Public health departments in the United States are authorized to carry out public health functions within ascribed jurisdictions. Authority and responsibility for case investigation and contact tracing resides with state, tribal, local and territorial health departments, and is granted through legislation and regulation. The US population is mobile. Some people live in one jurisdiction and work in another. Other people, including critical infrastructure workers, routinely travel through multiple local and state jurisdictions in the transport of goods or provision of services. And others travel through or stay in local jurisdictions, outside of the one they reside, during daily life, social or recreational activities.
Health departments may become aware of a person, diagnosed with COVID-19 or exposed to COVID-19, who resides outside of the health department’s jurisdictional boundaries. This information may come to their attention through a variety of means, including through provider and laboratory reports, or the efforts of case investigators and contact tracers who are following-up with persons infected with or exposed to COVID-19. Health departments routinely need to securely transfer protected personally identifying and health information regarding cases and contacts to the appropriate jurisdiction in order to facilitate prompt health department follow-up to provide test results or conduct exposure notification and link cases and contacts to local health care services and social supports, as indicated. Transfer of cases to the appropriate jurisdiction also allows for more accurate accounting of morbidity. Over the years, health department communicable disease control programs have employed various mechanisms by which to transfer cases and contacts; however, a universal interjurisdictional transfer mechanism, has yet to be established. This document provides guidance to health departments regarding critical points for consideration in the transfer of COVID-19 cases and contacts between health jurisdictions.
“Interjurisdictional” simply means across jurisdictions. Within the United States, public health jurisdictions are generally defined by the geographic boundaries of local city or county, states, territories, and tribal nations. Municipal and county health departments have their own public health jurisdictions and may have authorities to operate autonomously from their respective state health department. With autonomous municipal or county health departments, there are longstanding and well-understood processes for interjurisdictional transfer of communicable disease cases and contacts within a state. This Technical Assistance Note does not seek to guide transfer of information within a single state jurisdiction, but rather focuses on considerations for interjurisdictional transfers for COVID-19 cases and contacts, particularly between states, tribes and territories, where those processes may not already be well established.
Timeliness and Security
- For certain conditions such as sexually transmitted diseases, health departments may rely on Interstate Communications Control Record (ICCR) processes for interjurisdictional transfer of cases and contacts. While functional, these systems are heavily person- and paper-dependent; transfers often happen over the phone or by fax machine which are suboptimal for rapid transfer and tracking of a high volume of incoming and outgoing records. The low-tech nature of this platform can increase the risk of confidentiality breaches and can delay transfers between jurisdictions if key personnel are absent.
- CDC’s Epidemic Information Exchange (Epi-X) is one method for facilitating interjurisdictional data exchange. Epi-X is a secure, web-based platform that allows for instant transfer of public health data to jurisdictions across the US. Users authorized by their respective health departments can be enrolled in Epi-X; currently there are over 6000 authorized users.
- Epi-X was developed to provide a) a secure communication system and editorial staff to help national, state, and local health officials across program areas quickly prepare and distribute provisional or final postings of disease outbreaks and other health events and b) the means to discuss these events with one, some, or all Epi-X users
Access and Implementation
- Each potential user must obtain pre-approval from their organization before enrolling in Epi-X. The authorizing official at each participating organization designates public health officials who can enroll as Epi-X users. For users at the state level, this authorizing official is the state epidemiologist. Public health professionals interested in participating in the program can contact Epi-X at EpiXHelp@cdc.gov.
- Currently there is no limit on the number of authorized users per jurisdiction that can be granted access to Epi-X. Multiple personnel within health departments can execute transfers at any time of the day.
- Within Epi-X, transmitting health departments can track outgoing transfers and monitor the acceptance of their transfer by the receiving health department.
- There are no mandated forms or templates for transfer of cases and contacts; however, there are sample templates available to users within Epi-X. Within reason, each health department can transfer the case or contact information in a format that is aligned with their own processes and information systems. In many instances, health departments opt to transmit a simple spreadsheet of cases and contacts to the receiving health department. Reference the list of suggested data elements for transfer below.
- Online help is available within Epi-X and there are editorial staff available to users around the clock.
*Because contacts are usually identified through interviews with case clients, not all information listed here may be available (e.g. last name, date of birth)
**When COVID cases are surging, additional information can help the receiving jurisdictions prioritize cases and contacts for interview and follow-up. Useful information includes race/ethnicity, whether the case or contact is a health care worker or critical infrastructure worker, has underlying health conditions, or lives or works in a congregate setting such as a nursing home, dorm or shelter.