First-Of-Its-Kind Assessment Maps States’ Public Health Data-Sharing Policies

To effectively identify and reduce the spread of communicable diseases and other health threats, public health departments need timely standardized data from doctors, hospitals, and other health care providers.

As part of a nationwide assessment, The Pew Charitable Trusts identified different ways in which public health data is—and is not—being shared with public health agencies in practice, and the specific types of data-reporting policies on the books. The following maps show the variety of state-level policies governing how four types of clinical data flow to state public health agencies via electronic lab reports (ELR), electronic case reports (eCR), immunization information systems, and syndromic surveillance.

What are lab, case, syndromic surveillance, and immunization reports?

Lab reports are based on tests that labs perform on orders from health care providers. Labs send results to state and local health departments when patients’ results are positive for conditions of public health importance. In some cases, negative test results are also reported for certain conditions, such as hepatitis C. Positive lab reports help public health agencies confirm the presence of a reportable disease, initiate investigations, and conduct surveillance of reportable diseases if agencies receive them before case reports. Public health agencies can identify emerging threats more quickly by analyzing lab test orders, which reflect preliminary diagnoses and can be reported days before the results are in.

Case reports provide state and local health departments with information about individual patients with communicable diseases, environmental illnesses, or other conditions of public health importance (e.g., cancer, lead poisoning). Generated and shared by health care providers, these reports help agencies detect threats, conduct surveillance, and design strategies to reduce their spread and impact. Public health agencies can use demographic information in case reports (such as age, sex, race, ethnicity, and ZIP code) to identify communities and populations at heightened risk of different diseases and most urgently in need of public health intervention.

Immunization information systems collect data on individual vaccinations, especially for childhood vaccines. States and local jurisdictions manage these systems, which help providers and health agencies track immunization rates, identify communities that may lack access to vaccines, and investigate cases and outbreaks of vaccine-preventable diseases. Patients and providers also use the systems to keep track of their immunization records.

Syndromic surveillance is often anonymous, derived from de-identified data captured during visits, admissions, discharges, and transfers in health care facilities, primarily emergency departments. This data includes patients’ chief complaints, such as shortness of breath or vomiting, and diagnosis codes. The system is designed for speed; it can enable officials to perform real-time monitoring of known health threats and detect and identify emerging threats earlier than they can with confirmed case and lab reports.

What’s the difference between electronic and automated electronic?

Electronic technologies can improve the flow of timely, standardized, and complete data, but not always. It depends on how states define “electronic,” if they do so at all. Some count fax and email as electronic technologies, even when these kinds of reporting require significant manual input. Automation is the key factor that makes electronic reporting optimally effective.

• Often piggybacking on certified electronic health record (EHR) systems, automated electronic data reporting—such as ELR and eCR—requires limited to no manual input or reformatting from the health care entity sending the data. This can help ensure that the data is timely, standardized, and complete.
• Some electronic technologies are partially automated. Web-based portals and digital spreadsheets (e.g., .CSV files), for example, may require providers to enter data manually but then allow public health agencies to receive it automatically in standardized formats for rapid processing and analysis.
• Some electronic reporting processes feature no automation at all. This can include secure fax, email, or file transfers that require health care providers to manually input and transmit data to public health agencies, which must then manually reformat and reenter the data in their database. Manual input can introduce human error and delay analysis.
• Many jurisdictions specify that automated electronic methods may be used to share data with public health agencies, but most still allow manual transmission. Some jurisdictions require automated electronic reporting for lab, syndromic surveillance, and/or immunization data; none mandates it for case reports. The findings in Pew’s accompanying report detail these differences.

The researchers defined automated electronic reporting for the report as an electronic data transmission from a reporter, such as an EHR or laboratory information management system, that integrates into a public health data system with minimal manual intervention.