Study suggests better use of web could improve infectious disease reporting

03/02/04

HERSHEY, PA-- Better disease reporting information on state health departments' Web sites could help physicians more quickly and easily determine how, when and where to report infectious diseases that may represent outbreaks or bioterrorism-related events, according to a study by Penn State Milton S. Hershey Medical Center and Pennsylvania Department of Health researchers.

"Because nearly 80 percent of U.S. physicians use the Web, we feel it offers public health jurisdictions a great opportunity to facilitate disease reporting," said David Welliver, M.S., M.B.A., information technologist, Penn State Milton S. Hershey Medical Center. "Most of the 57 state and territory health departments that report diseases to the Centers for Disease Control and Prevention already maintain Web sites. However, we found that relatively few sites contained all the types of information important in facilitating infectious disease reporting, and in many cases the information was buried deep in the Web site."

This study offers the first assessment of the status of U.S. states' and territories' use of the Web to aid in infectious disease reporting. The study, "Use of the Web by State and Territorial Health Departments to Promote Infectious Disease Reporting," appears in the March 3 issue of the Journal of the American Medical Association.

"Physicians and other health care workers who want to comply with disease reporting mandates often encounter logistical barriers," said Kathleen G. Julian, M.D., infectious disease fellow, Penn State Milton S. Hershey Medical Center. "If you diagnose encephalitis and you are prepared to report it, you'll need contact and other health department information. An easily accessible disease reporting Web site could be a helpful resource."

The team surveyed state epidemiologists in 57 U.S. states and territories that participate in the National Notifiable Diseases Surveillance System (NNDSS) of the Centers for Disease Control and Prevention (CDC). The telephone and email survey asked about the availability of a reportable disease list on the health jurisdiction's Web site, and whether the jurisdiction offered a secure means for physicians to report via the Web. The research team then analyzed each jurisdiction's Web content to determine whether the Web site defined why, what, when, how and where to report infectious diseases. Finally, the team checked whether the sites included the reporting requirements for the six CDC Category A bioterrorism agents: anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers such as Ebola hemorrhagic fever.

Of the 56 survey responses, 47, or 84 percent, of the epidemiologists reported that they listed current reportable diseases on their Web sites, and five, or 9 percent, indicated they offered a secure means for Web-based reporting by physicians. The research team located disease information on 48 health department Web sites. Of the sites the team located, 46 specified time frames to report specific diseases and 43 provided a telephone number for immediate reporting. Case reporting cards suitable for printing and returning to the department were available on 20 sites, and 21 of the 48 jurisdictions mandated reporting of the six CDC Category A bioterrorism agents. Of the 48 sites, only nine provided a link to the infectious disease reporting Web page from the health department home page.

"From the public health surveillance perspective, the quality of the case reports received by the health department is critical," said Nkuchia M. M'ikanatha, Dr.P.H., Division of Infectious Disease Epidemiology, Pennsylvania Department of Health. "We expected a high percentage of department Web sites to provide a case reporting card to prompt physicians on what information the department needs to perform its disease control and prevention activities. Our finding that only 20 of the 57 jurisdictions provide the case reporting card on the Web points to an opportunity to improve disease surveillance."

The study suggests that updating these sites to provide complete, accessible disease reporting information should be relatively inexpensive, and may allow for more effective use of the Web for disease reporting, M'ikanatha said.

"This would not only ensure that physicians can find the information they need, but would also strengthen the partnership among clinicians and public health officials," he said.

In addition to Welliver, Julian and M'ikanatha, the study team included: Dale D. Rohn, M.P.H., Maryland Department of Health and Mental Hygiene; Ebbing Lautenbach, M.D., M.P.H., M.S.C.E., Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine.

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