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ISDS 2016 Conference Abstracts

Infectious Disease Reporting and Outbreak 
Management Improvement Project
Donald E. Brannen*, Melissa Branum and Amy Schmitt
Administration, Greene County Public Health, Xenia, OH, USA

Objective
Improve disease reporting and outbreak mangement.

Introduction
Specific communicable diseases have to be reported by law within 

a specific time period. In Ohio, prior to 2001, most of these disease
reports were on paper reports that were reported from providers to 

local health departments. In turn the Communicable Disease Nurse 
mailed the hardcopies to the Ohio Department of Health (ODH).  
In 2001 the Ohio Disease Reporting System (ODRS) was rolled out to 
all local public health agencies in Ohio.1 ODRS is Ohio’s portion of 
the National Electronic Disease Surveillance System. ODRS should 
not be confused with syndromic surveillance systems that are for 
detecting a disease outbreak before the disease itself is detected.2 
Chronic disease surveillance system data has been evaluated for 
long term trends and potential enhancements.3 However, the use of 
communicable disease reports vary greatly.4 However, the export 
data has not routinely been used for quality improvement purposes 
of the disease reporting process itself. In December 2014, Greene 
County Public Health (GCPH) begain a project to improve reporting 
of communicable diseases and the response to disease outbreaks.

Methods
Initial efforts were to understand the current disease reporting 

process: Quantitative management techniques including creating a 
logic model and process map of the existing process, brainstorming 
and ranking of issues. The diseases selected to study included: 
Campylobacteriosis, Cryptosporidiosis, E. coli O157:H7 & 
shiga toxin-producing E. coli, Giardiasis, Influenza-associated 
hospitalization, Legionnaires’ disease, Pertussis, Salmonellosis, 
and Shigellosis. The next steps included creating a data collection 
and analysis plan. An updated process map was created and the 
pre- and post-process maps were compared to identify areas to 
improve. The median number of days were compared before and 
after improvements were implemented. Modeling of the impact of 
the process improvements on the median number of days reported 
was conducted. Estimation of the impact in healthy number of days 
derived from the reduction in days to report (if any) were calculated.

Results
Process improvements identified: Ensure all disease reporters 

use digital reporting methods preferably starting with electronic 
laboratory reporting directly to the online disease reporting system, 
with other methods such as direct web data entry into system, faxing 
lab reports, or

secure emailing reports, with no or little hard copy mailing; 
Centralize incoming email and fax reports (eliminating process steps); 
Standardize backup staffing procedures for disease reporting staff; 
Formalize incident command procedures under the authorized person 
in charge for every incident rather than distribute command between 
environmental and clinical services; and place communicable disease 
reporting under that single authority rather than clinical services. The 
days to report diseases were reduced from a median of 2 to .5 days 
(p<.001). All the diseases were improved except for crytosporodium 
due to an outlier report two months late. The estimated societal 

healthy days saved were valued at $52,779 in the first eight months 
after implementation of the improvements.

Conclusions
Improvements in disease reporting decreased the reporting time 

from over 2 days to less than 1 day on average. Estimated societal 
healthy days saved by this project during the first 9 months was 
$52,779. Management of early command and control for outbreak 
response was improved.

Keywords
surveillance; communicable; quality improvement

Acknowledgments
Matched Funding through Ohio Development Services Agency Grant 
Control No. SBIG20150570

References
1. Brannen DE. Ohio Disease Reporting System Rollout. Orientation to

individual health departments throughout southwest Ohio to the web 
based Ohio Disease Reporting System. June 1, 2001 through January 
15th, 2002.

2. Ottaway, M., Brannen, D. E., Yund. C. B. (2002 Sept 23-24). Practical 
Evaluation of Electronic Disease Surveillance Systems for Local 
Public Health. National Syndromic Surveillance Conference, New 
York, New York. New York Academy of Medicine, NYC Department 
of Health and Mental Hygiene and the Centers for Disease Control & 
Prevention.

3 Brannen, D. E. (2013). Development of a Public Health Surveillance 
Method to Prevent Melanoma Morbidity. Dissertation, 1-237. 
ProQuest Publication Number 3591988.

4. Brannen, D. E., Schmitt, A., & McDonnell, M. (2009 Apr 18). Use of
Ohio Disease Reporting System export data by local public health 
epidemiologists in Ohio. Ohio Academy of Science Annual Meeting 
Wittenberg University. Abstract and podium presentation.

*Donald E. Brannen
E-mail: dbrannen@gcph.info

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 9(1):e108, 2017