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How The Digital Bridge Is Transforming Public Health Interoperability

Published on 11/7/2018
The push for interoperability in health care continues as organizations increasingly recognize the value of exchanging and interpreting patient information among secure systems. In 2016, health care, health IT and public health organizations partnered to create The Digital Bridge—an initiative to advance bidirectional electronic information flow between health care delivery systems and public health agencies. A governance body, work groups and program management make up The Digital Bridge structure. The Centers for Disease Control (CDC), Office of the National Coordinator for Health Information Technology, Association of State & Territorial Health Officials, Council of State & Territorial Epidemiologists (CSTE), National Association of County and City Health Officials, Association of Public Health Laboratories (APHL) and Cerner are among the group’s governing organizations. The CDC, Robert Wood Johnson Foundation and de Beaumont Foundation are funders. The project management office consists of the Public Health Informatics Institute and Deloitte. 


Better infectious disease reporting

The Digital Bridge’s current priority is the development of a multi-jurisdictional approach to electronic case reporting (eCR), which reduces the burden of public health reporting of infectious diseases and improves the timeliness, accuracy and value of the data. At the heart of the design is a central decision support platform and service to facilitate eCR. It leverages existing electronic health record (EHR) systems to automatically trigger and select potential reportable disease cases and create an initial electronic case report (eICR). The EHR then sends the eICR digitally to the central decision support service platform to validate its format and determine whether the case is reportable to public health. If so, the platform sends the reportable eICRs to the appropriate public health agencies. The platform also sends an electronic reportability response (RR) to the health care organization and public health agency.

The decision support service runs on a secure, cloud-based platform called the APHL Informatics Messaging Service (AIMS). The Reportable Conditions Knowledge Management System (RCKMS), which was developed by the CSTE, evaluates the case reports against public health reporting criteria.  Chlamydia, gonorrhea, pertussis, salmonellosis and Zika are among the initial reportable conditions for testing. Ultimately, reporting will include more than 70 conditions. 



The decision support service eliminates guesswork on case jurisdiction and alleviates laborious manual reporting processes – via web portals, fax, phone or mail – for health care professionals. This real-time, automated process improves the speed, accuracy and value of the data. It is designed to be system-agnostic and adoptable by any size organization and data provider. 


National eCR pilot program 

To effectively test the technical approach, The Digital Bridge is coordinating eCR implementations at selected sites in 2018 and 2019. Each site is composed of a state or local public health agency, a health care provider within the agency’s jurisdiction and the provider’s EHR vendor. Included in the initial six sites are Intermountain Healthcare in Salt Lake City; Lawrence Memorial Hospital in Lawrence, Kansas; the Michigan Health Information Network based In East Lansing; Methodist Hospital in Houston; UC Davis Medical Center in Sacramento; and the New York City Institute for Family Health.

The Digital Bridge evaluation committee created a plan to assess the eCR process and the overall implementation experience. As the sites continue through the process, each will provide feedback through data submission and key informant interviews.


Legal support for eCR deployment 

Health IT and privacy experts developed the legal framework and agreements required to implement the eCR technical approach. The current legal strategy positions the decision support service to act as a business associate of health care organizations or their existing health information exchange partners. This allows the AIMS data management platform and the RCKMS disease surveillance portal to access required patient data and facilitate case reporting on behalf of providers.  

While stakeholder groups have expressed consensus on this approach during the initial phase, there is interest in evaluating the long-term viability of the support service acting on behalf of public health agencies. This may require participation by the eCR partners in certified networks such as DirectTrust, Commonwell Health Alliance and others. 

As The Digital Bridge advances in its examination of sustainable strategies for eCR infrastructure and support of additional interoperability use cases, the goals of reducing costs and improving health and care will continue to guide the collaborative’s innovative efforts.  

Learn more about Cerner’s commitment to patient-centric interoperability through sharing data. For further information about The Digital Bridge, visit