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As more countries implement national electronic medical records, there is increasing demand for secondary use of electronic medical record (EMR) data. Among these is the use of EMR data for HIV case-based surveillance. HIV case and mortality reporting is recommended as a core component of 2nd generation HIV surveillance. Case-based surveillance of HIV collects information on key sentinel events for each person with HIV. It seeks to monitor and describe the longitudinal progression of HIV in each person.
To support The United States President’s Emergency Plan for AIDS Relief (PEPFAR)’s focus on sustainable control of the HIV epidemic, use of information from HIV case –based surveillance would provide a better understanding of epidemic trends over time, identify epidemic hotspots, and identify sub-populations at high risk of infection, among others; in a timely manner.
The documentation that follows below refers to use of HIV patient-level data from openMRS, an electronic medical record, for HIV case-based surveillance. The case reporting module in openMRS represents the case-based surveillance component of the system. Screenshots have been provided to illustrate a test patient’s HIV progression along the care cascade by generating the relevant case reports for each sentinel event being monitored.
For interoperability, the case reports are generated as Fast healthcare interoperable resources (FHIR) documents to be sent to a public health agency’s shared health repository.
1. Home Page
2. Register a patient
3.Trigger event: New HIV Case
Enter an observation for a reportable sentinel event. In this case, the patient's HIV test results are positive.
Since the observation entered is reportable, the New HIV Case trigger is fired and the related case report is queued for review by the surveillance officer.
After reviewing the queued case report, the surveillance officer either submits or dismisses the case report.
A list of submitted case reports
The submitted case report for a New HIV case trigger event as a FHIR document.
4. Trigger event: New HIV Disease
Enter WHO staging information based on a newly diagnosed HIV disease.
The New HIV Disease trigger is fired and the related case report is queued for review by the surveillance officer.
After reviewing the queued case report, the surveillance officer either submits or dismisses the case report.
A list of submitted case reports
Submitted case report as FHIR document.
5. Trigger event: New HIV Treatment
Enter information for the initial Treatment plan.
The New HIV Treatment trigger is fired and the related case report is queued for review by the surveillance officer.
After reviewing the queued case report, the surveillance officer either submits or dismisses the case report.
submitted case report
Submitted case report as FHIR document.
6. Trigger event: ART Therapy changed to second line
Select reason for switching HIV treatment to second line.
ART Therapy changed to second line trigger is fired and the related case report is queued for review by the surveillance officer.
After reviewing the queued case report, the surveillance officer either submits or dismisses the case report.
A list of submitted case reports.
Submitted case report as FHIR document.
7. Trigger event: HIV Treatment stopped
Select reason for stopping HIV treatment.
HIV Treatment stopped trigger is fired and the related case report is queued for review by the surveillance officer.
After reviewing the queued case report, the surveillance officer either submits or dismisses the case report.
A list of submitted case report
Submitted case report as FHIR document.
8. Trigger event: HIV treatment failure
Select reason for treatment failure.
HIV Treatment failure trigger is fired and the related case report is queued for review by the surveillance officer
After reviewing the queued case report, the surveillance officer either submits or dismisses the case report.
A list of submitted case reports.
Submitted case report as FHIR document.
9. Trigger event: Patient died
Enter deceased patient's information including date and reason for death.
HIV patient died trigger is fired and the related case report is queued for review by the surveillance officer.
After reviewing the queued case report, the surveillance officer either submits or dismisses the case report.
A list of submitted case reports.
Submitted case report as FHIR document.
References
[1] | WHO, UNAIDS, "Guidelines for second generation HIV surveillance: an update: know your epidemic," World Health Organization, Geneva, Switzerland, 2013. |
[2] | NASTAD, "Case-based surveillance toolkit," National Alliance of State and Territorial AIDS Directors, Washington, D.C, 2014. |
[3] | The Office of the U.S. Global AIDS Coordinator, "PEPFAR 3.0 controlling th epidemic: delivering on the promise of an AIDS free generation," The Office of the U.S. Global AIDS Coordinator, Washington, D.C, 2014. |
[4] | HL7, "FHIR DSTU2," HL7, Oct 2015. Accessed at https://www.hl7.org/fhir/documentation.html |