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Christopher Jason

Regenstrief and Indiana University utilized Indiana’s statewide health information exchange data to automate a previously burdensome process.

For most healthcare organizations, reporting and finding all the necessary information about a new case of a reportable disease can be a burdensome process that could take up to two weeks to fully process, and sometimes it can get lost in the shuffle.

It begins with the laboratory faxing a report to the health department. Then the health department follows up with the clinic to get a more detailed report. If the detailed report does not come back right away, an administrator would have to follow up with the clinic again.

With more cases piling up over the course of a week or two, the health department could be forced to close the case and move on if they did not receive the detailed report from the clinic.

Because of this manual process, Brian Dixon, PhD, director of public health informatics at the Regenstrief Institute, and his team of experts knew they needed to automate disease tracking and surveillance in the state of Indiana.

With sexually transmitted infection (STI) cases on the rise from around 2015 through 2019, a high volume of cases came through the Indiana health department. In return, administrators spent a lot of time calling clinics to get additional information.

“Could we automate this process better?” Dixon posited. “We've done it for labs. Let's try to do it for clinics, but in a way that's going to minimize provider burden.”

Regenstrief had been in this space before, doing a lot of work to automate laboratory-based reporting from labs to the public health department for public health reporting purposes.

“Our public health partners said, ‘The laboratory stuff is working great, but we still have this problem where we're not getting a lot of information from providers.’” Dixon said in an interview with EHRIntelligence.

Because a high volume of STI cases were coming through the laboratory, lab workers noticed providers weren’t sending additional information, such as the symptoms or if the patient was treated.

“That's really where a lot of this was started,” Dixon explained. “We were in communication with the health department. They identified this as a need, particularly for STI's, where they wanted to get additional information to support their activity.”

As a non-profit support community-based organization, Regenstrief works as the connecting organization. In this instance, the organization used its connection to the Indiana Health Information Exchange (IHIE) to link to researchers at Indiana University to utilize IHIE’s data to develop the EHR-implemented clinical decision tool.

To begin the implementation process, Regenstrief utilized Documents for Doctors (Docs for Docs), which has been utilized by IHIE in the past. Docs for Docs is similar to a traditional HIE use case where documents are generated and then exchanged.

“This is the platform that the doctors use to get the laboratory results, the radiology reports, and other consults from specialists, routed back to them at the primary care office,” Dixon explained. “It’s similar to direct messaging where it’s a virtual inbox hosted by IHIE.”

Because this system was already in place, researchers used the platform to integrate IHIE’s patient data into the PDFs, which were previously done by hand and oftentimes not filled out correctly. Once data populates into the PDF, the sheet gets sent to the provider, where the provider can review and sign off on it before sending it to public health.

“We would deliver that right at the same time we were delivering the laboratory results,” Dixon said. “It kind of came to them in parallel through Docs for Docs or the EHR platform. We took advantage of these existing connections and integrations that have already been done by the health information exchange to make the implementation process pretty easy.”

Dixon noted it made life easier for the clinics, which now just had to give IHIE permission to activate the system.

“We could just drop it right into where they were receiving documents from IHIE, and away they went,” he explained. “It's similar to getting an automated reminder saying, ‘This needs to be reported the public health,’ rather than getting that phone call from public health days later.”

The clinical decision tool cannot be optimized for COVID-19 until there is a vaccine or treatment. But, once there is a vaccine, the team will aim to optimize it for COVID-19 when patients are getting outpatient treatment.

On the other hand, COVID-19 has made Regenstrief and their partners think of other technological advances throughout the pandemic.

“COVID-19 has really shifted our focus to looking at how we can apply analytics, machine learning, and advanced techniques, to identify the diseases earlier in the process,” Dixon said.

“But on the analytics front, they’re doing more community-wide dashboards for diseases of focus. The community really came around the health system during COVID-19 to work together to address this major threat to health.”

Since COVID-19 has the nation’s attention, Regenstrief and its partners plan to try to keep the same level of attention and direct it towards other major health challenges in their community. If they can spend the same energy on obesity or diabetes, for example, as they did on COVID-19, then the possibilities are endless, Dixon said.

“So that's what we're thinking about for the future,” Dixon concluded. “How we can develop these technologies that can push information out, not just to the frontline physicians, but also to the health system administrators, to the two community-based organizations and to the public itself, to keep them informed about healthcare in their community.”