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GCN Home > 10/13/03 issue

Medical alert: Pa. health eliminates paper

By Trudy Walsh, GCN Staff

One of the first things Joel Hersh noticed in 1993 when he became director of Pennsylvania’s Bureau of Epidemiology was its dependence on paper.

It was practically an epidemic.

Almost every part of the disease reporting process was on paper. Hersh wondered if there was a way to do it electronically.

Laboratories, clinics, hospitals and physicians would mail or fax reports of the state’s 110 reportable diseases to their local health departments, which would forward the information to the state.

Reportable diseases are serious or infectious diseases or conditions that health care providers must report to local health departments. Under Pennsylvania law, the reports usually must be made within a few days—sometimes within hours—of diagnosis. Reportable diseases include anthrax, cholera, food poisoning, lead poisoning and tetanus.

But in disease outbreaks, time is a luxury that public health officials cannot afford. Many diseases have incubation periods of a week or less from the time of infection to the appearance of symptoms. So to wait for disease reports to come through the mail or to require hospitals to fill out lengthy forms was not only frustrating, it was potentially dangerous to the public. An integrated electronic reporting system wouldn’t just save trees; it could save lives.

Several electronic systems were in place, but they were all standalone, stovepipe systems, said David Andrews, project manager for Pennsylvania’s National Electronic Disease Surveillance System.

One was an MS-DOS system from the Centers for Disease Control and Prevention, called NETSS—for National Electronic Telecommunications System for Surveillance—a public health surveillance system that provides CDC with weekly data on cases of communicable diseases.

Another was for tuberculosis, and another was for reporting blood levels of lead in children.

Hersh and his team wanted Pennsylvania’s National Electronic Disease Surveillance System to eliminate paper at the point of diagnosis. Physicians, hospitals and other health care workers could send reports over the Internet, Hersh said. Disease investigators would no longer have to wait seven to 10 days to get a piece of paper in the mail.
Michelle S. Davis
Image: Henrik G. de Gyor
“Unless you’re registered and verified, you can’t get into” the system, Michelle S. Davis says.
Led by Hersh, Health Department officials decided to integrate these disparate data silos into one electronic disease surveillance and reporting system and put it on the Internet. Health Department officials began working on PA-NEDSS in 2000, which was loosely modeled after an initiative begun by CDC in 1998.

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