Case Study

Summary

The Centers for Disease Control and Prevention’s (CDC) ReportStream helps State, Tribal, Local, and Territorial (STLT) Health Departments quickly receive disease test result data from testing sites, for their jurisdiction, enabling them to make well-informed decisions that keep our communities safe and healthy. We partnered with CDC to operate and expand ReportStream, promoting a public health ecosystem that’s flexible and resilient in the face of disease outbreaks.

Approach

ReportStream was born out of the need to quickly deliver lab data on COVID-19 test results to public health departments during the pandemic. As the technology evolves post-public health emergency, CDC’s main goal with ReportStream is response readiness. This means equipping public health departments with the data they need to make informed decisions during outbreaks of any disease. 

Outcomes

All of our work on this project has been in service of response readiness. This means helping CDC prepare for outbreaks of conditions that are new to ReportStream, expanding ReportStream’s sender and receiver base, and streamlining how CDC’s infectious disease labs share data with state public health departments.   

To prepare for outbreaks of new or different conditions, we supported CDC in building a new data pipeline — or a system that aggregates and delivers data — to support test result data for diseases such as influenza A and B and respiratory syncytial virus (RSV). Notably, this pipeline can transmit data for new or different conditions in two days or fewer — something that previously took around six months. This means CDC will be able to act quickly should an outbreak occur.

Ensuring response readiness also means supporting as many testing sites as possible. Often, people use over-the-counter tests to determine what illness they have, and it’s important these test results get reported. That’s why we worked with CDC and the National Institutes of Health (NIH) to develop a solution that enables individuals and healthcare providers to report over-the-counter test results, helping to close the gap in data coverage.

Similarly, response readiness means maximizing the number of STLTs that can receive data from ReportStream. We partnered with CDC to expand the number of STLTs that can receive data from testing sites by decreasing the amount of time it takes to onboard receivers onto the pipeline. Overall, we helped ReportStream onboard seven STLTs. 

Finally, we are supporting development of an in-house solution to deliver test results from CDC’s infectious disease labs back to state public health departments. For this work, we are partnering with 27 labs at CDC to deliver test results for over 100 different viral, parasitic, bacterial, and fungal conditions. When complete, this solution will enable STLTs to receive test results quicker, helping them to make data-informed decisions in real time. 

Process

Expanding the conditions that ReportStream supports

The first iteration of ReportStream, the COVID-19 Pipeline, was specifically built to transport data on COVID-19 test results and later updated to support mpox test results. However, response readiness means that public health departments must be able to quickly receive test result data on conditions that are new to the pipeline.  

To achieve this, we helped CDC build a new, more flexible data pipeline — the Universal Pipeline — that can transport data on any type of disease. To ensure the pipeline worked as expected, we tested it with sample flu data, took note of errors that cropped up, and addressed those errors. We ran tests like this until the pipeline delivered accurate sample data to public health departments. 

Next, we ran another test with RSV data. This test returned far fewer errors, signifying that the Universal Pipeline was nearly ready to transport data on new diseases. Once the pipeline was able to transmit RSV data with 100% accuracy, we deployed it into production. 

Currently, we are migrating senders and receivers away from the original COVID-19 Pipeline and onto the Universal Pipeline. 

Increasing ReportStream’s sender/receiver base 

To maximize the impact of ReportStream, it must reach as many senders and receivers as possible. In general, senders are testing sites like hospitals or public health labs, but may also be more unconventional testing sites such as schools or hotels. Receivers are public health departments and CDC. 

To add more senders to ReportStream, we are working with NIH to develop a solution for people to report their at-home test results with Make My Test Count. When test manufacturers receive at-home test results, they can also use Make My Test Count for reporting.   

To add more receivers to ReportStream, we had to decrease the time it takes to onboard new organizations onto the pipeline. Onboarding includes meeting with the receiver to understand what kind of data they want to receive and how often, and then verifying that they’re correctly receiving that data.

Historically, it has taken up to 131 days to onboard receivers onto ReportStream. However, response readiness means public health departments must be able to immediately receive test results, should there be another outbreak of disease.

With CDC, we were able to reduce onboarding time to 19 days. For this work, we leveraged human-centered design to develop an onboarding guide and documentation that is easy for receivers to understand. Because receivers all have different system and policy needs, we enable them to customize the data they get from ReportStream. And to speed up the onboarding process, we are using automation to test whether receivers are getting the correct data. 

In addition to decreasing onboarding time, we leveraged CDC’s existing relationships to conduct outreach to public health departments and onboard as many of them as possible. 

Helping STLTs receive test results quicker

When a positive test result occurs for certain diseases, public health best practices require a second test to confirm the result. In this scenario, a state public health department can work with CDC’s infectious disease labs to confirm the positive test result. 

Currently, states must spend time decrypting data they receive from CDC, which can be burdensome and time-consuming. On the other hand, ReportStream is within CDC’s firewall and can route data without encryption. Therefore, it is more efficient, secure, and cost-effective to use ReportStream when sending test results back to states. 

We piloted a solution that delivered sample data from CDC to two states. The states successfully received the data, enabling us to submit our pilot solution for internal security review from CDC. Once that review is complete, we will start transmitting real data to the states.

Conclusion

CDC is helping the public prepare for the next pandemic with response readiness. Nava has been involved in this effort by helping CDC expand the conditions that ReportStream supports, increasing ReportStream’s sender/receiver base, and streamlining how public health departments receive data from CDC. Ultimately, our shared work is helping public health departments make data-informed decisions about the public’s well-being.

Special thanks to Chloe Hilles for contributing to this article.