Completeness and timeliness of notifiable disease reporting: a comparison of laboratory and provider reports submitted to a large county health department

Abstract

Background: Most public health agencies expect reporting of diseases to be initiated by hospital, laboratory or clinic staff even though so-called passive approaches are known to be burdensome for reporters and produce incomplete as well as delayed reports, which can hinder assessment of disease and delay recognition of outbreaks. In this study, we analyze patterns of reporting as well as data completeness and timeliness for traditional, passive reporting of notifiable disease by two distinct sources of information: hospital and clinic staff versus clinical laboratory staff. Reports were submitted via fax machine as well as electronic health information exchange interfaces.

Methods: Data were extracted from all submitted notifiable disease reports for seven representative diseases. Reporting rates are the proportion of known cases having a corresponding case report from a provider, a faxed laboratory report or an electronic laboratory report. Reporting rates were stratified by disease and compared using McNemar's test. For key data fields on the reports, completeness was calculated as the proportion of non-blank fields. Timeliness was measured as the difference between date of laboratory confirmed diagnosis and the date the report was received by the health department. Differences in completeness and timeliness by data source were evaluated using a generalized linear model with Pearson's goodness of fit statistic.

Results: We assessed 13,269 reports representing 9034 unique cases. Reporting rates varied by disease with overall rates of 19.1% for providers and 84.4% for laboratories (p < 0.001). All but three of 15 data fields in provider reports were more often complete than those fields within laboratory reports (p <0.001). Laboratory reports, whether faxed or electronically sent, were received, on average, 2.2 days after diagnosis versus a week for provider reports (p <0.001).

Conclusions: Despite growth in the use of electronic methods to enhance notifiable disease reporting, there still exists much room for improvement.

Keywords: Completeness; Disease notification; Electronic laboratory reporting; Health information exchange; Public health surveillance; Timeliness.

Fig. 1

Venn diagram depicting the count of unique cases with at least one report from one of the following data sources: Provider, Laboratory or Health Information Exchange (HIE). The overlapping sections of the diagram indicate how many unique cases contained at least one report from two or more data sources

Fig. 2

A series of Venn diagrams, stratified by disease, depicting the relative proportion of unique cases with at least one report from one of the following data sources: Provider, Laboratory or Health Information Exchange (HIE). The overlapping sections of the diagram indicate the proportion of unique cases for a given disease contained at least one report from two or more data sources