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Electronic Laboratory Reporting: Opportunities for Innovation and the Public Health Workforce

Posted By Sara Ramey, Wednesday, March 19, 2014
Updated: Tuesday, March 18, 2014
Untitled Document
The Health Information Technology for Economic and Clinical Health Act (HITECH) and the associated Meaningful Use (MU) requirements represent an unprecedented opportunity for public health to benefit from greater electronic connectivity, public health reporting and population health monitoring. Health information technology innovation and improvements motivated by the MU program offer tremendous potential to improve the timeliness, quality, quantity, and efficiency of public health surveillance. This in-turn enables public health decisions makers to take action to protect their communities more rapidly and effectively. Electronic laboratory reporting and other public health MU objectives provide a bridge for public health agencies to engage healthcare professionals and health information technologists in order to link public health agencies and systems more effectively with the clinical care system. To achieve full benefits of ELR, electronic health record transformations and the MU program public health should expect there will be work flow and workforce challenges and changes.

A recent article in the Online Journal of Public Health Informatics, “Estimating Increased Electronic Laboratory Reporting Volumes for Meaningful Use: Implications for the Public Health Workforce,” describes some of the workforce challenges and opportunities faced by public health. The authors cite specific challenges around receipt of an increase in volume of laboratory reports received as a result of implementing ELR. While public health can expect to receive an increase in volume of reports received, public health will also be able to have a more complete picture of the actual disease burden in the community leading to improved outbreak detection, investigation prioritization and thus opportunities to improve disease prevention and protect the public’s health.
The benefits of ELR are widely recognized. ELR has become a critical part of the reportable disease data submission process. Many communicable and environmental diseases that are currently under surveillance across the country are identified and confirmed by laboratory observations. In some states, ELR now accounts for the first identification of as much as 60-70% of reportable diseases. Electronic laboratory reporting provides substantial increases in efficiencies, completeness, and timeliness of reporting. Timely and complete electronic laboratory reports are an important source of information for the core public health functions of disease surveillance and responding to public health events. Reduced disease identification times as a result of ELR enables states to implement disease control measures more quickly (as in identifying outbreaks of foodborne disease, excluding ill children from daycares preventing others from getting ill; or ensuring all potentially exposed contacts of invasive meningococcal disease are identified and get their prophylactic treatment necessary to prevent life-threatening disease onset). In addition, some surveillance initiatives, such as monitoring new and reemerging antimicrobial resistance (e.g., Carbapenem-Resistant Enterobacteriaceae, considered one of CDC’s top five health threats in 2014), are conducted entirely based on laboratory observation findings and are only made possible through ELR as manual data collection processes are too resource intensive.
ELR and MU are important opportunities to support the overarching goals of improving population health management to serve more than just those that seek care but make “meaningful use” of health data to improve health for all. While states will expect an overall increase in the number of reports received due to the implementation of ELR, ELR also provides opportunities to improve the efficiency and effectiveness of public health systems through innovative data collection and processing. With ELR, the public health workforce can expect to spend less time entering data into surveillance systems allowing more time to conduct actual disease surveillance and investigation work. ELR presents ideal opportunities to leverage automated technological capacity to increase reportable disease case reporting specificity and timeliness and reduce data entry burden. The public health workflow change will require initial investments of time and human resources to transform information systems. One specific example of workflow change and innovation made possible by ELR is from my home state, FL. We were able to modify existing manual work flows. After the receipt of an ELR, the results are received automatically by the general communicable disease surveillance application, processed and interpreted electronically, created or assigned to an existing case and finally reported while at the same time the disease investigators are conducting any necessary follow-up or case investigations. This pilot was implemented for a subset of diseases where receipt of ELR volume was high (hepatitis B and C) and has resulted in increased ability to fully document chronic hepatitis B and C cases while retaining our ability to detect and investigate acute infections. Analysis of the workflow change identified an overall manual data entry and processing savings of 6.3 FTEs annually.
ELR has made the act of understanding the disease burden in the community more efficient while requiring less time for hospitals and labs to provide information to public health departments. By testing innovations and disseminating lessons learned, there are unique opportunities to improve public health surveillance (and ultimately health outcomes), and improve access to timely, quality information. In summary, ELR will positively impact the health status of the community by allowing health departments to more effectively and efficiently deploy their resources to conduct investigations around the spread of disease in their jurisdictions.
Janet J Hamilton, MPH
Surveillance and Surveillance Systems Manager
Florida Department of Health

Tags:  electronic laboratory reporting  member spotlight  surveillance 

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