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Lazarus et al., Electronic Support for Public Health
JAMIA
The Practice of Informatics
Application of Information Technology
Electronic Support for Public Health: Validated Case Finding
and Reporting for Notifiable Diseases Using Electronic Medical
Data
ROSS LAZARUS, MBBS, MPH, MICHAEL KLOMPAS, MD, MPH, FRANCIS X. CAMPION, MD,
SCOTT J. N. MCNABB, PHD, MS, XUANLIN HOU, MSC, JAMES DANIEL, MPH, GILLIAN HANEY, MPH,
ALFRED DEMARIA, MD, LESLIE LENERT, MD, MS, RICHARD PLATT, MD, MSC
A b s t r a c t Health care providers are legally obliged to report cases of specified diseases to public health
authorities, but existing manual, provider-initiated reporting systems generally result in incomplete, error-prone,
and tardy information flow. Automated laboratory-based reports are more likely accurate and timely, but lack
clinical information and treatment details. Here, we describe the Electronic Support for Public Health (ESP)
application, a robust, automated, secure, portable public health detection and messaging system for cases of
notifiable diseases. The ESP application applies disease specific logic to any complete source of electronic medical
data in a fully automated process, and supports an optional case management workflow system for case
notification control. All relevant clinical, laboratory and demographic details are securely transferred to the local
health authority as an HL7 message. The ESP application has operated continuously in production mode since
January 2007, applying rigorously validated case identification logic to ambulatory EMR data from more than
600,000 patients. Source code for this highly interoperable application is freely available under an approved open-
source license at http://esphealth.org.
J Am Med Inform Assoc. 2009;16:18–24. DOI 10.1197/jamia.M2848.
Introduction and Background
Mandatory reporting of infectious diseases forms a corner-
stone of cost-efficient, preventive public health programs.
Timely, complete and accurate case reports facilitate contact
tracing, appropriate trea