Volume 21, Number 10—October 2015
Synopsis
Electronic Public Health Registry of Extensively Drug-Resistant Organisms, Illinois, USA
William E. Trick
, Michael Y. Lin, Robynn Cheng-Leidig, Mary Driscoll, Angela S. Tang, Wei Gao, Erica Runningdeer, M. Allison Arwady, and Robert A. Weinstein
, Michael Y. Lin, Robynn Cheng-Leidig, Mary Driscoll, Angela S. Tang, Wei Gao, Erica Runningdeer, M. Allison Arwady, and Robert A. Weinstein
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.
Page created: September 22, 2015
Page updated: September 22, 2015
Page reviewed: September 22, 2015
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