Occupational health surveillance has long lagged behind other kinds of public health surveillance, despite an ongoing need to track occupational diseases. In our article “A Breath of Fresh Air: Pilot Testing Electronic Case Reporting for Public Health Surveillance of Occupational Lung Diseases in Wisconsin,” we evaluate a process that has the potential to improve this imbalance. Electronic Case Reporting (eCR) automates the exchange of case reports between healthcare facilities and public health agencies directly from the electronic health record.

Jurisdictions often require that specific diseases and disorders are reported to public health agencies within a specific timeframe. In practice, however, reporting is often missed and/or delayed. Providers are already burdened with many reporting requirements and are not always aware of what all is reportable. For many diseases where laboratory work is used to diagnose (eg, carbon monoxide poisoning, chlamydia, etc.), electronic laboratory reporting (ELR) systems are used across the country to report labs to public health agencies. However, in occupational health, few conditions are diagnosed with laboratory tests. For instance, occupational lung diseases (eg, silicosis, asbestosis, and farmer’s lung disease) are determined through direct provider diagnoses.

In the absence of labs and consistent provider reporting, occupational health programs have relied primarily on hospital discharge data to assess trends in reportable conditions. This kind of surveillance has interlocking weaknesses. First, cases are always captured several months or years after they are diagnosed. Second, hospital discharge data only captures cases that are hospitalized – ie, not those found in clinics or other health care settings. Given the delay and limited clinical settings, it is difficult to catch cases in real-time that might be sentinel cases for ongoing health hazards. One of the primary functions of public health surveillance is early detection of risks that might be more widespread. The growing use of eCR, which increased in prominence during the COVID-19 pandemic, provides a unique avenue to obtain near-real time information on occupational disease and risk.

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In Wisconsin, we sought to test our eCR system against our existing surveillance of several reportable occupational lung diseases. We did this by matching cases in our existing surveillance system to cases that came in via eCR and assessing what percentage of cases were new (ie, would not have been detected without the eCR system in place). Our findings showed that for each of the three occupational lung diseases that we studied (ie, silicosis, asbestosis, and farmer’s lung disease), more than half of the incoming eCR cases could not be matched to the existing system. The percent that could not be matched ranged from 55% to 81.2%, suggesting that eCR provided a meaningful number of cases that would not have otherwise been captured.

While increased case capture is an important test of the utility of eCR for occupational diseases. Another advantage of eCR is the ability to capture reportable cases sooner. Anecdotal evidence suggests that delaying follow-up with an individual substantially reduces the possibility of getting additional information about the circumstances surrounding their diagnosis. As medical records are often not capturing detailed information about patients’ work, follow-up with recently diagnosed patients is an important daily task for public health program staff. It is via these interviews that we obtain information about the nature of the work, the use of personal protective equipment (PPE), and whether or not risks still exist for others in the community. Having cases reported to the state within 24-72 hours of diagnosis, as is the case with eCR, provides public health officials with the best opportunity to gather this critical information in a timely manner. This, in turn, provides the public health community with the best possibility to intervene sooner and potentially prevent others from succumbing to debilitating occupational diseases. In our article “A Breath of Fresh Air: Pilot Testing Electronic Case Reporting for Public Health Surveillance of Occupational Lung Diseases in Wisconsin,” you will find additional insights and details.

Acknowledgements

We would like to acknowledge the other co-authors of our study, Dr. Katherine E. McCoy, PhD, and Dr. Komi K. S. Modji, MD, MS, CPH, for their invaluable contributions to this work. 

Paul D. Creswell, PhD, is the Senior Epidemiologist for the Occupational Health and Safety Surveillance Program at the Wisconsin Department of Health Services. Dr. Creswell’s recent work focuses on occupational health surveillance of conditions such as asbestosis, COVID-19, and legionellosis. He has over 20 years of experience in public health and has worked on a variety of subjects including carbon monoxide poisoning, alcohol-related mortality, climate effects on workers, cancer health disparities, and tobacco control.

Sara Mader, RN, MPH, is the electronic case reporting (eCR) Data Exchange Specialist for the Wisconsin Department of Health Services. In this role, she leads eCR onboarding for new healthcare organizations, adds and evaluates new conditions for eCR, and does strategic planning for the future of eCR in Wisconsin.