. LTCFs that do not have I-NEDSS access do not have an identifier and are encouraged to enroll in I-NEDSS.
CRE events are entered without systematic validation of data entry Web entry form has logic embedded to minimize data entry errors. A microbiologic validation of a subset of CRE isolates will be performed in 2015.
Single users reporting for multiple facilities Facility drop-down list created for users who report from multiple facilities. User–facility relationships managed by email request to the registry and human verification.
Non-Enterobacteriaceae entered through free-text option
The free text option was removed. Pseudomonas spp. were the most common non-Enterobacteriaceae entered.
Work flow
Manual query function is time consuming Manual querying is most appropriate for facilities with few admissions (e.g., LTCFs). IDPH is developing an automated query system for large facilities.
Administratively linked, geographically distinct facilities assigned same code Request facilities to submit reports as distinct facilities.
CRE definition changes CDC has proposed new criteria for identifying CRE, which requires updating website design and rules.
Health departments want to edit cases Developed after the launch and for now restricted to a few users at the state health department who understand when edits and entries are appropriate.
Reference laboratories report CRE events for health care facilities Each reference laboratory designates a reporter for the registry. Reports linked to individual facilities through a customized drop-down list during submission process.

CDC, Centers for Disease Control and Prevention; CRE, carbapenem-resistant Enterobacteriaceae; HIPAA, Health Insurance Portability and Accountability Act; IDPH, Illinois Department of Public Health; I-NEDSS, Illinois Notifiable Electronic Surveillance System; LTCF, long-term care facility; XDRO, extensively drug-resistant organism.

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Page created: September 22, 2015
Page updated: September 22, 2015
Page reviewed: September 22, 2015
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.