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Challenges of ELR Implementation: Moving Toward Semantic Understanding through Vocabulary Validation


Meaningful Use has increased interest in submission of ELR to public health agencies, prompting these agencies to analyze their reporting process. Tennessee’s reporting regulations require anyone with knowledge of or suspecting a reportable disease or event report to the local health department. Although it is understood that laboratories are more diligent and routine reporters, focus in listing of these events is from the healthcare provider perspective. Public health agencies must acknowledge the differences in provider case reporting and laboratory result reporting. Despite Tennessee Department of Health's (TDH) required use of standardized vocabulary for ELR such as Logical Observation Identifiers Names and Codes (LOINC) to identify the test performed and Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) to identify organism names, ordinal results, and specimen type, internally inconsistent information in messages has been identified. For example, a performed test with LOINC value 13950-1 encodes for a hepatitis A virus IgM antibody test from serum or plasma using an enzyme immunoassay (EIA) and calls for an ordinal result. However the sender describes a Hepatitis C Antibody (Anti HCV) test and provides a numeric result. In order to achieve semantic understanding of the actionable content of ELR messages, a systematic means to document and validate vocabulary is needed.


To develop a means for validating standardized vocabulary used to report laboratory events via prescribed electronic laboratory reporting (ELR) standards and implementation guides in order to limit internally inconsistent information within ELR messages intended for public health action.

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