1 / 34

Meghan M. Weems, MPH June 4, 2012

Electronic Disease Notification (EDN). Immigrant, Refugee, and Migrant Health Branch Division of Global Migration and Quarantine. Meghan M. Weems, MPH June 4, 2012. Overview. Background The evolution of EDN Direction forward. EDN Background.

dana
Download Presentation

Meghan M. Weems, MPH June 4, 2012

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Electronic Disease Notification (EDN) Immigrant, Refugee, and Migrant Health Branch Division of Global Migration and Quarantine Meghan M. Weems, MPH June 4, 2012

  2. Overview • Background • The evolution of EDN • Direction forward

  3. 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 .

  4. EDN Background Cont. • Refugees and immigrants with culture- or smear-positive 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.

  5. Notification History AIS* IMP* EDN 2007 1999 1995 2008—100% centralization 2000 2005 2010 1995 DGMQ Quarantine Stations mail to U.S. Health Depts EDN sends electronic notification AIS—AlienInformation System IMP—Information of Migrant Population EDN—Electronic Disease Notification *limited medical data collected

  6. 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

  7. EDN Information Flow

  8. 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 Department of State Medical Forms (DS Forms)

  9. DS-2054—Medical Examination

  10. The Evolution of EDN

  11. 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)

  12. EDN Users 2006-2011

  13. 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

  14. EDN Jurisdictions- 2012

  15. 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)

  16. 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-squarep <0.01). Table. Reporting Rates Stratified by Access Type • Excludes all U.S. territories • Numbers are based on arrival data from October 2010 to March 2011.

  17. 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

  18. Days from Arrival to Notification2009-2011

  19. EDN Data January-December 2011 *Number of EDN notifications

  20. Top 5 Birth Countries for US-bound Immigrants and Refugees- 2011 • Immigrants • Philippines • Mexico • China • Dominican Republic • India • Refugees • Cuba • Myanmar • Bhutan • Iraq • Nepal

  21. Top 10 Birth Countries of US-bound Immigrants and Refugees- 2011

  22. Areas of Progress • EDN Improvements • Continued partnerships

  23. 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

  24. 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.

  25. 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)

  26. 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

  27. 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

  28. 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 pre-departure vaccinations

  29. 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

  30. 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

  31. 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.

  32. 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

  33. 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

  34. Thank you! • Meghan M. Weems • MWeems@cdc.gov • EDN Helpdesk • edn@cdc.gov • 1-866-226-1617

More Related