Can Existing Health Information Exchanges Be Leveraged To Modernize Public Health Surveillance?

In 2023, the California Department of Public Health’s Division of Communicable Disease Control (DCDC) set out to explore if health information organizations (HIOs), rich in crucial and current health data, such as demographics, encounters, labs, and test results, could improve public health surveillance data, and as a result, health equity. DCDC partnered on a pilot project with two nonprofit California HIOs – a regional community HIO, and a statewide HIO, Manifest MedEx. 

For this pilot, Manifest MedEx delivered a one-time data file based on two rosters provided by CDPH from its communicable disease data system to enrich CDPH’s case reporting datasets: 

• Approximately 250,000 patients reported with TB disease (2016-2022) or latent TB infection (LTBI) (2019-2022) statewide 

• A statewide random sample of 1 million patients with COVID-19 (diagnosed 2020-2022) 

Manifest MedEx matched longitudinal patient records against a number of data match points and then returned and uploaded patient health information from its vast network (i.e., demographic data, clinical condition data, utilization data) into a portal in the cloud to facilitate secure transfer of the matched dataset to CDPH.  

While CDPH continues to evaluate the value of the enriched data received from Manifest MedEx, here are some preliminary findings from the pilot: 

• Race, Ethnicity and Language (REaL) data for more than 50% of TB/LTBI and COVID-19 patient roster before opt-outs were removed. 

• With the REaL data from Manifest MedEx:
  • For its matched dataset of COVID-19 cases, CDPH identified increases in completeness of:
    • Race/ethnicity data fields from 74% to 87% 
    • Language data fields from 28% to 67% 
  • For its matched data set of LTBI cases, CDPH identified increases in completeness of:
    • Race/ethnicity data fields from 45% to 94%
    • Language data fields from 0% to 65%