Electronic Lab Report (ELR)

Monitoring laboratory test reports could aid disease surveillance by adding diagnostic specificity to early warning signals and thus improving the efficiency of public health investigation of detected signals. Laboratory data could also be employed to direct and evaluate interventions and countermeasures, while monitoring outbreak trends and progress; this would ultimately result in better outbreak response and management, and enhanced situation awareness. Since Electronic Laboratory Reporting (ELR) has the potential to be more accurate, timely, and cost-effective than reporting by other means of communication (e.g., mail, fax, etc.), ELR adoption has been systematically promoted as a public health priority.  However, the continuing use of non-standard, local codes or text to represent laboratory test type and results complicates the use of ELR data in public health practice. Use of structured, unique, and widely available coding system(s) to support the concepts represented by locally assigned laboratory test order and result information improves the computational characteristics of ELR data. Out of several coding strategies available, the Office of the U.S. National Coordinator for Health Information Technology has recently suggested incorporating Logical Observation Identifiers Names and Codes (LOINC) for laboratory orders and Systemized Nomenclature of Medicine- Clinical Terms (SNOMED CT) codes for laboratory results to standardize ELR.

Objective:

To examine the use of LOINC and SNOMED CT codes for coding laboratory orders and results in laboratory reports sent from 63 non-federal hospitals to the BioSense Program in calendar year 2011.

 

In Louisiana, information contained on electronic laboratory reports is not able to identify the pregnancy status for the majority of HIV-infected women. Laboratories have access to ICD9/ICD10 codes which could provide information about pregnancy status, but few laboratories provide these codes to Health Departments. In some areas, such as New York City, the reporting of pregnancy status, if available, is required. This study quantifies the opportunities for reducing perinatal HIV transmission if pregnancy status was available on laboratory reports and determines if this information would have been useful for targeting these pregnancies for follow up from Disease Intervention Specialists (DIS). If pregnancy status is found to be useful, states should require pregnancy status in their laboratory reporting guidelines.

Objective

Quantify the opportunities for reducing perinatal HIV transmission risk if pregnancy status was available on electronic laboratory reporting in Louisiana.

All positive laboratory tests of reportable conditions on persons residing in New York State (NYS) are mandated to be sent to the NYS Department of Health (NYSDOH) via ECLRS. NYS, excluding New York City (NYC), receives over 100,000 ECLRS messages on general communicable diseases (CD) and hepatitis (HEP), not including Lyme disease and Influenza, annually. Although ECLRS is integrated with CDESS, the local health departments (LHD) need to review each lab report for proper initiation of a case investigation. Once the investigation is created, the LHD may need supportive evidence to create a reportable case or may dismiss it if evidence does not support the case definition.

Our goal is to follow all ECLRS records from official retrieval by the LHD through CDESS case creation, to ensure all cases are reported and are done so in a timely manner. Cases for diseases that are nationally notifiable are sent to CDC the following week for publication in the Morbidity and Mortality Weekly Report. Timely reporting to CDC allows for more accurate description of disease occurrence, which is essential for public health planning and response.

Objective

Ensure all reportable communicable disease data coming through the Electronic Clinical Laboratory Reporting System (ECLRS) is reported to the Communicable Disease Electronic Surveillance System (CDESS) in a timely and complete manner.

CHIKV is transmitted by mosquitoes and often occurs in large outbreaks with high attack rates. Common symptoms (which can be severe and disabling) include fever, joint pain/swelling, headache, muscle pain and rash. In December 2013, the World Health Organization reported local CHIKV transmission in the Caribbean. In July 2014, the first locally-acquired case in the continental U.S. (Florida) and increasing cases in Puerto Rico (PR) were reported. Due to the growing outbreak, VA Office of Public Health began conducting ongoing surveillance.

Objective

We describe challenges and lessons learned conducting surveillance for Chikungunya virus (CHIKV), an emerging infectious disease in the Americas.

Since November 2014, the Houston Health Department has been receiving antimicrobial resistance information for Streptococcus pneumoniae from a safety net hospital via electronic laboratory reporting (ELR). Antimicrobial characteristics and vaccination rates of pneumococcal disease are of public health interest due to potential implications in treatment and prevention. Ten states participate in the CDC’s Active Bacterial Core surveillance (ABCs) program. Texas, which represents a different and diverse demographic compared to other states, is not an ABCs participating state. No studies have compared local antimicrobial susceptibility percentages to those of the ABCs. The aim of this study is to 1) report the antimicrobial susceptibility of S. pneumoniae in a local cohort, 2) characterize the demographics of the cohort including the use of pneumococcal vaccine, and 3) compare antimicrobial susceptibility percentages of the local cohort to the 2013 ABCs program.

Objective

Our objective is to report the antimicrobial susceptibilities of Streptococcus pneumoniae received from a local safety net hospital via electronic laboratory reporting (ELR), and compare susceptibility percentages with those of the Centers for Disease Control and Prevention’s Active Bacterial Core surveillance (ABCs) program.

DENV, CHIKV and ZIKV are all transmitted by mosquitoes and have occurred in outbreaks in the Caribbean. Common symptoms (which can be severe and disabling) are similar among the 3 viruses and include fever, joint pain/swelling, headache, muscle pain and rash. In December 2015, the first endemic case of ZIKV infection was reported by VACHS. Since that time, an increasing number of ZIKV infections have been reported in Puerto Rico. Due to the growing ZIKV outbreak, we performed ongoing testing and surveillance.

Objective

We describe surveillance for Dengue virus (DENV), Chikungunya virus (CHIKV) and Zika virus (ZIKV) in VA Caribbean Healthcare System (VACHS) from the start of ZIKV transmission in Puerto Rico.