Communicable Disease Reporting

When County of Santa Clara Public Health Department (SCCPHD) Deputy Health Officer Dr. Sarah Rudman read the report at 4 p.m. on a Saturday afternoon, her first thought was gratitude for the diagnosing provider. The provider had grown up in Ukraine and remembered her mom, a nurse, telling her about the cases of measles she’d seen over and over again. It was her mom’s voice in her head that helped her recognize Koplik’s spots on the young patient’s throat, ask about travel and measles vaccination status, and know to keep other staff out of the exam room while she looked for the emergency number to contact Public Health on a weekend.

Thanks to this quick thinking by the physician, Dr. Rudman was able to work with her and the County Public Health Laboratory to coordinate collection and testing of a measles PCR specimen over the weekend and ensure appropriate notifications to exposed contacts before individuals at high risk returned to work or school on Monday.

Healthcare providers and other individuals and organizations are required to report communicable diseases like measles, as well as outbreaks and certain conditions, to their local health department. This requirement is mandated by Title 17 of the California Code of Regulations and falls under exemptions to the Health Information Portability and Accountability Act (HIPAA) such that patient consent is not required for reporting. Subsection 2500 specifies which diseases are reportable by the diagnosing provider and how quickly they need to be reported.

Not all diseases require the urgent phone call needed for measles, but timely and complete reporting is often key in the ability to prevent life-threatening outcomes. For example, appropriate identification and reporting of syphilis in a pregnant patient can ensure treatment is complete more than 30 days before delivery, preventing an expensive and potentially harmful 10-day admission to the neonatal intensive care unit for the neonate to be treated with IV penicillin.

As SCCPHD investigates the spread of diseases and develops protocols to stop transmission, healthcare providers – whether they work in a hospital setting or an outpatient clinic – are an invaluable first line of defense against communicable disease spread by ordering tests, delivering care, providing initial isolation or prevention messages, and informing Public Health of diagnoses in their local communities.

Currently, there are over 80 reportable diseases. Some diseases are immediately reportable by telephone while others should

be reported within one working day or one week. A current list of reportable diseases and the required reporting timeframe is maintained by the California Department of Public Health (CDPH). Providers are required to report to the county where the patient resides, which may be different than the county in which the provider works. However, if a communicable disease could be causing an outbreak with local spread in Santa Clara County, even if the case patients live elsewhere, SCCPHD wants to know.

Reporting Resources

SCCPHD has an extensive provider reporting website at publichealthproviders.sccgov.org/reporting with many resources and reporting forms. Confidential Morbidity Reports (CMRs) should be as complete as possible, including: • Demographic information • Date the diagnosis is made • Relevant medical records such as a history and physical • Any specialist notes • Copies of relevant lab results

Data from these reporting forms are used for statistics on mortality, morbidity, health behavior, and health outcomes which aid the development of public health policies and programs.

When a healthcare provider reports an exposure via telephone, public health officials can provide infection control guidance and facilitate additional testing resources, in addition to launching sometimes time-sensitive disease control actions available only to governmental public health departments.

The California Reportable Disease Information Exchange, or CalREDIE, is a secure system that CDPH has implemented for electronic disease reporting and surveillance. The purpose of CalREDIE is to improve the efficiency of surveillance activities and the early detection of public health events through the collection of complete and timely surveillance information on a statewide basis. This allows for 24/7/365 reporting and receipt of notifiable conditions.

SCCPHD and CDPH have access to disease and laboratory reports in near real-time for disease surveillance, public health investigation, and case management activities. Healthcare providers can set up an account to report diseases themselves, or they can delegate this to a staff member in their organization or practice.

Prompt Reporting is Essential

Prompt reporting of communicable diseases allows the Communicable Disease program to initiate appropriate public health actions as soon as possible. For instance, if Public Health gets a report of Shigellosis or Salmonellosis in a person who works in a high-risk occupation like food handling, they can investigate and restrict them from returning to work to help stop further transmission. Similarly, if a physician diagnoses a case of measles and reports it to Public Health, then SCCPHD can start an investigation to identify susceptible contacts and offer them post exposure prophylaxis.

“Some common mistakes when reporting cases include submitting a CMR form with no lab result, a missing phone number or a missing address.”

The CalREDIE reporting system owned and operated by the State is expected to undergo redesign in the coming years, with a plan to improve ability for providers and even patients to enter data directly via web portals.

If you are uncertain what to send to Public Health, err on the side of too much information. When public health officials do not have enough information, they must contact various hospitals or other healthcare providers and request medical records, which can delay the investigation and cost valuable time in preventing further transmission.

Common Reporting Mistakes

Some common mistakes when reporting cases include submitting a CMR form with no lab result, a missing phone number or a missing address. Those errors make it complicated for Public Health to take immediate action because it takes time to find out where patients live and how to get in contact with them. Other times, they receive forms that are handwritten rather than typed, rendering them illegible. Healthcare providers may also rely on the commercial or public health laboratories to report the test results. However, this assumption delays data reporting because those labs may not know about symptoms or other tests that may have been ordered – they are just reporting the one positive test result.

One common question from healthcare providers is whether something is reportable. If uncertain, SCCPHD suggests providers call the department to ask. It’s better that SCCPHD be notified and be able to decipher what is considered a reportable case. They can also help the provider find and complete the correct form to accurately report information.

The Future of Communicable Disease Reporting

The CalREDIE reporting system owned and operated by the State is expected to undergo redesign in the coming years, with a plan to improve ability for providers and even patients to enter data directly via web portals. As healthcare providers have moved almost universally to electronic health record systems, Public Health has worked with state and local partners to examine ways to streamline and automate communicable disease reporting.

Independent from the automated process by which laboratories provide results related to reportable diseases to SCCPHD, the California Department of Public Health has begun pilot testing “electronic Case Reporting” in which electronic health records can automatically send certain information about reportable diseases, bypassing or simplifying the need for healthcare providers to manually submit information. As these projects progress, and other data streams become usable for communicable disease monitoring, SCCPHD continually looks for ways to reduce the reporting burden on healthcare provider organizations.

When public health officials do not have enough information, they must contact various hospitals or other healthcare providers and request medical records, which can delay the investigation and cost valuable time in preventing further transmission.