Browsing by Author "Kirbiyik, Uzay"

Now showing 1 - 8 of 8
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    Automating Provider Reporting of Communicable Disease Cases using Health Information Technology
    (Office of the Vice Chancellor for Research, 2014-04-11) Dixon, Brian E.; Lai, Patrick T. S.; Kirbiyik, Uzay; Grannis, Shaun J.
    Introduction Disease surveillance is a core public health (PH) function, which enables PH authorities to monitor disease outbreak and develop programs and policies to reduce disease burden. To manage and adjudicate cases of suspected communicable disease, PH workers gather data elements about persons, clinical care, and providers from various clinical sources, including providers, laboratories, among others. Current processes are paper-based and often yield incomplete and untimely reporting across different diseases requiring time-consuming follow-up by PH authorities to get needed information. Health information technology (HIT) refers to a wide range of technologies used in health care settings, including electronic health records and laboratory information systems. Health information exchange (HIE) involves electronic sharing of data and information between HIT systems, including those used in PH. Previous research has shown that using HIE to electronically report laboratory results to PH can improve surveillance practice, yet there has been little utilization of HIE for improving provider-based disease reporting [1]. Methods Our study uses an intervention to electronically pre-populate provider-based communicable disease case reporting forms with existing clinical, laboratory and patient data available through one of the largest and oldest HIE infrastructures in the U.S., the Indiana Network for Patient Care. Evaluation of the intervention will be conducted utilizing mixed methods in a concurrent design framework in which qualitative methods are embedded within the quantitative methods. Quantitative data will include reporting rates, timeliness and burden and report completeness and accuracy, analyzed using interrupted time-series and other pre-post comparisons. Qualitative data regarding pre-post provider perceptions of report completeness, accuracy, and timeliness, reporting burden, data quality, benefits, utility, adoption, utilization and impact on reporting workflow will be collected using semi-structured interviews and open-ended survey items. Data will be triangulated to find convergence or agreement by cross-validating results to produce a contextualized portrayal of the facilitators and barriers to implementation and use of the intervention. Results The intervention has been implemented in seven primary care clinics in the metropolitan Indianapolis area plus one rural clinic in Edinburgh. Analysis of baseline data shows that provider-based reports vary in their completeness, yet they contain critical information not available from laboratory information systems [2]. Furthermore, PH workers access a range of sources to gather the data they need to investigate disease cases [3]. Discussion and Conclusion By applying mixed research methods and measuring context, facilitators and barriers, and individual, organizational and data quality factors that may impact adoption and utilization of the intervention, we will document whether and how the intervention streamlines provider-based manual reporting workflows, lowers barriers to reporting, increases data completeness, improves reporting timeliness and captures a greater portion of communicable disease burden in the community. Early results are promising, and continued evaluation will be completed over the next 24 months.
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    Completeness and timeliness of notifiable disease reporting: a comparison of laboratory and provider reports submitted to a large county health department
    (Springer Nature, 2017-06-23) Dixon, Brian E.; Zhang, Zuoyi; Lai, Patrick T. S.; Kirbiyik, Uzay; Williams, Jennifer; Hills, Rebecca; Revere, Debra; Gibson, P. Joseph; Grannis, Shaun J.; BioHealth Informatics, School of Informatics and Computing
    BACKGROUND: Most public health agencies expect reporting of diseases to be initiated by hospital, laboratory or clinic staff even though so-called passive approaches are known to be burdensome for reporters and produce incomplete as well as delayed reports, which can hinder assessment of disease and delay recognition of outbreaks. In this study, we analyze patterns of reporting as well as data completeness and timeliness for traditional, passive reporting of notifiable disease by two distinct sources of information: hospital and clinic staff versus clinical laboratory staff. Reports were submitted via fax machine as well as electronic health information exchange interfaces. METHODS: Data were extracted from all submitted notifiable disease reports for seven representative diseases. Reporting rates are the proportion of known cases having a corresponding case report from a provider, a faxed laboratory report or an electronic laboratory report. Reporting rates were stratified by disease and compared using McNemar's test. For key data fields on the reports, completeness was calculated as the proportion of non-blank fields. Timeliness was measured as the difference between date of laboratory confirmed diagnosis and the date the report was received by the health department. Differences in completeness and timeliness by data source were evaluated using a generalized linear model with Pearson's goodness of fit statistic. RESULTS: We assessed 13,269 reports representing 9034 unique cases. Reporting rates varied by disease with overall rates of 19.1% for providers and 84.4% for laboratories (p < 0.001). All but three of 15 data fields in provider reports were more often complete than those fields within laboratory reports (p <0.001). Laboratory reports, whether faxed or electronically sent, were received, on average, 2.2 days after diagnosis versus a week for provider reports (p <0.001). CONCLUSIONS: Despite growth in the use of electronic methods to enhance notifiable disease reporting, there still exists much room for improvement.
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    Effect of Electronic Health Record Systems Access on Communicable Disease Report Completeness
    (2013) Kirbiyik, Uzay; Dixon, Brian E.; Grannis, Shaun J
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    Evaluating the Variation on Public Health’s Perceived Field Need of Communicable Disease Reports
    (2013-04) Kirbiyik, Uzay; Gamache, Roland; Dixon, Brian E.; Grannis, Shaun
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    Investigating the Reasons of Undeliverable Mail Sent to Communicable Disease Patients
    (Office of the Vice Chancellor for Research, 2015-04-17) Shah, Hassan; Kirbiyik, Uzay; Dixon, Brian E.
    Preventing spread of communicable diseases is a primary objective of public health (PH). Marion County Public Health Department (MCPHD) notifies carriers of contagious diseases via United States Postal Service (USPS) to remind patients their social responsibility not to spread the disease. We examined MCPHD’s completed case files for hepatitis C, acute hepatitis B and salmonellosis. We investigated the rate and cause of delivery failure of documented returned letters for these periods: acute hepatitis B and salmonellosis (8/2010-7/2012 & 9/2013-5/2014), hepatitis C (2/2012-7/2012 & 9/2013-5/2014). These patient addresses used on the letters were obtained from provider and lab reports and from databases that have records of previous addresses. We examined the address source and the process information went through. The overall initial delivery failure rate of the letters sent to these patients was 6.6% (80 out of 1211). We grouped the reasons into patient-originated (44%) and process-originated (56%). Patientoriginated reasons included patient giving false information to avoid the bill, being homeless (shelters, churches given as address). Process-originated reasons included typo, incomplete address, and postal errors. Since there are several steps to the process, there is no single solution to undeliverable mail problem. Using Coding Accuracy Support System (CASS) system may help initial entry errors, sending an initial confirmatory mail by the provider or using phone or email may be alternatives. Our analysis establishes a baseline for error rates for the management of address information, thus gives insights to improve the process. The framework also allows cost-effectiveness analysis for possible solutions like implementing CASS or using electronic records.
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    Return to Public Health- Undeliverable letters of Communicable Disease Patients
    (International Society for Disease Surveillance, 2015) Kirbiyik, Uzay; Shah, Hassan; Lai, Patrick T.; Williams, Jennifer L.; Dixon, Brian E.; Grannis, Shaun; Department of Epidemiology, Richard M. Fairbanks School of Public Health
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    Systematic Exploration of Associations Between Select Neural and Dermal Diseases in a Large Healthcare Database
    (2022-03) Kirbiyik, Uzay; Dixon, Brian E.; Nan, Hongmei; Grannis, Shaun J.; Janga, Sarath Chandra; Zou, Jian
    In the age of big data, better use of large, real-world datasets is needed, especially ultra-large databases that leverage health information exchange (HIE) systems to gather data from multiple sources. Promising as this process is, there have been challenges analyzing big data in healthcare due to big data attributes, mainly regarding volume, variety, and velocity. Thus, these health data require not only computational approaches but also context-based controls.In this research, we systematically examined associations among select neural and dermal conditions in an ultra-large healthcare database derived from an HIE, in which computational approaches with epidemiological measures were used. After a systematic cleaning, a binary logistic model-based methodology was used to search for associations, controlling for race and gender. Age groups were chosen using an algorithm to find the highest incidence rates for each condition pair. A binomial test was conducted to check for significant temporal direction among conditions to infer cause and effect. Gene-disease association data were used to evaluate the association among the conditions and assess the shared genetic background. The results were adjusted for multiple testing, and network graphs of significant associations were created. Findings among methodologies were compared to each other and with prior studies in the literature. In the results, seemingly distant neural and dermal conditions had an extensive number of associations. Controlling for race and gender tightened these associations, especially for racial factors affecting dermal conditions, like melanoma, and gender differences on conditions like migraine. Temporal and gene associations helped explain some of the results, but not all. Network visualizations summarized results, highlighting central conditions and stronger associations. Healthcare data are confounded by many factors that hide associations of interest. Triangulating associations with separate analyses helped with the interpretation of results. There are still numerous confounders in these data that bias associations. Aside from what is known, our approach with limited variables may inform hypothesis generation. Using additional variables with controlled-computational methods that require minimal external input may provide results that can guide healthcare, health policy, and further research.
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    Timeliness of Chlamydia Laboratory and Provider Reports: A Modern Perspective
    (Office of the Vice Chancellor for Research, 2015-04-17) Lai, Patrick T.S.; Johns, Janae E.; Kirbiyik, Uzay; Dixon, Brian E.
    Timeliness of reports sent by laboratories and providers is a continuous challenge for disease surveillance and management. Public health organizations often collect communicable disease reports with various degrees of timeliness raising the concern about the delay in patient information received. Timely reports are beneficial to accurately evaluate community health needs and investigate disease outbreaks. According to Indiana state law, chlamydia reports are required to be sent to public health within 3 days after a positive test result confirmation. Therefore, laboratories and providers must be accountable and comply with regulation to ensure accurate data quality of disease assessment. The objective of this research study is to analyze the time delay between a chlamydia positive test diagnosis and when a laboratory and/or a provider send a report to a local public health department. A sample of 2,428 chlamydia laboratory and provider reports were collected during the period from May 2012 through July 2012 from a local health department serving the Indianapolis area. Due to absence of test confirmation dates, dates that a report is sent to public health, and other missing data, only 1,752 reports were included in this study. The time delay was calculated by determining the difference between when the initial report is sent to public health following positive confirmatory test by the laboratory. Reports were differentiated as either a laboratory report or a provider report coming directly from a clinician or a hospital setting. Statistical analyses and frequency tables were conducted using SAS 9.4. Table 1 displays the counts of chlamydia laboratory and provider reports according to the time delay in days, the percentage of reports sent to public health within 3 days, and the summary statistics for the two types of reports with a graphical representation shown in Figure 1. There is a clear lag between a lab test and when a provider report is sent to public health. Negative binomial regression result was highly significant with p < 0.001. This study shows the importance of continuing to examine the timeliness of disease reporting from both laboratory and provider settings. Most lab reports are received electronically and comply with state law. However, reports from providers tend to be fax-based and received later than the 72 hours desired by health officials. Given greater adoption electronic health records, it might be possible to further enhance disease surveillance through more timely provider-based reporting, which could also reduce the volume of missing data from provider reports like observed with ELR. Future research should examine EHR capacity and clinical workflows to improve provider-based reporting processes.