EDN Workgroup

Report
Electronic Disease
Notification (EDN)
Meghan M. Weems, MPH
June 4, 2012
Immigrant, Refugee, and Migrant Health
Branch
Division of Global Migration and Quarantine
National Center for Emerging and Zoonotic Infectious Diseases
Division of Global Migration and Quarantine
Overview
•Background
•The evolution of EDN
•Direction forward
National Center for Emerging and Zoonotic Infectious Diseases
Division of Global Migration and Quarantine
EDN Background
•
Immigrants and refugees required to
undergo TB screening/medical
examinations before entering US.
•
Over 670 panel physicians (overseas
physicians), designated by the US
Department of State, perform these
screenings.
~450,000 new immigrants and refugees
arrive in the US each year with their
medical examination documentation.
•
These medical documents—for all
refugees and only immigrants with
medical conditions such as TB—are
collected at one of 20 CDC
quarantine stations .
EDN Background Cont.
•
•
•
•
Refugees and immigrants with culture- or smearpositive TB are treated prior to arrival in the US.
After arrival, CDC’s Electronic Disease Notification
system (EDN) notifies nearly 500 TB and Refugee
Health coordinators in health departments of the
results of overseas medical examinations.
Heath departments can enter results of post-arrival TB
evaluations into EDN (TB follow up).
In October 2008, EDN completely replaced the
previous paper-based system.
Notification History
AIS*
1995
IMP*
EDN
2007
1999
2008—100% centralization
1995
2000
2005
2010
DGMQ Quarantine Stations mail to U.S. Health Depts
EDN sends electronic notification
AIS—Alien Information System
IMP—Information of Migrant Population
EDN—Electronic Disease Notification
*limited medical data collected
Broad Partnerships
• Division of TB Elimination (CDC)
• State and local health departments
– Refugee Health Coordinators
– TB Controllers
• Federal partners
– Department of State
– Department of Homeland Security
• International Organization for Migration (IOM)
• Resettlement Agencies
EDN Information Flow
Department of State Medical Forms
(DS Forms)
• Forms used under 1991 and 2007 TB
Technical Instructions
– DS 2053/2054 Medical Examination for
Immigrant or Refugee Applicant
– DS 3024/3030 Chest X-Ray and
Classification Worksheet
– DS 3026 Medical History and Physical
Examination Worksheet
– DS 3025  Vaccination Documentation
Worksheet
DS-2054—Medical Examination
The Evolution of EDN
EDN User Community
• Nearly 500 active users
• Health Departments in all 50 States (state,
county, and local) & Washington, D.C.
– 263 jurisdictions
• TB Controllers (199)
• TB/Refugee Health Coordinators (176)
• Refugee Health Coordinators (110)
EDN Users 2006-2011
300
250
200
Number of Users
150
Number of
Jurisdictions Added
100
50
0
2006
2007
2008
2009
2010
2011
EDN Users Cont.
•
11 states have local jurisdictions (171
total)
• Arizona- 1 County
• California- 61 Counties
• Colorado- 1 County
• Florida- 67 Counties
• Georgia- 1 County
• Idaho- 3 Health Districts
• Illinois- 1 City, 1 County
• Michigan- 4 Counties
• New York- 1 City
• Oregon- 3 Counties
• Texas- 27 Counties and Health Districts
•
•
Newly added jurisdictions in 2011 (10)
• Midland County TX
• DeKalb County GA
• Public Health District 3 Idaho
• Public Health District 4 Idaho
• Public Health District 5 Idaho
• Wayne County MI
• Detroit City MI
• Kent County MI
• Oakland County MI
• Maricopa County AZ
States with first time local jurisdictions (4)
• Georgia
• Idaho
• Michigan
• Arizona
EDN Jurisdictions- 2012
EDN Jurisdictions
• Current local jurisdiction setups:
• Major Metro – High-volume counties have
direct access; state controls lower volume
counties (AZ, CO, GA, ID, IL, MI, OR)
• Complete Split – State is completely
segmented into counties/regions, state-level
users are only supervisory (CA, FL, TX)
Local Jurisdiction Access
• TB follow-up rates were greater in states where
local and city health departments had access to
EDN than those who did not (chi-square p
<0.01).
Table. Reporting Rates Stratified by Access Type
•
•
Access Type
Mean Reporting (%)
Local Access
80.0
No Local Access
70.6
Excludes all U.S. territories
Numbers are based on arrival data from October 2010 to March 2011.
Notification Data for 2011
•
•
•
US Total- 73,493
• Average time from arrival to notification- 5 days
• FY 2010- average time was 11 days
Immigrants- 18,412
• Average time from arrival to notification- 5 days
• FY 2010- average time was 13 days
Refugees- 51,097
• Average time from arrival to notification- 5 days
• FY 2010- average time was 11 days
Days from Arrival to Notification
2009-2011
45
40
35
30
Median Days- Total
25
Median Days- Immigrant
20
Median Days- Refugee
15
10
5
0
2009
2010
2011
EDN Data
January-December 2011
Visa Type
n*
All TB
Conditions
%
Refugee
51,097
4,205
8.23
Asylee
3,984
183
4.59
Immigrant
18,412
17,846
96.93
TOTAL
73,493
22,234
30.2
*Number of EDN notifications
Top 5 Birth Countries for US-bound
Immigrants and Refugees- 2011
• Immigrants
– Philippines
– Mexico
– China
– Dominican Republic
– India
• Refugees
– Cuba
– Myanmar
– Bhutan
– Iraq
– Nepal
Top 10 Birth Countries of US-bound
Immigrants and Refugees- 2011
Areas of Progress
• EDN Improvements
• Continued partnerships
Recent EDN Improvements
• Easier access to EDN
– System upgrade—Microsoft SQL server upgraded to
alleviate stalls
– Single password access with 1 year expiration
• Users no longer required two passwords to access the
EDN web-interface. The 30 day password expiration was
removed.
• System activity reports
– Percentage of TB worksheets started
– Sub-migrations to and from
Recent EDN Improvements cont.
• Alien information page now includes some
Pre Departure Medical Form (PDMS) data
– Anti-Malarial and Anti-Helminthic treatment
– Pre Departure vaccination information
• Added Hansen’s Disease module
– Federal Hansen’s disease users will receive
notifications of refugee/immigrants diagnosed
with Hansen’s disease.
Continued Partnerships
• EDN Workgroup
• IOM (International Organization for
Migration)
• Department of State (DOS): Refugee
Processing Center (RPC), Bureau of
Population, Refugees and Migration (PRM),
Consular Affairs (DOS)
• Department of Homeland Security (DHS):
Custom Border Protection (CBP)
EDN Workgroup
• Began as NTCA EDN Workgroup
• Re-structured
– Current Members
• 2 co-chairs TB and refugee health
coordinator
• 10 representatives representing US regions
• DTBE and DGMQ Federal participants
• Purpose a forum to address user needs/concerns
and to provide accountability for improvements
• Meet every other month
• Created subgroup to discuss TB follow up form
EDN Worksheet Sub-Workgroup
• Sub-workgroup created May 5, 2011
• Goals
– Discuss and finalize goals of TB follow-up
data collection
• Guide revision process
– Update current TB worksheet to increase
• Consistency and accuracy of data collection
• User friendliness
• Overall EDN reporting
– Develop standardized protocol for
secondary migration
IOM Data
• Data feed ~65% of refugee
data comes from IOM’s
MiMOSA database
• Providing additional data to
better assist US health
coordinators
– Information refugee camp,
language, ethnicity, etc.
– Pre-departure treatment
against intestinal parasites
and malaria, and predeparture vaccinations
Refugee Processing Center
• Receive scan documents for 100% of
refugees within 24-48 hours of arrival
• Coupled with ~65% electronic refugee data
from IOM
• Outcome=Improved notification time
Consular Affairs and CBP
• Collaborate with US Department of State and
Custom Border Protection (CBP) on Consular
Electronic Application Center (CEAC) project
• To provide electronic medical data from overseas panel physicians
•
•
•
•
Decreased need for manual data entry at CDC
Improved accuracy of data
Faster notification times
A work in progress
Direction forward
• Continue to improve notification time
• Improve data quality
– Data from panel physicians
• Establish new users
– Encourage local health department access
– Users in Puerto Rico, Virgin Islands, Guam, etc.
Direction forward continued
• Fulfill DTBE/DGMQ MOU
- Implement new TB follow up form
• Implement recommendations to improve TB
follow-up reporting
– New access types for local health
departments
– System reports
• Continue active collaboration with Federal
partners
EDN Team
• Medical Director Rossanne Philen, MD, MS, CAPT USPHS
• Program Coordinator Meghan M. Weems, MPH
• Public Health Advisor Kendra Cuffe, MPH
• Data Entry Center (DEC) Manager Nekeia Gray, BS
• Data Entry Center Staff  Ashley Mizell, Iris Gaye, Willie Bradley,
Rhonda Rhodes-Price, Keisha Thomas, Dale Atkinson, Tanya
Garcia, Mytrice Grier, Matrilla King, Sharon Davenport, Kourtney
Powers, Jason Rochon
• Informatics team
 Daniel Wenger, Charlie Miller, Wei-Lun Juang, Dan Reed
Thank you!
Meghan M. Weems
[email protected]
EDN Helpdesk
[email protected]
1-866-226-1617
National Center for Emerging and Zoonotic Infectious Diseases
Division of Global Migration and Quarantine

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