Posted By John Satre,
Friday, November 20, 2015
Updated: Friday, November 20, 2015
The Public Health ELR Network: A working model that increases interstate communication and reduces connections required between laboratories and public health1
The concept of a nationwide electronic laboratory reporting (ELR) network among state public health agencies organically sprang out of a field that had already been planted with seeds requiring time to develop and grow. Over the course of the last decade, these seeds have developed and are now producing fruit across the nation. It is appropriate to briefly outline some of the relevant components that make it possible to realize a nationwide, functioning public health ELR network.
Planting the Seeds
The following developments have been necessary for a public health ELR network to blossom:
Health Level 7 (HL7) Standardization – The ELR 2.5.1 HL7 Version 2.5.1 Implementation Guide: ELR to Public Health, Release 1 (US Realm) provided a target for partners involved in public health disease surveillance to develop independent interoperable messaging.
NEDSS and ELC – the National Electronic Disease Surveillance System (NEDSS) initiative provided the overarching vision and the Epidemiology and Laboratory Capacity (ELC) cooperative agreements provided the support to adopt or develop new surveillance systems capable of handling data in a much more sophisticated manner.
LOINC, SNOMED, and HL7 – these coding systems provide a common language for data sharing partners to communicate key concepts.
HITECH – The Health Information Technology for Economic and Clinical Health (HITECH) Act provided education, valuable work products, and technical assistance to public health jurisdictions related to Meaningful Use and ELR.
Meaningful Use Public Health Objectives – These incentives provide impetus for hospitals to approach public health with the necessary resources to plan, develop, and implement electronic connections in each state.
Activities in public health often take excessive amounts of time, but they also happen to be spread over short spans measured only in minutes. These activities, when summed up by day or week accumulate into a large amount of time. One of these activities is simply referring a laboratory result received by one public health jurisdiction to a different state public health jurisdiction for investigation. It is not uncommon for a public health jurisdiction to receive a reportable laboratory result when it should have been reported to a different jurisdiction. In addition, there are times when one jurisdiction – upon receipt of a laboratory report - sends a request for assistance to another state (for example, collecting treatment information from a healthcare provider in the second state). This interaction generally occurs through mail, fax, or phone communication; timeliness of the referral or response tends to linger in the midst of busy schedules. Iowa’s electronic laboratory reporting team – in collaboration with multiple disease surveillance teams in Iowa and Nebraska – has developed program-specific rules and technology to evaluate electronic lab reports upon receipt for possible referral to another jurisdiction; the process is called ELR Redirect. Every laboratory result received by ELR passes through a component where the reportable condition is identified, so it can be associated with program rules. Then the appropriate state is calculated from the combination of up to three addresses for potential referral or an automated request for assistance. These include patient state, ordering physician state, and ordering facility state. Based on the combination of condition and addresses, the laboratory report is either redirected to another state public health jurisdiction or passed on to the original recipient’s surveillance system. Sometimes it is appropriate for the lab result to be kept by the original recipient and redirected to another state. This innovative design accomplishes several things: it saves time for the original recipient and the secondary recipient, provides the lab result to the appropriate public health jurisdiction in near real-time, and allows the surveillance system to consume a standard message automatically thereby eliminating manual data entry of this record into the final destination system(s).
Taking the Next Step
Standards have been implemented over the past 10 years along with new innovative design. The next step allows for a nationwide electronic surveillance network. If a state public health agency is able to receive a laboratory report electronically and electronically pass that report on to another state public health agency, the potential exists for every state public health agency to redirect a laboratory result to every other state public health agency. Costly electronic connections that have yet to be established between laboratories and public health agencies to achieve ELR may now be rendered unnecessary. The possibility of a disease surveillance community that is 100 percent electronic is within sight.
Iowa is currently working with United Clinical Labs (UCL) which serves healthcare providers and their patients in Iowa, Illinois, and Wisconsin. Multiple projects are underway to establish an electronic connection between UCL, which is located in Dubuque, IA, and the public health agencies in Iowa, Illinois, and Wisconsin through the UCL-to-Iowa ELR connection.
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John Satre is an Informatics–Training in Place (I-TIPP) fellow at the Iowa Department of Public Health. For more information or to request the customizable software component, e-mail John Satre. If you would like to become an I-TIPP fellow, apply before April 1, 2016. For more information about ELR, join one of CSTE’s three Surveillance/Informatics subcommittees.