Volume 21, Number 10—October 2015
Electronic Public Health Registry of Extensively Drug-Resistant Organisms, Illinois, USA
|Legal and regulatory: sharing patient CRE information without explicit informed consent
||Public health rule written to authorize reporting/sharing of CRE information, as allowed under HIPAA 45 CFR 164.512(b)
|Securely maintain username/password permissions||IDPH maintains permissions through existing portal infrastructure in parallel with the I-NEDSS application. User table synchronized with XDRO registry permissions.|
|Electronic laboratory reporting of CRE results
||Not implemented; standardized values not defined for all CRE criteria. Custom codes need to be created. Reconciliation between electronic and manual reports will require development.
|Susceptibility criterion exclusive to Klebsiella pneumoniae and Escherichia coli. Selected inappropriately for other organisms||To prevent users from including other species for this “susceptibility criterion,” this criterion could not be selected unless K. pneumoniae or E. coli were chosen as the organism.|
|No master patient identifier available||Combinations of patient last name, first name, and date of birth used as an identifier (Figure 3). Disclaimer to hospital staff to confirm matched patient queries.|
|No universal health care facility identifier available||We use existing IDPH facility codes. LTCFs that do not have I-NEDSS access do not have an identifier and are encouraged to enroll in I-NEDSS.|
|CRE events are entered without systematic validation of data entry||Web entry form has logic embedded to minimize data entry errors. A microbiologic validation of a subset of CRE isolates will be performed in 2015.|
|Single users reporting for multiple facilities||Facility drop-down list created for users who report from multiple facilities. User–facility relationships managed by email request to the registry and human verification.|
|Non-Enterobacteriaceae entered through free-text option
||The free text option was removed. Pseudomonas spp. were the most common non-Enterobacteriaceae entered.
|Manual query function is time consuming||Manual querying is most appropriate for facilities with few admissions (e.g., LTCFs). IDPH is developing an automated query system for large facilities.|
|Administratively linked, geographically distinct facilities assigned same code||Request facilities to submit reports as distinct facilities.|
|CRE definition changes||CDC has proposed new criteria for identifying CRE, which requires updating website design and rules.|
|Health departments want to edit cases||Developed after the launch and for now restricted to a few users at the state health department who understand when edits and entries are appropriate.|
|Reference laboratories report CRE events for health care facilities||Each reference laboratory designates a reporter for the registry. Reports linked to individual facilities through a customized drop-down list during submission process.|
CDC, Centers for Disease Control and Prevention; CRE, carbapenem-resistant Enterobacteriaceae; HIPAA, Health Insurance Portability and Accountability Act; IDPH, Illinois Department of Public Health; I-NEDSS, Illinois Notifiable Electronic Surveillance System; LTCF, long-term care facility; XDRO, extensively drug-resistant organism.