Q: Describe your roles with the Utah DHHS.

Boulton: As informatics director, I oversee the development of our public health data ecosystem, and my team builds, maintains, and modernizes the systems that take in and store the public health data we collect. We make sure that information from labs, hospitals, and other healthcare providers comes to us securely, rapidly, and in a format that is compatible with our systems. Eason: As the director of the Office of Communicable Diseases, I’m primarily responsible for making sure that our epidemiologists and local health department experts have the resources and infrastructure that they need to turn information provided by our informatics team into public health action. My team creates reports and dashboards to classify cases of disease and other resources that help ensure that our public health teams have good, reliable data to inform effective interventions.

Q: How do your divisions help prevent the spread of communicable diseases?

Boulton: Using the public health “data superhighway” analogy, the informatics team creates the “roads” and the “on- and off-ramps” for Jeff and his teams to safely “drive” the data where it needs to go so that they can make effective, actionable decisions. So, it's critical that we work together, because there's no point in building infrastructure if it doesn't allow us to implement successful public health interventions. Eason: Yes, Rachelle and the informatics program bring ideas on how we can better organize ourselves and help alleviate some of the manual strains on our epidemiologist investigators. The infrastructure they build enables our epidemiologists to be more effective and more efficient, and ultimately decreases the resource drain in Utah.

Q: What was the motivation for updating Utah’s communicable disease rule?

Boulton: During COVID-19, it became painfully clear that public health was under-resourced, particularly our abilities to collect, process, and use data. We realized that we were still living in a world that was built on paper-based faxes and manual spreadsheets and that created a detrimental lag time in data exchange. With the volume and velocity of data we process, we just could not stay on top of the situation. We had the technology, but the policies hadn’t kept pace. We needed a structural overhaul of our communicable disease rules so that we could mandate modern standards-based electronic data exchange. Eason: I agree, and given that we're in an environment of limited, sometimes decreasing resources, public health needs to be able to do more with less. Automated electronic reporting for case and lab reports helps us take advantage of what’s already available and capture more quality data more quickly without requiring error-prone manual processes. The result we wanted to achieve is better-informed and more streamlined processes and public health investigations.

Q: What do you hope will be achieved now that the rule has been updated?

Eason: I'm hoping that the updates will make it easier for data reporters to comply with the rule, so that we see increases in the completeness and quality of our data. If that happens, the DHHS ultimately will have better information to provide back to healthcare providers, to decision-makers, and to our communities. Boulton: My end goal is that we have long-term sustainable processes across the entire public health ecosystem. That includes healthcare providers, where a lot of our data originates. Too often in the past, those providers have done a ton of work to share critical data and then don’t really see where it goes or what the value is. With this update, we really wanted to set up a data reporting process that was a win-win for all of us.

Q: Could you tell us more about the experience of bringing informatics and epidemiology teams together to collaborate on this rule revision?

Boulton: We brought complementary strengths. Informatics brought that technical reality of what was possible. And epidemiology brought that clinical reality. And together, we were able to determine not just what we can do but also what we should do. What makes sense given the fuller picture we’re able to create and see together? Eason: That collaboration was further enhanced by bringing in other partners. By listening to our stakeholders, we were able to fill in the gaps and address misconceptions or misunderstandings. And that was an area where Pew’s support was critical. Pew really helped make the stakeholder engagement meaningful, and as a result, we were able to make our rule much more robust. For example, the stakeholder feedback helped us see that we needed clearer terminology and definitions for fundamental things—like what qualifies as a laboratory or as a critical access hospital? By getting that feedback early on, we were able to make updates so that now it’s much easier and more straightforward for healthcare providers to know what categories they fall into, and therefore easier to know what parts of the rule apply to them.

Q: How will the updated rule benefit hospitals and the health department?

Boulton: With the new eCR requirements, we are now able to receive more of the rich clinical data, including diagnoses, travel histories, comorbidities, pregnancies, etc., that’s really valuable to public health, straight from the hospitals’ electronic health records. And the data coming to the public health department is also more timely and less likely to have errors because eCR doesn't require any of the tedious, manual work—like filling out forms and faxing information. The moment a physician inputs a diagnosis or a positive test result for a reportable disease comes back, that data is packaged up and sent to us automatically. Eason: So now with the more timely and accurate data coming from eCR, we can more quickly and effectively prioritize issues for follow-up and make sure that we’re focusing our resources for time-intensive efforts, like contact tracing, in the right places and in ways that are most meaningful and impactful for Utahns. Boulton: Another benefit is that eCR really saves practitioners time—something we were able to quantify in a time-motion study as part of an early eCR pilot. For the conditions that the DHHS analyzed, the time-motion study showed that eCR reduced the staff time spent on manual case review from 4:22 minutes to 2.4 seconds per case, resulting in over 160 hours of annual staff time saved for those conditions alone. And, eCR also automates compliance, which means more complete data for public health. We just recently were looking at a chickenpox evaluation, and we found that eCR allowed us to find 64% more cases than were being reported manually. Having that additional case data is a real difference maker for protecting people’s health. It gives us a fuller picture of how the disease is spreading and makes our disease prevention and other public health interventions more effective. Eason: In addition to finding more cases of disease with eCR, the more detailed, quality data shared via eCR also translates to an improved ability to detect severe complications and differentiate between similar diseases—something that typically requires time/resource-intensive investigator outreach/follow-up.

Q: What advice would you give to health departments in other states that are looking to expand the use of eCR?

Boulton: One recommendation I’d make is to update policies and regulations hand-in-hand with technology, because often technical tools are only as effective as the laws that are backing them. I’d also say it’s helpful to emphasize that eCR and other electronic data exchange technologies are a win-win that benefits everyone. And, finally, be collaborative and engage partners and the broader public health community. Whether it’s other health departments or organizations like Pew, there’s a willingness to brainstorm and share lessons learned. Eason: Making the economic case to decision-makers and demonstrating impact over time helps build support and momentum around the work that we do. Over the last several updates to the communicable disease rule, we’ve been able to concretely show that each update has had benefits to the public health system and improved our data quality and our response time, and ultimately those translate into economic savings. Lastly, don’t let perfection be the barrier to progress. We've done these updates to our communicable disease rule over years, and each iteration has improved the rule. It's incremental. Boulton: Yes, that's a big one: a stepwise approach is OK. You can have smaller successes and build on those.

Utah Modernizes Public Health Data Reporting—a Win for Government and Residents

How state became one of the first to expand automated, real-time exchange of reportable disease information

Article July 16, 2026

On June 1, Utah became one of the first states in the U.S. to require acute care hospitals to use electronic case reporting (eCR)—the automated, real-time exchange of information—to notify public health agencies about instances of reportable communicable diseases. This new eCR requirement was a key part of a broader update to the state’s communicable disease rule, which is designed to protect Utahns from transmissible illnesses, environmental hazards, or unusual conditions that can pose a significant threat to public health (for example, a salmonella outbreak or lead poisoning).

In the U.S., each state designates a priority list of communicable diseases and health conditions that healthcare providers and others are legally required to report to their public health agencies. Public health agencies use the data to monitor and detect threats and to design and implement strategies to reduce disease spread and impact.

The Pew Charitable Trusts provided technical assistance to Utah’s Department of Health and Human Services (DHHS) to support the development and finalization of the new eCR requirement, collaborating with state communicable disease experts. For this Q&A, we spoke with Rachelle Boulton, informatics director for the Division of Population Health, and Jeffrey Eason, director of the Office of Communicable Diseases, about the role of interdepartmental collaboration, the impetus for modernizing the state’s electronic reporting requirements, and how Utahns will benefit from the updated rule.

This interview has been edited for clarity and length.

Courtesy of Rachelle Boulton

Courtesy of Jeffrey Eason

Q: Describe your roles with the Utah DHHS.

Boulton: As informatics director, I oversee the development of our public health data ecosystem, and my team builds, maintains, and modernizes the systems that take in and store the public health data we collect. We make sure that information from labs, hospitals, and other healthcare providers comes to us securely, rapidly, and in a format that is compatible with our systems.

Eason: As the director of the Office of Communicable Diseases, I’m primarily responsible for making sure that our epidemiologists and local health department experts have the resources and infrastructure that they need to turn information provided by our informatics team into public health action. My team creates reports and dashboards to classify cases of disease and other resources that help ensure that our public health teams have good, reliable data to inform effective interventions.
Q: How do your divisions help prevent the spread of communicable diseases?

Boulton: Using the public health “data superhighway” analogy, the informatics team creates the “roads” and the “on- and off-ramps” for Jeff and his teams to safely “drive” the data where it needs to go so that they can make effective, actionable decisions. So, it's critical that we work together, because there's no point in building infrastructure if it doesn't allow us to implement successful public health interventions.

Eason: Yes, Rachelle and the informatics program bring ideas on how we can better organize ourselves and help alleviate some of the manual strains on our epidemiologist investigators. The infrastructure they build enables our epidemiologists to be more effective and more efficient, and ultimately decreases the resource drain in Utah.
Q: What was the motivation for updating Utah’s communicable disease rule?

Boulton: During COVID-19, it became painfully clear that public health was under-resourced, particularly our abilities to collect, process, and use data. We realized that we were still living in a world that was built on paper-based faxes and manual spreadsheets and that created a detrimental lag time in data exchange. With the volume and velocity of data we process, we just could not stay on top of the situation.

We had the technology, but the policies hadn’t kept pace. We needed a structural overhaul of our communicable disease rules so that we could mandate modern standards-based electronic data exchange.

Eason: I agree, and given that we're in an environment of limited, sometimes decreasing resources, public health needs to be able to do more with less. Automated electronic reporting for case and lab reports helps us take advantage of what’s already available and capture more quality data more quickly without requiring error-prone manual processes. The result we wanted to achieve is better-informed and more streamlined processes and public health investigations.
Q: What do you hope will be achieved now that the rule has been updated?

Eason: I'm hoping that the updates will make it easier for data reporters to comply with the rule, so that we see increases in the completeness and quality of our data. If that happens, the DHHS ultimately will have better information to provide back to healthcare providers, to decision-makers, and to our communities.

Boulton: My end goal is that we have long-term sustainable processes across the entire public health ecosystem. That includes healthcare providers, where a lot of our data originates. Too often in the past, those providers have done a ton of work to share critical data and then don’t really see where it goes or what the value is. With this update, we really wanted to set up a data reporting process that was a win-win for all of us.
Q: Could you tell us more about the experience of bringing informatics and epidemiology teams together to collaborate on this rule revision?

Boulton: We brought complementary strengths. Informatics brought that technical reality of what was possible. And epidemiology brought that clinical reality. And together, we were able to determine not just what we can do but also what we should do. What makes sense given the fuller picture we’re able to create and see together?

Eason: That collaboration was further enhanced by bringing in other partners. By listening to our stakeholders, we were able to fill in the gaps and address misconceptions or misunderstandings. And that was an area where Pew’s support was critical. Pew really helped make the stakeholder engagement meaningful, and as a result, we were able to make our rule much more robust.

For example, the stakeholder feedback helped us see that we needed clearer terminology and definitions for fundamental things—like what qualifies as a laboratory or as a critical access hospital? By getting that feedback early on, we were able to make updates so that now it’s much easier and more straightforward for healthcare providers to know what categories they fall into, and therefore easier to know what parts of the rule apply to them.
Q: How will the updated rule benefit hospitals and the health department?

Boulton: With the new eCR requirements, we are now able to receive more of the rich clinical data, including diagnoses, travel histories, comorbidities, pregnancies, etc., that’s really valuable to public health, straight from the hospitals’ electronic health records. And the data coming to the public health department is also more timely and less likely to have errors because eCR doesn't require any of the tedious, manual work—like filling out forms and faxing information. The moment a physician inputs a diagnosis or a positive test result for a reportable disease comes back, that data is packaged up and sent to us automatically.

Eason: So now with the more timely and accurate data coming from eCR, we can more quickly and effectively prioritize issues for follow-up and make sure that we’re focusing our resources for time-intensive efforts, like contact tracing, in the right places and in ways that are most meaningful and impactful for Utahns.

Boulton: Another benefit is that eCR really saves practitioners time—something we were able to quantify in a time-motion study as part of an early eCR pilot. For the conditions that the DHHS analyzed, the time-motion study showed that eCR reduced the staff time spent on manual case review from 4:22 minutes to 2.4 seconds per case, resulting in over 160 hours of annual staff time saved for those conditions alone. And, eCR also automates compliance, which means more complete data for public health. We just recently were looking at a chickenpox evaluation, and we found that eCR allowed us to find 64% more cases than were being reported manually. Having that additional case data is a real difference maker for protecting people’s health. It gives us a fuller picture of how the disease is spreading and makes our disease prevention and other public health interventions more effective.

Eason: In addition to finding more cases of disease with eCR, the more detailed, quality data shared via eCR also translates to an improved ability to detect severe complications and differentiate between similar diseases—something that typically requires time/resource-intensive investigator outreach/follow-up.
Q: What advice would you give to health departments in other states that are looking to expand the use of eCR?

Boulton: One recommendation I’d make is to update policies and regulations hand-in-hand with technology, because often technical tools are only as effective as the laws that are backing them. I’d also say it’s helpful to emphasize that eCR and other electronic data exchange technologies are a win-win that benefits everyone. And, finally, be collaborative and engage partners and the broader public health community. Whether it’s other health departments or organizations like Pew, there’s a willingness to brainstorm and share lessons learned.

Eason: Making the economic case to decision-makers and demonstrating impact over time helps build support and momentum around the work that we do. Over the last several updates to the communicable disease rule, we’ve been able to concretely show that each update has had benefits to the public health system and improved our data quality and our response time, and ultimately those translate into economic savings.

Lastly, don’t let perfection be the barrier to progress. We've done these updates to our communicable disease rule over years, and each iteration has improved the rule. It's incremental.

Boulton: Yes, that's a big one: a stepwise approach is OK. You can have smaller successes and build on those.