Public health reporting

Public health reporting: what it sends and how to turn it on

Admin → Public health reporting sends the reports your health department requires and shows what it answered. It covers two kinds of report, each with its own switch in Admin → Additional Features, both off by default:

Immunization registry reporting stays in Admin → Immunization Registry and has no separate switch; see Immunization registry.

1. Turn on the reports you need. In Admin → Additional Features, switch on Syndromic surveillance reporting, Electronic case reporting, or both, and click Save Changes.
2. Open Admin → Public health reporting. It is under Practice in the Admin menu. The page has a Syndromic surveillance tab and a Case reporting tab (each only when its switch is on) and a Message log.
3. Connect each report to your health department (Connect to your health department), send a test, then Turn on.

Reports sent for a patient are listed in that patient’s Disclosure history when that feature is on.

Connect to your health department

The Syndromic surveillance and Case reporting tabs each have their own connection, laid out the same way.

1. Choose where reports go. Under Where reports go (“Your health department gives you the web address and sign-in.”), Send to starts on Test mode — Hero answers like an agency would; nothing leaves Hero. When your agency is ready, choose My health department’s secure web address and enter the Web address and Sign-in (None, User name and password, or Access token). A saved password or token is never shown again; the field reads Saved — type to replace.
2. Choose the environment. Environment is Testing (messages marked as test) by default, or Live once your agency has approved you.
3. Fill in your facility. Under Your facility: Facility name, Facility NPI (10 digits), Kind of facility (Urgent care, Primary care clinic or Specialty clinic), and, if your agency gave them, Receiving system and Receiving facility. Syndromic surveillance also asks for the County code (FIPS, 5 digits). The first save fills in the practice’s name and NPI when you leave them empty.
4. Click Save (or Discard changes). Hero says Settings saved.
5. Click Send test message. A test uses a made-up patient, so it can be sent before reporting is on. The result shows as Test message: ….
6. Click Turn on. The status bar changes from Reporting is off to Reporting is on, with where reports go (Test mode: nothing leaves Hero or Sending to …), Live or Testing, and when the last report was delivered.

Syndromic surveillance: choose the visits

On the Syndromic surveillance tab, Which visits says: “Each chosen visit sends a short notice when it starts, when it changes and when it ends. Patient names are never sent.”

• Walk-in visits on the urgent care board (on by default) — every walk-in on the Waiting Room board.
• Also these visit types — pick any practice visit types to report as well (none by default). A walk-in whose visit type you also chose is reported once.
• Send an update when the diagnosis or complaint changes (on by default).
• Replies — The agency does not reply to each message (the default) or The agency replies to each message; your agency tells you which.

A notice carries the chart number, birth date, age, sex, race and ethnicity, city, state, ZIP and county (never the street or the patient’s name), the complaint, diagnoses and vital signs. A walk-in removed from the board cancels anything still waiting to go for it.

Electronic case reporting: from a reportable visit to public health’s answer

On the Case reporting tab, a line confirms that the national list of reportable conditions is loaded (“Reportable condition list loaded: version …”). If it says the list is not loaded yet, no visit can match: ask Hero support to load it.

When to report

• Send case reports automatically (off: a clinician reviews each one on the chart and sends it) — on by default.
• Include positive lab results — on by default. Lab orders on the list are checked either way.
• Show a notice on the chart until a clinician reviews a reportable answer — on by default.
• Wait after signing (minutes) — 0 by default, up to 1440.

What makes a visit reportable

Hero checks each signed visit, and visits whose lab orders or results change, against the national list: the visit’s diagnoses and linked problems, lab orders on the list, and positive or abnormal lab results (negative results never count). A lab ordered outside a visit is checked with the patient’s latest visit from up to 14 days before the order. Each visit has one case; if its matches change after a report was sent, Hero sends an updated report. Unlike syndromic notices, a case report identifies the patient.

Case reports

The Case reports card lists each matched visit with Found, Matched (the conditions), Status and Answer; filter by status at the top.

An answer that arrived another way. If public health sent its answer outside Hero, click Add a response on a sent or answered case, paste the response, and click Add response. Hero checks that it answers that exact report; otherwise it says, for example, “This response answers a different case report”.

In test mode, Hero answers each report itself with Reportable and says so: “Test mode: reportability determined by Hero’s test double, not by public health.” With no cases yet, the card reads “No case reports yet”.

The case report notice on the chart

While Electronic case reporting is on, an amber line appears at the top of the patient’s chart (in both chart layouts and in the inbox patient bar) when a case needs a clinician:

Physicians and practice administrators can act on the notice, and so can nurses with “Review results and mark them nurse reviewed (the physician still reviews them).” Others with access to the chart see the line without buttons. At most two cases show at a time.

If Send case report says “Case reporting is not turned on”, the connection on the Case reporting tab is off; ask whoever manages public health reporting to turn it on.

Message log: what was sent and what came back

The Message log tab lists “Every report Hero sent or is about to send, with the agency’s answer.” Filter by kind (All reports, Syndromic surveillance, Case reports) and status. Each row shows When, Report (for example Syndromic · Visit started, with a Test badge on test messages), Status and a Note.

When the agency has a temporary problem or does not answer in time, Hero tries again after 1 minute, 5 minutes, 15 minutes, 1 hour and 6 hours, then marks the message Failed (Gave up after … attempts). A refused sign-in or a rejected request fails at once: fix the connection, then resend.

Click a row for its details: Created, Sent, Answered, Attempts, Message ID, and public health’s answer. Send again re-queues a failed or rejected message; Cancel stops one that is waiting or failed. Show the message as sent shows its content to people with audit log access; after 90 days the content is removed and only the status trail stays.

Immunization registry: new choices and what the chart shows

Recording vaccines and connecting a state registry are described in Immunizations & MIIS. The registry connection is in Admin → Immunization Registry (staff need “Configure the state immunization registry connection and review submissions.”). These choices are new:

Connection

• Standard CDC format under State, for a registry that accepts the standard CDC immunization format (or for certification testing). Choosing it starts with refusals reported and a patient’s doses sent together; you can change both in Sync Settings.
• Receiving application (MSH-5) and Receiving facility (MSH-6), issued by the registry during onboarding, when the chosen registry does not fix them.
• How messages travel: Registry web service (CDC WSDL) (the default) or Copy and paste (registry portal or test tool). With copy and paste there is no web address, sign-in or connection test: each message waits in Activity until you paste the registry’s reply, and look-ups wait in the patient’s Immunizations tab.

Sync Settings

• Refusals and doses not given (off by default) — “Report when a patient or parent declines a vaccine, or a dose is not given (contraindication, immunity).”
• Doses for one patient — Send each dose in its own message (the default) or Send a patient’s waiting doses together.
• Query type — History plus the state’s forecast (Z44), where the registry offers it, fills the registry tables in the chart.
• Manual only under when to report now sends a dose when you release it with Send from Activity.

Copy and paste in Activity and the chart

1. A report: in Activity, open a row marked Waiting for the reply, click Copy, send the message through the registry’s portal or test tool, paste the reply into Paste the registry’s acknowledgement here, and click Record reply. One reply applies to every dose in that message.
2. A look-up: on the chart’s Immunizations tab, Check registry prepares the query (Query ready to copy). Click Copy, send it through the registry, paste the reply, and click Read the reply. A waiting query survives a reload.

Copying a message’s content needs audit log access. A reply for a different message is refused.

In the chart

• Registry history — “How the registry counted each dose it holds, read-only.” Columns Vaccine, Given, Age, Counts toward, Dose (for example 2 of 4) and Valid.
• Registry forecast — read-only, from the registry, with Earliest, Due, Latest and Overdue dates. The chart’s own Due & recommended list remains the source of truth.
• No match. “The registry found too many possible matches. Add county, phone or the mother’s maiden name to the chart and check again.”

Recording a dose

• For the state registry appears for doses given here while registry exchange is on, listing what the registry needs for every dose: always VFC eligibility; for most registries Vaccine Information Statement given on (it starts on the dose date); and, depending on the registry, VIS barcode, NDC or Funding source. A missing one reads Needed for the state registry. For patients 19 and older, VFC eligibility starts as not eligible.
• Reaction after this dose (optional) records a coded reaction, for example Anaphylaxis or Seizure within 72 hours, which is sent to the registry with the dose.
• Parent or guardian refused is a new Reason not given. Refusals and doses not given are reported only when Refusals and doses not given is on.
• Doses copied from your previous EHR are never reported; that system already reported them.

When the registry asks for a correction, Activity now says what to fix in plain words, for example “Add the date the Vaccine Information Statement was given (Chart → Immunizations → open the dose).”, followed by the technical detail.