Evaluating the Completeness and Timeliness of Tuberculosis Case-Reporting by Laboratories in Washington State, 2019-2023

Background: The Washington Disease Reporting System (WDRS) is an electronic disease surveillance system used by public health professionals across Washington State to enter, track, and analyze disease-related data on nationally and Washington State notifiable conditions. The information comes from a variety of sources, including healthcare providers, facilities, and laboratories within Washington. Moreover, WDRS serves as the integral system between state and local health departments to communicate and coordinate disease investigations and public health responses. Electronic Laboratory Reporting (ELR) is a method that laboratories use to report notifiable conditions to public health agencies to aid in prompt response. Historically, health care facilities and laboratories notified state and local health departments of notifiable conditions through email, fax or phone calls, followed by manual data entry into the disease surveillance system. However, ELR now automates this process by translating information in a laboratory system into an electronic message that is automatically sent to the public health department. The Washington State Department of Health (WADOH) maintains an ELR system through the Washington State Electronic Laboratory Reporting System (WELRS) data base, which tracks and provides laboratory reports to public health professionals across Washington State. Information from the ELR reports ultimately gets integrated into WDRS, providing public health professionals with a comprehensive view of laboratory data. ELR is thought to improve laboratory report quality due to the faster electronic transmission, increased accuracy and consistency of information across various sources. This evaluation was conducted using the WDRS and WELRS datasets from 2019-2023 to compare the completeness and timeliness of laboratory tuberculosis case reporting in Washington State by the traditional method of faxed reports versus automated ELR. Methods: Completeness of case reporting was assessed by the proportion of key fields present in laboratory case reports, as required by Washington Administrative Code (WAC) 46-101-115 that have been determined to have value in public health response to TB cases. Timeliness of manual faxed data reporting was determined by calculating the time in days from the date the laboratory received the specimen to the date the result was reported. To assess ELR laboratory results, timeliness was determined by the time in days from when the laboratory result was reported to DOH to the date DOH processed the message. Timeliness was categorized as either timely or untimely based on the Washington State reporting law, which requires reporting within 2 business days for laboratories. T-tests and Z-tests were conducted to assess significant differences in means and proportions across data sources. Cases were stratified by clinical or laboratory case defining criteria, and by urban and rural based off patient’s reported address. Results: A total of 4,324 ELR reports, and 151 manual fax reports were included in the analysis. Overall, ELR reports demonstrated higher average completeness (76.2%) compared to manual fax reports (35.7%). ELR reports had a significantly shorter mean lag time (1 day) and a larger proportion of timely reports (94%) as compared to manual fax reports (3 days, 66.2%). Both ELR and manual fax reports had higher completeness for laboratory-confirmed cases as opposed to clinical-confirmed cases. Case reports from urban areas were more complete for ELR reported cases (75.8) and had fewer lag days (1.1 days) as compared to rural areas (44.1%, 3.6 days). For manual fax reports, there was no significant difference in completeness or timeliness between urban and rural areas. Conclusion: This study highlights the enhanced performance of ELR over manual fax reporting in terms of completeness and timeliness for TB laboratory case reporting in Washington State. These findings emphasize the value and utility of electronic laboratory reporting to strengthen public health surveillance and response efforts, ultimately contributing to more robust disease control and prevention as well as healthier communities across Washington State.