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Electronic Lab Report (ELR)

Current practices of automated case detection fall into the extremes of diagnostic accuracy and timeliness. In regards to diagnostic accuracy, electronic laboratory reporting (ELR) is at one extreme and syndromic surveillance is at the other. In regards to timeliness, syndromic surveillance can be immediate, and ELR is delayed 7 days from initial patient visit. A plausible solution, a middle way, to the extremes of diagnostic precision and timeliness in current case detection practices is an automated Bayesian diagnostic system that uses all available data types, for example, freetext ED reports, radiology reports, and laboratory reports.We have built such a solution - Bayesian case detection (BCD). As a probabilistic system, BCD operates across the spectrum of diagnostic accuracy, that is, it outputs the degree of certainty for every diagnosis. In addition, BCD incorporates multiple data types as they appear during the course of a patient encounter or lifetime, with no degradation in the ability to perform diagnosis.

 

Objective

This paper describes the architecture and evaluation of our recently developed automated BCD system.

Referenced File
Submitted by hparton on

The Influenza Division (ID) in the Centers for Disease Control and Prevention (CDC) maintains the WHO/NREVSS surveillance system, a network of laboratories in the U.S. that report influenza testing results. This system has seen many changes during the past 40 years, especially since the 2009 H1N1 pandemic. This was due in large part to increased adoption of HL7 messaging via PHLIP. PHLIP data is detailed, standardized influenza testing information, reported in near real-time. The data received through this and other report methods is published online in national and regional aggregate form in FluView, a weekly surveillance report prepared by CDC.

Objective

Describe the changes to the World Health Organization/National Respiratory and Enteric Virus Surveillance System (WHO/NREVSS) influenza surveillance system over time, with a focus on the Public Health Laboratory Interoperability Project (PHLIP) and how it has influenced the system

Submitted by elamb on

Electronic laboratory reporting (ELR) was demonstrated just over a decade ago to be an effective method to improve the timeliness of reporting as well as the number of reports submitted to public health agencies. The quality of data (inc. completeness) in information systems across all industries and organizations is often poor, and anecdotal reports in the surveillance literature suggest that ELR may not improve the completeness of the data in the submitted reports.

 

Objective 

To examine the completeness of data submitted from clinical information systems to public health agencies as notifiable disease reports.

Referenced File
Submitted by elamb on

Although U.S. Mother to Child transmission (MCT) rates of HIV have been reduced from approximately 25% to less than 2%, transmissions continue to occur.1 This reduction comes in a large part from treating pregnant mothers with antiretroviral medications.2 Despite these efforts, Louisiana has one of the highest rates of MCT of HIV in the U.S.3 Real-time identification of pregnancy status would allow high risk HIV-infected pregnant women to be targeted for follow-up. In Louisiana, laboratories are required to report positive HIV tests to SHP, most of which are received in electronic lab reporting (ELR) format. Although pregnancy status is not a variable provided on lab reports, some reports do contain information that is useful in identifying pregnancy status.

Objective

To identify, in real-time, pregnancy status of HIV-infected women through information found in laboratory reports received by the STD/HIV Program (SHP) at the Louisiana Office of Public Health. This identification will be used for targeted follow-up.

Submitted by knowledge_repo… on

New York State has implemented a statewide Electronic Clinical Laboratory Reporting System (ECLRS) to which laboratories can electronically submit test results for reportable conditions. The Communicable Disease Electronic Surveillance System (CDESS) was used by 57 Local Health Departments (LHDs) to transfer ECLRS information and initiate investigations. Currently over 98% of licensed clinical labs are reporting via ECLRS. Positive laboratory test results are required to confirm over 80% of communicable diseases and they are often the first indication of a disease. Early detection of disease outbreaks is important for timely implementation of disease prevention and control measures. The space-time permutation scan statistic only requires disease counts, event date and disease location, which are collected from ECLRS and can be used to detect potential disease outbreaks by identifying spatial-temporal lab report clusters.

Objective

This abstract explains how the space-time permutation scan statistic only requires disease counts, event date and disease location, which are collected from ECLRS and can be used to detect potential disease outbreaks by identifying spatial-temporal lab report clusters.

Submitted by knowledge_repo… on

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.

Objective

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.

Submitted by knowledge_repo… on

The use of health information systems to electronically deliver clinical data necessary for notifiable disease surveillance is growing. For health information systems to be effective at improving population surveillance functions, semantic interoperability is necessary. Semantic interoperability is “the ability to import utterances from another computer without prior negotiation” (1). Semantic interoperability is achieved through the use of standardized vocabularies which define orthogonal concepts to represent the utterances emitted by information systems. There are standard, mature, and internationally recognized vocabularies for describing tests and results for notifiable disease reporting through ELR (2). Logical Observation Identifiers Names and Codes (LOINC) identify the specific lab test performed. Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) identify the diseases and organisms tested for in a lab test. Many commercial laboratory and hospital information systems claim to support LOINC and SNOMED CT on their company websites and in marketing materials, and systems certified for Meaningful Use are required to support LOINC and SNOMED CT. There is little empirical evidence on the use of semantic interoperability standards in practice.

Objective:

To characterize the use of standardized vocabularies in real-world electronic laboratory reporting (ELR) messages sent to public health agencies for surveillance.

 

Submitted by Magou on

The American Recovery and Reinvestment Act of 2009 authorized the Centers for Medicare and Medicaid Services (CMS) to incentivize hospitals and physicians to become meaningful users of electronic health record (EHR) systems. In a final rule issued August 2012, CMS outlined the requirements for Stage 2 meaningful use to be effective in 2014 (1). The Stage 2 criteria require eligible hospitals to submit electronic laboratory reports to health departments. While many state health departments receive some portion of notifiable disease reports electronically, the final Stage 2 rule is likely to increase the volume of incoming electronic reports. The Centers for Disease Control and Prevention are urging health departments to prepare for the sharp increase in electronic laboratory reporting (ELR). Crucial to preparedness is estimation of how many ELR reports can be expected. However, few health departments have experience with high volume ELR, making estimation difficult. The Indiana Network for Patient Care (INPC), a regional health information exchange, has been processing high volumes of ELR for over a decade (2). To support health departments estimate potential ELR increases, the INPC examined its current volumes from hospitals with advanced EHR capabilities.

Objective:

To support health department estimation of future electronic laboratory report volumes from hospitals that achieve Stage 2 meaningful use.

 

Submitted by Magou on

The North Dakota Veterinary Diagnostic Laboratory (NDVDL) manages animal disease laboratory tests, results and diagnostic services using the software VetStar Animal Disease Diagnostic System (VADDS) (Advanced Technology Corporation, Ramsey, NJ). The North Dakota State Board of Animal Health with the Department of Agriculture, in collaboration with the North Dakota Department of Health (NDDoH), has developed an electronic laboratory reporting system using data streams exported from the VADDS system for statewide animal health and public health surveillance.

Objective

 To describe the North Dakota Electronic Animal Health Surveillance System and data analysis using the CDC EARS V4r5.

Referenced File
Submitted by elamb on

There is growing interest in leveraging available health information exchange (HIE) infrastructures to improve public health surveillance (1). The Health Information Technology for Clinical and Economic Health Act and Meaningful Use criteria for electronic health record (EHR) systems are among the factors driving the development, adoption and use of HIEs. HIEs deliver or make accessible clinical and administrative data as patients are admitted, discharged, and transferred across hospitals, clinics, medical centers, counties, states and regions (2). While several HIE infrastructures exist (3), there is little evidence on the engagement in HIE initiatives by state and local health agencies.

Objective

To characterize state and local health agency relationships with health information exchange organizations.

 

Submitted by uysz on
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