Health information exchange (HIE) is the capacity to electronically transfer and share health information among health care-related stakeholders and organizations such as clinics, laboratories, payers, hospitals, pharmacies and public health
. HIEs promise to reduce health care costs
, improve patient safety
, and provide access to more timely surveillance data for public health organizations
; however the success of HIE implementations and their system improvements can depend on the context in which data flow and clinical care workflow are integrated. For example, an investigation of one HIE’s impact on emergency department (ED) charges reported a reduction of approximately $26 per encounter (p = 0.03) at one hospital with no effect on charges at a second independent hospital in the same HIE
. Similarly, in a comparison of HIE utilization among municipalities, Maenpaa et al. (2012) reported a difference in system usage between specialized and primary care providers depending on the numbers of ED visits, laboratory tests, radiology exams and appointments
. An investigation of HIE usage in EDs and ambulatory clinics also found that system utilization varied by site, patient population and characteristics, specialization of services, and site policies governing use and administrative access
. Studies such as these suggest that outcomes resulting from HIE interactions, access and interventions can be context-sensitive.
An unexplored area is reporting of communicable and infectious diseases, such as pertussis, tuberculosis, salmonella, Chlamydia and Hepatitis C, among others, to public health in an HIE. Most states utilize a dual reporting structure: mandatory case reporting of a disease by providers and mandatory reporting of test results by laboratories to public health authorities. Conventional provider-initiated paper-based reports, transmitted through fax and mail, have been shown to be incomplete, error-prone and untimely. Report completeness ranges from 9 to 99 percent
. Highly prevalent diseases like sexually transmitted infections are reported approximately 79 percent of the time and many diseases like pertussis and Lyme disease are reported less than 50 percent of the time
. Report timeliness of reporting ranges from one day to three weeks after diagnosis, depending on the disease
. In addition, provider reports often lack demographic details that public health workers need, requiring them to perform follow-up calls to get this additional information
In comparison to conventional paper-based reporting, electronic laboratory reporting (ELR) has been successful in delivering more timely laboratory test results to public health
 and increasing the proportion of notifiable disease reports that are reported to public health
[11, 12]. However, implementation of ELR can increase or exceed local investigative capacity by significantly increasing the volume of reported cases to public health agencies
[13, 14] and, like provider reports, ELR can lack clinical and treatment details, such as complete patient demographics, vital signs, pregnancy status or prescribed drugs, needed to fully characterize or prioritize a case for public health purposes
Integration of ELR into electronic health record (EHR) systems and HIE networks—i.e., an ELR-EHR-HIE infrastructure—has been shown to connect clinical and public health stakeholders without interrupting existing workflows or adding burden to clinical providers
. Given that many states have (or will have in the near future) an infrastructure supporting ELR and HIE
 and EHRs contain clinical and treatment data often missing from ELR, there is potential to use an integrated ELR-EHR-HIE infrastructure to improve provider-based notifiable disease reporting beyond existing improvements to lab-based reporting.
The “Improving Population Health through Enhanced Targeted Regional Decision Support” study aims to leverage an available ELR-EHR-HIE infrastructure to electronically pre-populate provider-submitted notifiable disease report forms with available clinical, lab and patient data. This intervention has the potential to streamline provider-based reporting workflows, lower barriers to reporting, increase data completeness, improve reporting timeliness and capture a greater portion of communicable disease burden in the community.
We hypothesize clinics that implement the intervention will effectively incorporate the pre-populated reporting form into their workflow, providers will report high satisfaction with the intervention, and that, compared to clinics in which the intervention is not implemented, barriers to reporting will be reduced, timeliness of reporting and completeness of report data fields will improve, and need for providers to provide supplemental or corrected data to public health will be reduced. The implementation of the intervention will be evaluated using mixed methods. The study protocol described will evaluate the implementation of the pre-populated form intervention in the context of an operational HIE.