State Synergies and Disease Surveillance: Creating an Electronic Health Data
Communication Model for Cancer Reporting and Comparative Effectiveness Research in
Kentucky
Authors: Reams Christopher , Powell Mallory , Edwards Rob 
Published: August 2014

Purpose: This case study describes the collaboration between a state public health
department, a major research university, and a health extension service funded as part
of the Health Information Technology for Economic and Clinical Health (HITECH) Act to
establish an interoperable health information system for disease surveillance through
electronic reporting of systemic therapy data from numerous oncology practices in
Kentucky. The experience of the Kentucky cancer surveillance system can help local and
state entities achieve greater effectiveness in designing communication efforts to
increase usage of electronic health records (EHRs) and health information exchanges
(HIEs), help eligible clinicians meet these new standards in patient care, and conduct
disease surveillance in a learning health system.Innovation: We document and assess the
statewide efforts of early health information technology (HIT) adopters in Kentucky to
facilitate the nation’s first electronic transmission of a clinical document
architecture (CDA) from a physician office to a state cancer surveillance registry in
November 2012. Successful transmission of the CDA not only represented a landmark for
technology innovators, informaticists, and clinicians, but it also set in motion a new
communication mechanism by which state and federal agencies can capture and trade vital
cancer statistics in a way that is safe, secure, and timely. The corresponding impact
this has on cancer surveillance and comparative effective research is immense. With
guidance from the Centers for Disease Control and Prevention (CDC), the Kentucky Cancer
Registry (KCR), the Kentucky Health Information Exchange (KHIE), and the Kentucky
Regional Extension Center (KREC) have moved one step further in transforming the
interoperable health environment for improved disease surveillance.Credibility: This
case study describes the efforts of established and reputable agencies, including the
KCR, the state department of health, state and federal governmental agencies, and a
major research university in leveraging existing networks, infrastructure, and federally
awarded funding to implement interoperable health information systems for disease
surveillance. Project assessment through quasi-qualitative interviews with key
stakeholders facilitated evaluation of attitudes and beliefs for continued use of the
cancer surveillance model.Conclusion and Discussion: In Kentucky, the cancer reporting
initiative leveraged and enhanced a solid foundation for statewide collaboration to
achieve better health and improved disease surveillance through a learning health
system. Leveraging the Meaningful Use (MU) program as an overarching policy and
structural driver is imperative. The cancer reporting initiative in Kentucky suggests
that future surveillance and reporting initiatives will require locally adaptable
solutions and that there is a need for increased technical assistance in rural settings.
Kentucky's experience also indicates that stakeholders should be diligent in identifying
state-level criteria that align with MU for vetting EHR vendors.