MDSS Training For Health Care Providers

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MDSS TrainingFor Health Care Providers
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The Michigan Disease Surveillance System
Why were launching a new tool for public health
surveillance in Michigan

• Makes reporting of diseases/conditions easier,
  more efficient and closer to real-time so public
  health interventions can be implemented
• Reduces delays in initiation of public health
  follow-up by correctly reporting to county of
  residence rather than county of diagnosis
• Allows reporting 24 hours/day from your PC
• Clarifies whether the case reported involves
  multiple providers/facilities
• Provides documentation of facilitys role in
  reporting for regulatory and accreditation
  agencies
• Allows instantaneous retrieval of summary reports
  of diseases
• Reduces volume of necessary telephone
  communications for additional information between
  LHD and facility-based ICP

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MDSS Healthcare Provider (HCP) Responsibilities

• Confidentiality
• The MDSS will contain confidential medical
  information on individuals reported into the
  system. Data is protected by system security and
  role defined access, but participants will
  continue to be bound by rules of confidentiality
  while accessing system information. MDSS is
  compliant with HIPAA regulations.
• Participation
• To realize the goals of this system, patient
  information must be entered in a timely manner.
• HCP reporting responsibilities remain unchanged
  with this new, electronic method of reporting
  (Communicable Disease Rules R325.171 et al.).
• Your enthusiastic support will make the MDSS a
  more productive and effective method of
  communicable disease surveillance

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Accessing the MDSS

• Software and System Requirements
• Internet Access
• Internet Browser (Internet Explorer 6.0
  recommended)
• Adobe Reader 5.1 or higher (www.adobe.com)
• Single Sign-on (SSO) User ID and Password
• Authorization to use the MDSS
• Healthcare providers should partner with their
  local health department to register and utilize
  MDSS

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MDSS Roles and Their Functions

• Healthcare Providers (HCP)
• Submit new cases
• Search for, view, and edit data on cases
  submitted by that particular HCP
• Run reports
• Local Health Department (LHD) users
• Local user administration
• Submit new cases
• Search for, view, and edit data on cases in their
  jurisdiction
• Run reports
• State Health Department users
• Collaborate with local users
• Submit new cases
• Search for, view, and edit data on cases
  statewide
• Run reports

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How to access, navigate in, and exit the MDSS
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Entering the MDSS

• Point browser to https//sso.state.mi.us/
• Log In with SSO User ID and Password

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The Top Navigation Bar

• The Top Navigation Bar consists of links to
  different modules
• Case Investigation Contains all of the
  functions to enter and manage cases. You can
  add, change, and search the communicable disease
  information stored within MDSS.
• Reports Contains all of the reports available
  on MDSS. You can specify the type of report you
  wish to create and what information you would
  like to include on the report.
• Logout Terminates your session and returns you
  to the State of Michigan Department of Community
  Health Application Portal.

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The Side Navigation Bar
Case Investigation
Reports
The Side Navigation Bar displays links to
available functions within the current module.
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On Line Help

• The User Guide is accessible on-line. It can be
  searched by the table of contents, by the index,
  or by keyword.
• Click the HELP buttons throughout the application
  for assistance relative to your current screen.
• Appendix C of the User Guide offers helpful data
  entry tips.

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MDSS Security

• Browser buttons (Back, Forward, Refresh, etc.)
  are not available for use in MDSS.
• For security, MDSS and SSO will automatically log
  you out if your session remains inactive for more
  than 60 minutes.
• Save your work frequently
• Always save your work and log out of MDSS and the
  SSO portal if you leave your computer
• You will lose unsaved work if youre
  automatically logged out

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Logging Out

• Click Logout in MDSS, AND
• Click Sign Off in the SSO Portal

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Welcome to the MDSS
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How to Enter a Case into the MDSS
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New Case Entry

• The New Case function allows new cases to be
  manually added to MDSS.
• The New Case entry process is divided into three
  sections.

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New Case Entry Screen One
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Screen One Key Field Definitions

• Fields in Red with are required fields. Case
  entry will not proceed unless they are completed
  (Unknown is generally an option).
• Case Status refers to the case definition
  criteria (Confirmed, Suspect, Not a Case,
  Probable, Unknown).
• Patient Status - This field is used to indicate
  the present condition of the patient.
• Patient Status Date - Automatically set to
  current date during case entry and updated when a
  change is made to the Patient Status. Can also
  be entered directly.
• Refer to the section New Case in Chapter 4 of
  User Guide or view Online Help for more details.

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New Case Entry Screen Two
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Screen Two Key Field Definitions

• Age - Reflects the age at illness onset by
  subtracting Onset Date from Date of Birth (when
  available). Referral Date is used if no Onset
  Date is available.
• Age Unit Pertains to the measurement of the age
  of the patient at illness onset (in days, months,
  or years).
• If Date of Birth is not available, Age and Age
  Units can be entered directly. Age units should
  be
• Days if Age is less than or equal to 30 days
• Months if Age is less than 2 years
• Years if Age is greater than or equal to 2 years

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New Case Entry Screen Three
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Entering Lab Data for Referrals

• Laboratory data is vital to most public health
  investigations.
• There are two options for entering laboratory
  data during the New Case Entry process
• In the Notes section
• Or the Enter Lab Data section

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Entering Lab Data in the Notes Section During
New Case Entry

• Minimal lab information that should be entered
• Laboratory Name
• Test Name
• Specimen Information (type and collection date)
• Results (including result date)

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Choosing Enter Lab Data During New Case Entry

• You may choose to enter lab data through the
  Enter Lab Data option on the third screen of
  New Case Entry

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• Click Create New Lab Report
• Add Lab Order information
• Click Add New Lab
• Add Lab Result information
• Click Add Result

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6. Click Submit Changes 7. Click Save
Finish The case will then finish the last steps
of the new case entry process behind the scenes .
. .
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Validation
Clicking SAVE FINISH or CONTINUE initiates a
validation process. You must correct errors
prior to proceeding.
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Background Processing
Once a case is entered, the following processes
occur behind the scenes

• Geocoding Validates address, assigns
  coordinates to map address, supports LHJ
  referral.
• De-Duplication The process of identifying and
  merging duplicate patients and case reports.
  This can result in the case not being immediately
  available to view.
• Case Referral Determines the referral LHJ based
  on the Investigation Address (case address if
  available, otherwise provider or lab address),
  and assigns the case to the LHJ Administrator to
  initiate follow-up.

More information about these processes can be
found in the section Background Processing in
Chapter 4 of the User Guide or by viewing Online
Help.
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Exercise - New Case Entries

• Instructor Example
• Student Exercise
• Log in to the MDSS at https//sso.state.mi.us/
• Enter a New Laboratory Confirmed Case
• Choose Salmonellosis as the Reportable Condition
• Complete the three screens of new case entry
  including adding lab results in the case notes
  area
• Enter New Case of Meningitis with suspected viral
  etiology
• Choose Meningitis-Aseptic as the reportable
  condition
• Add negative bacterial cultures, symptoms and CSF
  study results into the case notes area

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Welcome Back to the MDSS
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How to View and Edit a Case in the MDSS
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Case Listings Overview
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Case Listings - Sort Option

• The Case Listings are displayed in order of
  Referral Date the default sort order.
• Select a different Sort Order and click SORT to
  change sort order (sorts are ascending order).
• Investigator and Patient Name are sorted on last
  name.
• See the section Cases in Chapter 4 of the User
  Guide or view Online Help for more details.

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Case Listings - Search Option

• The cases that appear on Case Listings screen are
  initially based on the default search criteria
  and your role and permissions.
• When your User ID was created, the system
  automatically created some default searches for
  you.
• When you change the Case Listings search option,
  the selected search becomes your default search
  for the duration of your session or until you
  select another search option.

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Accessing the Case Details

• Locate the specific case you want to access.
• Click the EDIT button and the "Case Detail"
  screens will appear.

• Note When you select a case, all cases
  associated with that patient will be un-editable.
  

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Case Locking

• When a case is selected for editing or viewing,
  all cases for the associated patient are locked
  by the user who first accesses the record.
• All of the screens within Case Details will
  indicate that the case is locked and by which
  user.

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Viewing a Locked Case

• While the lock is in effect, other users will be
  able to view the case information but will not be
  able to edit any of the field values.

• All of the fields are grayed out for the other
  user who is viewing this case. This indicates
  that all of the fields are disabled to the user
  until the case is unlocked.
• This lock remains in effect until the user
  navigates away from the record.

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The Case Reporting Tab

• The first tab contains the basic information
  about the case.
• From this screen, you can monitor the
  Investigation Status
• This is also where you can access the disease
  specific forms.

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Case Investigation Status

• Investigation Status refers to the stage of the
  LHD investigation (New, Active, Completed,
  Cancelled, Superceded). This is the
  responsibility of LHD.
• Resolved cases are marked Confirmed or Not a
  Case for Case Status and Completed or
  Probable for Investigation Status.
• If duplicate cases are entered, all but one are
  marked Superceded for Investigation Status
  with one case investigated to resolution.
• Cancelled is selected if the case cannot be
  investigated to resolution (e.g., patient or
  provider can not be reached).

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Disease Specific Forms

• Disease Specific Forms provide
• A place to record supplemental data for
  reportable conditions requiring more detailed
  information
• A common format for handwritten and computer data
  entry
• A substitute for mailing in case investigation
  forms
• The Disease Specific Forms are based on the
  communicable disease forms used for case
  investigations
• These forms can be saved, retrieved, and printed
  at any stage in the case investigation
• All Web interface information entered, except
  Notes and Laboratory Reports, are automatically
  transferred to the Disease Specific Form when the
  form is Activated.

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Disease Specific Form Access
From the Case Listings screen click EDIT next
to appropriate case

• Click the DETAIL button to open the Disease
  Specific Form
• The Disease Specific Form opens in the MDSS
  window.

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Disease Specific Forms Controls
Activate Form Retrieves data and displays it in
the form.
Cancel Form Cancels changes without saving.
You MUST start with Activate Form
Case Definitions Opens Case Definitions in a New
Window (Coming Soon)
Submit Form Validates and Saves changes
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Working With Disease Specific Forms

• After opening form, always start by clicking the
  ACTIVATE button. This retrieves the form data
  from the database.
• Add or edit data to form as required
• Click the SUBMIT FORM button to save changes
• Save changes frequently
• Click the printer icon in the upper
  left corner to print partially or fully completed
  forms
• Details are provided in the section Disease
  Specific Forms in Chapter 4 of the User Guide or
  by viewing Online Help.

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Exercise Disease Specific Forms

• Instructor Example
• Student Exercise
• Create a new case (using a different name and
  demographic information) with Meningococcal
  Disease as the reportable condition
• Find the new case in your case listings, open the
  Disease Specific Form and click ACTIVATE
• Add laboratory, epidemiologic and other
  information including the following data
• Bacterial species Neisseria meningitidis of
  serogroup W135.
• Symptoms confusion/memory loss and stiff
  neck/back
• Muscle paralysis in the neck muscles
• Fever of 101 degrees Fahrenheit
• Save the new information by clicking SUBMIT FORM

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Welcome Back to the MDSS
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Editing Address Information

• Address information can be edited in the Address
  History tab
• Refer to the section Cases in Chapter 4 of the
  User Guide or view Online Help for more details.

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Change of Jurisdiction Warning
The Change in Jurisdiction Warning occurs if you
change the Onset Date, Investigation Address, or
Home Address From and To Dates because the
Address dates and Onset Date determine LHJ
referral.
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The Lab Reports Tab

• The Lab Reports tab is where you can view
  electronic lab reports (ELRs).
• Electronic value of Yes means it was received
  by automated referral.
• Electronic lab reports cannot be modified.
• Click CREATE NEW LAB REPORT button to manually
  add a lab report.
• Click EDIT to view or edit an existing lab
  report.
• Use DELETE only if an entered report is not
  supposed to be associated with the patient.
• The Lab Reports tab lists all labs associated
  with a patient and not just the particular case
  you are viewing.

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Other Case Detail Tabs

• Demographics - provides information regarding the
  patient and collects important demographic
  information.
• Referrer - provides information regarding the
  case reporting and who made the referral.
  Referrer information has two major sections
• Person Providing Referral
• Primary Physician
• Notes - provides a free form entry of text notes
  that are associated with a case investigation.
• Refer to the section Cases in Chapter 4 of User
  Guide or view Online Help for more details about
  these sections.

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How to Search in the MDSS
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New Searches

• The New Search function allows you to create a
  new search.

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Basic Searches

• When the New Search function opens, the "Basic
  Search" screen will open.
• You can toggle between the "Basic Search" screen
  and the Advanced Search screen using the BASIC
  and ADVANCED buttons found at the bottom of each
  screen.

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General Notes on Searching

• You are only able to search on cases that you
  have entered.
• Text Searches use an asterisk () as a wild
  card
• L gives all entries that start with L
• Date searches
• Enter only From Date for all cases after and
  including a certain date
• Enter only To Date for all cases before and
  including a certain date
• Each new variable added operates like an and
  the search becomes more restrictive (i.e., Male
  and 2-6 YOA and Salmonella)
• Each selection within a variable operates like an
  or the search becomes less restrictive (i.e.,
  Detroit or Jackson or Alpena)

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Selecting and De-selecting Multiple Options

• Selecting Multiple Sequential Options
• Move the mouse cursor to first desired option on
  the list and click left mouse button.
• Move the mouse cursor to the last desired option
  of the list and hold down the SHIFT key while
  clicking the left mouse button.

• Selecting Multiple Non-Consecutive Options
• Move the mouse cursor to first desired option on
  the list and click left mouse button.
• Move the mouse cursor to the next desired option
  on the list and hold down the CTRL key while
  clicking the left mouse button. Repeat 2 until
  all desired options selected.

• De-Selecting Options
• Move the mouse cursor to option you want to
  de-select and hold down the CTRL key while
  clicking the left mouse button

See Appendix C for more details
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Creating a Saved Search

• Enter name of search in Name of Saved Search box.
• Select criteria.
• Check Default Search box if you want to make this
  your default search.
• Click on Save Finish to save
• Click on Search to create a temporary search that
  will not be saved.

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Executing a Saved Search
There are two ways to execute a saved Search
In Case Listings
In Searches
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Editing and Deleting Saved Searches

• The Searches function provides access to your
  saved searches to execute, edit, or delete
  existing searches.

• You cannot delete your default search, but Edit
  allows you to select a new default search.
• EDIT search works just like New Search but starts
  with the existing search criteria.

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Disease Specific Search

• The Search and New Search functions limit the
  selectable criteria to basic case information -
  information that is common to all diseases such
  as the patient last name and allows you to search
  across multiple diseases.
• The Disease Specific Search expands the
  selectable criteria to include all of the data
  collected for a particular reportable condition
  but you can only search one disease at a time.

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Disease Specific Search Results

• QUERY FORM launches the search and returns cases
  meeting the search criteria to the case listings
  page
• Refer to the section Disease Specific Search in
  Chapter 4 of the User Guide or view Online Help
  for more details.

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Exercise Creating a New Search and Modifying a
Search

• Instructor Example
• Student Exercise
• Create search for all current (Investigation
  Status of New or Active) cases of
  Salmonellosis in the last six months
• Save as Salmonella and then execute
• Open your Salmonella search from your saved
  searches
• Add Meningococcal Disease from the Reportable
  Condition list
• Save as Salmonella and N.Meningitidis and then
  execute

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Exercise Disease Specific Search

• Instructor Example
• Student Exercise
• Use the Disease Specific Search to find cases of
  Meningococcal Disease that match the following
  criteria
• W135 is the serotype
• And the case had muscle paralysis in the neck
  muscles

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Welcome Back to the MDSS
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Closing a Case and Reporting to CDC

• Only LHJ Administrators and State staff may close
  a case
• Only cases with Case Status Confirmed and
  Investigation Status Completed or Probably
  are reported to the CDC
• Changes made to cases that have been reported to
  the CDC will be resolved during annual data
  cleaning

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Print Investigation

• Currently, the Print Investigation feature within
  the Case Detail tabs has been disabled within
  MDSS.
• For now, use the Disease Specific Form to print
  case investigation information.
• 1) Open the form, 2) click Activate Form, and
  then 3) click the Printer icon in the toolbar.

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Display the Supplemental Forms
MDSS offers a method for printing and displaying
blank Disease Specific Forms.

• From the Side Navigation bar, point and click the
  DISPLAY SUPPLEMENTAL FORMS link. The
  Supplemental Forms screen will appear.
• Click the VIEW button. The Disease Specific form
  will open.
• Click the Close Form button to close the form and
  return to the form list.

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How to Run a Report in the MDSS
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Reports
There are several reports formats available
within the MDSS Reports module

• Report 1 - Line Listing
• Report 2 - Disease by Demographics
• Report 3 - Diseases YTD
• Report 4 - Diseases 5 Year History
• Report 5 - Diseases YTD by Geography
• Report 6 - Disease History by Geography
• Report 7 - Diseases by Geography
• Report 8 - Epi Curve
• Report 9 - GIS Reports

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Report Characteristics

• Each report provides a report parameter screen.
• Report parameters are used to identify which
  cases you would like to include in the report and
  determine the report format.

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Notes about MDSS Reports

• Reports contain data for cases that are
• Identified as "Suspected", "Confirmed,
  "Probable, or Unknown in the Case Status
  field, AND
• Identified as New, Active, or Completed in
  the Investigation Status field.
• (Not A Case, Canceled, and Superceded cases
  are excluded from Reports.)
• When you enter a date range as the Time Period
  parameter, MDSS selects cases with Onset Dates
  that fall within that range. If Onset Date is
  unavailable (missing), MDSS will use Referral
  Date instead.
• Report 1 Line Listing presents patient-level
  data. This report is limited to what is
  available to that user in the case listings.
• The rest of the reports presents counts or rates
  for all the cases in the state (no identifying
  data) therefore, there are no user-associated
  restrictions.

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Exercise Epi Curve Report

• Instructor Example
• Student Exercise
• Go into the Reports module by clicking Reports
  link at the top of the screen
• Select Report 8 Epi Curve
• Create a graph with the following properties
• All the cases of salmonella in the entire state
  since the beginning of the year grouped by week
• Display the report in PDF format and save it to
  your desktop

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Welcome Back to the MDSS
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Support and Help Contacts

• For browser and connectivity issues contact your
  local IT support
• Your Local Health Department is the primary point
  of contact for MDSS issues
• If your Local Health Department is unavailable
• Contact a MDCH Regional Epidemiologist (see next
  slide for info), or
• Contact the CD Immunization Division of MDCH at
  [phone] or mdch_mdss_at_michigan.gov

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Regional Epidemiologists
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Acknowledgements

• Michigan Department of Community Health
• Bureau of Epidemiology
• Bureau of Laboratories
• Office of Public Health Preparedness
• Michigan Department of Information Technology
• Altarum Institute
• Scientific Technologies Corporation
• MDSS Pilot Jurisdictions
• Macomb, Kent, Washtenaw, Marquette and Central
  Michigan
• MDSS Steering Committee Members
• Matthew Boulton, Bill Colville, Frances Downes,
  John Dyke, Jim Lee, Pamela Masur, Whitney Mauer,
  Linda Myers, John Petrasky, Girish Salpekar, Bill
  Schneider, Melinda Wilkins

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Thank you!Any questions?
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