Since the inception of viral testing, disseminating summary results has been a priority. The method of dissemination has evolved from a manual system to the automated system described below. Initially, reports were manually created and posted in web pages (that were not well advertised) and e-mailed to ~20 medical directors and division heads at PCMC. As the process was automated, we also: 1) expanded the listservs and created geographically regional reports as testing came on line throughout the state, 2) posted printouts in various hospital locations, 3) developed a dedicated web site – Germ Watch – to serve as a consistent source for the information. The design objectives of Germ Watch were to automatically generate weekly summary surveillance reports of viral testing and disseminate these reports with minimal intervention to the intended users (70+ clinicians practicing within the 28 urgent care clinics of IH).
In November 2004, we convened 3 focus group meetings, with a total of 14 physicians in urgent care or general practice, to assess interest in population data about viral pathogens and discuss the design of the system for distributing reports. All of the participants desired access to information about circulating viral pathogens. The majority of participants were not aware of other resources for this type of information. Desired frequency of updates was variable, ranging from quarterly when activity was low to weekly and possibly more frequently during times of peak or unusual activity (e.g. winter). All agreed the information would be helpful but the reasons varied and included validating viral diagnoses and treatment decisions; report sharing leading to increased parent/patient satisfaction with their diagnosis; broader impact on ordering diagnostic testing (e.g., chest x-rays, labs); initiating preventive treatments (e.g., vaccination, antiviral prophylaxis or treatment) on at-risk patients; and antibiotic or steroid prescribing. Time series graphs were the preferred format for providing a quick overview, but most felt that a brief textual summary describing the “big picture” could be helpful. Ease of access was emphasized and the preferred method of communication was electronic format combining an ‘active notification’ including a brief textual summary message with a link to a ‘passive display.’
Viral testing results are stored in the laboratory information system (LIS) with a set of standardized test codes and result codes developed by central laboratory personnel. A load script, run each night between the hours of 10pm and 6am populates general laboratory tables in the enterprise data warehouse (EDW) Oracle 9i® database with data from the LIS. This means that the laboratory testing results are available with a 24-hour lag time. A materialized view, containing the specific microbiology results of interest, is used to improve the efficiency of reporting tools running against this data and to remove duplicate test results, quality assurance testing and results entered on test patients.
Time-series graphs displaying the weekly counts of positive test for the various viruses are automatically generated every Monday morning using IHs’ enterprise reporting tool, Crystal Reports®. The reports, in portable document format (PDF) are directly posted to the web site and e-mailed to analysts and 1st line reviewers (authors ATP and PHG) for integrity checking and generation of a brief synopsis. If an error is detected, reports can be quickly suppressed on the web site until corrected. Once the synopsis is written, usually a few sentences describing overall trends, the reports are forwarded to an email list of intended users and the ‘Weekly Bulletin’ on the Germ Watch home page is updated.