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PhD Dissertation Defense - Deepthi Rajeev

Dissertation Title

Deepthi Rajeev

Development and Evaluation of New Strategies to Enhance Public Health Reporting

Location: HSEB 5100C
Date: Apr. 12, 2012
Time: 9:00 am

Supervisory Committee: Catherine Staes, Ph.D.; R. Scott Evans, Ph.D.; Stanley Huff, M.D.; Robert Rolfs, M.D.; Jim Vanderslice, Ph.D.


Public health reporting is an important source of information for public health investigation and surveillance, which are necessary for the prevention and control of disease. There are two main problems with the current public health reporting process in the United States: (a) the reporting specifications are unstructured and are communicated with reporting facilities using non-standard public health department Web sites and (b) most reporting facilities transmit reports to public health entities using manual and paper-based processes. Our research focuses on the development and evaluation of new strategies to improve the public health reporting process by addressing these problems.

To improve the communication of public health reporting specifications by public health authorities, we: (a) examined the business process of a laboratory complying with the reporting requirements, (b) evaluated public health department Websites to understand the problems faced by reporting facilities while accessing the reporting specifications, (c) identified the content requirements of a knowledge management system for public health reporting specifications, (d) designed the representation of the public health reporting specifications, and (e) validated the content and design using a prototype web-based query system for public health reporting specifications.

To improve the transmission of case reports from healthcare facilities to public health entities, we: (a) described public health workflow associated with the management of case reports, (b) identified the content of a case report to meet the needs of public health authorities, (c) modeled the case report using Health Level Seven (HL7) v2.5.1, and (d) evaluated the electronic case reports by comparing the timeliness, completeness of information content, and the completeness of the electronic reporting process with the paper-based reporting processes.

We demonstrated a model for public health reporting specifications using a prototype web-based query system. The validation conducted with users from laboratories, healthcare facilities, and public health entities showed that the proposed model met most of the users' needs and requirements. We also identified variation in the reporting specifications that can be standardized to improve reporting compliance.

We implemented HL7 v2.5.1 case reports from Intermountain Healthcare hospitals to the Utah Department of Health. The electronic reports transmitted from the Intermountain hospitals were more timely (median delay: 2 days) than the paper reports sent from other clinical facilities (median delay: 3.5 days) but less timely than the paper reports from Intermountain laboratories (median: 1 day). However, the evaluation of the completeness of data elements needed for public health triage prior to investigation showed that electronic case reports from Intermountain hospitals included more complete information than paper reports from Intermountain laboratories. Even though the paper reports from Intermountain laboratories were more timely, the incomplete reports may delay investigation. There are informatics opportunities and public health needs to improve both electronic laboratory reporting and electronic case reporting.


Deepthi Rajeev is a Ph.D. candidate and NLM fellow in the Department of Biomedical Informatics at the University of Utah. She received a Masters degree in Statistics from Brigham Young University and a Masters degree in Computer Science from Osmania University, India. Her primary research interests are in the area of public health reporting. Her work has appeared in the Journal of American Medical Informatics, 2010 and the Proceedings of the American Medical Informatics Annual Symposium, 2011.