Direct Laboratory Notification of Communicable Diseases

2 Overview: Before and after the law change

Under the Health Act 1956 certain individuals are required to notify scheduled medical conditions to a Medical Officer of Health.¹ Clinicians (both hospital and community) currently represent the main group required to notify. Conditions are required to be notified on clinical suspicion and/or confirmation, and notification should occur as soon as is practicable.
As of December 2007 laboratories will be required to report test results that indicate a person or thing has, has been or may be infected with a notifiable disease to a Medical Officer of Health at a public health unit (PHU). There are 20 PHU offices around the country. PHU staff are responsible for delivering core public health services, including the management and containment of outbreaks of communicable diseases.
Medical Officers of Health located at each PHU are public health medicine specialists responsible for undertaking a range of public health actions in response to notification. These actions may include contact tracing, immunisation, giving advice about management of the case and contacts, outbreak investigation, environmental evaluation, exclusion of an individual from a school, workplace or other facility, and public awareness campaigns.

2.1 Pre-December 2007 notification process

Prior to 18 December 2007, the source, method and form of transfer for notification information varied between PHUs. Most notifications are presently received by telephone or fax (‘manually’). Notification information may be recorded on a locally designed notification form by staff at the medical practice, or by PHU staff as it is received.
At the PHU, information may be written on a paper form and then entered into EpiSurv (the national notifiable diseases database) via a web-based form, or entered directly into EpiSurv and the case report form printed from there, thus creating an electronic copy and a hard-copy record. Most PHUs use some form of cover sheet to record processing information for the case. The case report form and cover sheet may then be forwarded to other PHU or territorial authority staff for review and investigation of the case.
The initial details recorded in EpiSurv are updated and added to as more information becomes available (investigation and outcome). Once all investigations have been completed, the case is closed. Cases may be reopened if further information becomes available.
A schematic overview of the pre-December 2007 system is shown in Figure 1.

Figure 1: The pre-December 2007 system for notification

2.2 Post-December 2007 notification processes

To meet the new legal requirements to report directly to a Medical Officer of Health, the person in charge of a medical laboratory will have several options, depending on their laboratory’s capacity. The following methods may be used to notify Medical Officers of Health:

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  manual notification, including phone or fax
  
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  electronic copying of test results from a District Health Board (DHB) laboratory to a DHB public health unit (for DHB patients only)²
  
• 
  use of a modified³ HL7 message sent electronically to the Medical Officer of Health
  
• 
  electronic notification via the national EpiSurv system.
  

Laboratories may decide to continue to use the current manual system, and in some smaller districts this will not cause any problems due to their small volumes of notifiable disease results. In the larger districts, volume increases will mean more work for both laboratories and the PHUs.

Those PHUs that receive an HL7 message directly from laboratories may wish to consider using an HL7 viewer (a basic software package) to enable the receipt and display of electronic information from laboratories. The PHUs will need to work closely with their local laboratories to ensure the information received using an HL7 viewer remains compliant with the Privacy Act.
DHB hospital laboratories will need to approach their corporate services to determine what information can be transferred from the hospital laboratories to the local PHU. Organisation structures, governance and contractual arrangements will differ from DHB to DHB. It may be permissible to send test results unconnected to the notification to another medical practitioner (eg, a Medical Officer of Health within the same DHB). Because the determinants will differ for each DHB, the Ministry advises DHBs to seek their own legal advice on this issue.
For private laboratories, all information not linked to the notification must be removed from the test result before it can be transmitted to the Medical Officer of Health.
Laboratories and PHUs are encouraged to continue working together to develop solutions/processes appropriate to local circumstances, bearing in mind that a national electronic system with a central repository is the desired outcome of the laboratory notification project. Whatever interim solution is adopted post-18 December 2007, PHUs and their local laboratories should plan for a transition to the national electronic system over time.

2.3 Overview of participating organisations and systems that support the direct notification of notifiable diseases

Target notification data flow

Figure 2 provides a simplified view of the targeted future flow of information for the direct notification of notifiable diseases.
Figure 2: Target system for notification


The participants and their functions are as follows.

Clinician	Requests laboratory tests and sends a notification message to a public health unit (via episurv) on suspicion of a notifiable disease. A clinician may also contact the phu directly.
Laboratory	Undertakes the tests requested, sends the results to the requesting clinician and sends a notification message (via episurv) to a public health unit on confirmation of a notifiable disease.
ESR	Receives a notification message from a laboratory, stores the notification information in the episurv database, and alerts the appropriate public health unit. Episurv is a national notifiable diseases reporting and basic case management system.
Medical officer of health	Accesses a ‘notifications module’ on Episurv via a web browser at the phu. Case report forms are created where necessary (an automated process). The medical officer of health may contact the attending clinician, testing laboratory and/or patient for information, follow-up or public health action purposes.
Message broker	While not shown in the diagram, the message broker’s role is to manage laboratory order and results messages and notification messages to ensure they are securely passed between the appropriate parties  in this case a clinician and a laboratory, a laboratory and esr, and a clinician and esr.
Communication network	While not shown in the diagram, this is the underlying telecommunications-related infrastructure over which messages are securely passed between the parties  in this case the health network.

Laboratory test orders, results and notification messages ensure information is provided in a structured and consistent manner and can be easily stored and processed by ESR’s EpiSurv system. A PHU does not need to manually create a case in EpiSurv. These messages comply with the current HISO HL7 standard (as at December 2007 this is v2.4).

Direct contact between a clinician and a PHU may be via phone, fax or email. Typically this would be because a clinician wants to provide early warning to a PHU of a suspected patient with a notifiable disease. In the future, clinicians will probably also be able to send electronic notifications to a PHU via EpiSurv using, for example, their practice management system.

Interim notification data flow

Figure 3 provides a simplified view of the interim flow of information for the direct notification of notifiable diseases.
Figure 3: Interim system for notification

The participants are the same as in the target state diagram. Notification messages must comply with the current HISO HL7 standard (as at December 2007 this is v2.4) and HealthLink’s HL7 v2.1 message format (as an interim solution only).

Direct contact between a laboratory and a public health unit may be via phone, fax or secure email, or possibly an electronic message. Typically this would be because a laboratory is unable to send a notification message that meets the required specification. Where an electronic message is sent directly to a Medical Officer of Health, the PHU will require the capability to receive such information and will need to manually create a case in EpiSurv.