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Reportable Disease Program in Louisiana

Posted By Raoult Ratard, Friday, February 27, 2015
Updated: Tuesday, February 24, 2015

Reporting of notifiable diseases in Louisiana has been in transition for years. Until 1998 reporting was done by phone and mostly by cards, followed by a Microsoft Access database installed in every hospital. The next step was to develop a home-grown web-based Reportable Disease Database (RDD). To meet security requirements, a commercial web-based Infectious Diseases Reporting Information System (IDRIS) replaced RDD. As the cost of maintenance became a financial burden and Electronic Laboratory Reporting became a priority, the Louisiana Infectious Disease Epidemiology Section took a leap of faith and decided to move to a free and ELR-friendly reportable system, namely the NEDSS Base System (National Electronic Disease Surveillance System).

Past the initial enthusiasm, we were overwhelmed by the magnitude of the task we had volunteered to undertake. As there were financial restrictions, the transition had to be done in house by our troupe of young and dedicated epidemiologists. The hurdles were to learn the new vocabulary, the structure of the poorly documented database, the system management, user accounts, permissions, lab and case workflow. There were over a dozen system reference tables that required SQL (Structure Query Language) scripts to populate. Besides, there were about 30 unused tables and utilities (they may be useful but we could not find how to use them and have done well without). Then there were 37 case investigation pages to be built with a page builder to be consistent with CDC and Louisiana state case report forms.

Originally it seemed that NBS was not designed to be used by external partners (in Louisiana infection preventionists or their helpers enter data into the system). For example, external partners cannot get reports on what they have entered. A workaround solution had to be designed.

The legacy data from 1988 to October 2014 had been consolidated into IDRIS. The decision was to create LaRD (Louisiana Reportable Disease), which would incorporate the legacy data plus the new data from IDRIS2. LaRD, an Access database is used to produce summary data for the surveillance reports, infection preventionists’ reports, media inquiries, performance indicators, dashboards and other documents. LaRD has the advantage of having all variables consolidated in one data warehouse, accessible to all the Infectious Disease Epidemiology Section’s epidemiologists. The policy in our section is that epidemiologists are allowed to use the statistical package they know best, ranging from their own fingers to Statistical Analysis System (SAS).

Incorporating the legacy data into NBS proved to be very time-consuming and is making slow progress. However, it allows us to search for past infections and upgrade case statuses and disease registries.

To placate those who object to change, the name IDRIS was kept and a ‘2’ added at the end. IDRIS2 has been working for the past six months without any major problems. The benefits of this transition have been a savings of $200,000 a year, a boost to the morale of the epidemiologists who can now look even smarter, and a compliance with PHIN and many other acronyms to come.

Raoult Ratard, MD MS MPH and TM (Tropical Medicine) is the state epidemiologist at the Louisiana Department of Health and Hospitals. For more information about disease reporting systems, see the Surveillance and Informatics page. To learn about the National Notifiable Disease Surveillance System Modernization Initiative (NMI), visit the NMI page.

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