标题：Benefits and Barriers to Electronic Laboratory Results Reporting for Notifiable Diseases: The New York City Department of Health and Mental Hygiene Experience
摘要：Objectives. Despite national support for electronic laboratory reporting (ELR), the transition from paper to electronic reporting has been slow both nationally and locally. We assessed the ELR experience of New York City’s surveillance programs to identify barriers to ELR implementation and generalizable lessons about automated electronic notifiable disease surveillance. Methods. We conducted interviews with key staff of the New York City Department of Health and Mental Hygiene to evaluate ELR implementation. A review of paper and ELR disease reports enabled a comparison of the reporting systems. Results. The completeness and timeliness of ELR were similar to, and sometimes better than, paper reporting for certain diseases. Incorporating electronic data into surveillance databases created new problems with data quality, shifted work demands, and required additional skills for data monitoring. ELR improved the handling of high-volume and time-sensitive diseases but did not completely automate reporting for diseases that required complicated assessments by staff. Conclusions. Although ELR streamlines data processing, electronic reporting has its own limitations. A more successful use of ELR can be achieved by understanding its strengths and limitations for different disease types. To identify outbreaks and prevent transmission of communicable diseases, accurate, complete, and timely reporting of notifiable diseases is critical, but traditional methods of paper reporting are slow and depend on active participation of laboratory and clinical staff. Electronic laboratory reporting (ELR) can increase the volume of tests reported to surveillance programs and improve the timeliness and completeness of reports. 1 – 3 Because of the promise of increased efficiency, ELR has been promoted as being integral to improving disease surveillance. 4 Over the past decade, much progress was made in understanding and addressing the challenges of translating local laboratory codes into public health standards 5 and creating secure systems for electronic data transmission. To accelerate adoption of ELR, the Centers for Disease Control and Prevention advanced standards for vocabulary, format, and messaging; funded the development of software; and conducted an extensive outreach campaign to state and local health departments to increase use of the software. Despite these efforts, the transition from paper to electronic reporting has been slow both nationally and locally. By April 2005, nearly 5 years after states received federal funding to initiate plans for ELR, only 35 state and 2 municipal health departments had begun developing or implementing an electronic system for disease surveillance. 6 Comparisons between electronic and paper reporting have focused on expected improvements to the completeness and timeliness of reporting. 7 – 11 Less attention has been paid to understanding the barriers and benefits of adopting ELR by health departments and, in particular, the challenges of incorporating electronic data into surveillance databases in an automated fashion. The experience of the New York City Department of Health and Mental Hygiene (NYC DOHMH) can be illustrative. In 2002, NYC DOHMH began receiving electronic reports through the Electronic Clinical Laboratory Reporting System (ECLRS). Because of concerns about the quality and completeness of ECLRS, laboratories were required to undergo a certification process during which they temporarily sent electronic and paper reports in tandem, for comparison, before any electronic reports were uploaded into routine surveillance databases. Beginning in July 2006, the NYC Board of Health legally mandated ELR of notifiable diseases to NYC DOHMH. We sought to assess the benefits and disadvantages of ECLRS experienced during the premandate time frame from the perspective of the NYC DOHMH disease surveillance programs.
