Share this article on:

Neisseria gonorrhoeae Outbreak: Unintended Consequences of Electronic Medical Records and Using an Out-of-State Laboratory—California, July 2009–February 2010

Murray, Erin L. PhD, MSPH*†; Samuel, Michael C. DrPH; Brodsky, Jennifer MPH; Akiba, Christopher F. MPH; King, Courtney BA; Li, Michael MPH; Wollesen, Miriam MA; Gonzales, Patricia E. BS; Watt, James P. MD, MPH; Bolan, Gail MD

Sexually Transmitted Diseases: July 2013 - Volume 40 - Issue 7 - p 556–558
doi: 10.1097/OLQ.0b013e3182927c8c

Twenty of 37 gonorrhea cases identified during an outbreak were diagnosed at one health care organization that used an out-of-state laboratory. The results were transmitted into electronic medical records without provider notification. Delays in treatment and reporting were identified. Systems should be implemented to ensure provider notification of electronic laboratory results.

Lack of provider notification of positive gonorrhea test results by an electronic medical record system likely contributed to a gonorrhea outbreak by delaying case treatment and reporting to public health.

From the *Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; and †Sexually Transmitted Diseases Control Branch and ‡Division of Communicable Disease Control, California Department of Public Health, Richmond, CA

The authors thank Joe Sanchez, Romni Neiman, and Carol Kong at the California Department of Public Health for their field and epidemiologic support; Susan Philips and Mark Pandori at the San Francisco Department of Public Health for their laboratory support; and Diana Bensyl at the Centers for Disease Control and Prevention for her comments on the manuscript. The outbreak investigation and preparation of this manuscript were conducted in full collaboration with the county department of health staff. These staff would have been coauthors on this manuscript if county anonymity was not desired. The county jail and juvenile hall and Healthcare Organization A were all fully cooperative throughout the investigation and provided critical support.

Supported by the California Department of Public Health.

Conflicts of interest: The authors have no conflicts of interest to declare.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Current affiliation of Erin L. Murray: Immunization Branch, California Department of Public Health, Richmond, CA. Current affiliation of Jennifer Brodsky: Family Health Care Nursing, School of Nursing, University of California San Francisco, 2 Koret Way, Room N-411, San Francisco, CA. Current affiliation of Christopher Akiba: Department of Psychiatry and Behavioral Sciences, The Washington Institute for Mental Health Research and Training, 9601 Steilacoom Blvd, Tacoma, WA. Current affiliation of Michael Li: Chiang Mai University School of Medicine, Suthep, Mueang Chiang Mai, Chiang Mai, Thailand. Current affiliation of Miriam Wollesen: The Wright Institute, 2728 Durant Ave, Berkeley, CA. Current affiliation of Gail Bolan: Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

Correspondence: Erin L. Murray, PhD, MSPH, Immunization Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA 94804. E-mail:

Received for publication June 15, 2012, and accepted March 11, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association