PHIN-Compliant Systems CDC needs to contribute to more timely development of PHIN-compliant systems in all jurisdictions. A review of the literature evaluating the timeliness of reporting of infectious diseases found that reporting lag and the variability among states limit the usefulness of data. The inconsistency in reporting limits CDC’s ability to identify and respond to multistate outbreaks in a timely manner. The review called for a more standardized approach in evaluating and describing surveillance-system timeliness (Jajosky and Groseclose, 2004). Although it did not look specifically at hepatitis B or hepatitis C, its conclusions are relevant to the present report.


Electronic Medical Records The reporting of relevant infectious-disease test results should be a component of electronic medical-record systems. CDC should support state and local jurisdictions in working with clinical and community health-center partners to develop algorithms for automatic viral-hepatitis disease reporting based on electronic medical records. It has already been shown to be effective in enhancing acute-HBV reporting without adding to the burden on medical providers (Klompas et al., 2008).

Case Investigation and Followup

Standards for case investigation and followup should be developed and implemented to ensure that newly diagnosed patients receive adequate information and referrals. An effective surveillance system should identify most of the diagnosed cases of both acute and chronic HBV and HCV infections. Identification of infected people by health departments should be the first step in getting them into appropriate care. Because of resource and system inadequacies, it is not. Most health departments indicated that they were unable to do more than follow up on potentially pregnant HBV-positive women (personal communication, Adult Viral Hepatitis Prevention Coordinators, May 2009). If state health departments had appropriate funding to follow up recently diagnosed cases of HBV and HCV infection directly, more people would be able to receive appropriate education and referral into the array of medical and social-service care that may be indicated.

Analyzing, Reporting, and Disseminating Findings

Once the capacity for state health departments to conduct HBV and HCV surveillance is improved, CDC should report accurate results that are based on the improved data. As discussed earlier in this chapter, there are important concerns about underreporting, particularly of the incidence of



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