Nationwide Electronic Lab Reporting

The American Hospital Association (Chicago) and the College of American Pathologists (Northfield, Ill.), along with the cooperation of the St. Paul, Minn.-based Surescripts recently embarked on a two-year grant to electronically link hospital laboratories with public health agencies. The $5 million grant from the Centers for Disease Control and Prevention (CDC) began on Jan. 31, and will include a recruitment phase, a pilot phase, and then will finally connect the targeted 500 hospital laboratories, 100 of which will be critical access hospitals.Real-time DataSeth Foldy, M.D., M.P.H., director of the CDC Public Health Informatics and Technology Program Office says the main driver of this program is to reduce the time for action for public health agencies. “Ultimately, the work of managing communicable diseases and some environmental conditions may be reduced through automation—that’s the long-term goal: faster, more efficient response to conditions that threaten the community,” he says. The communicable diseases that will be reported electronically will be a core set of about 100 diseases and conditions that will include tuberculosis, STDs, diarrheal outbreaks, salmonella, and anthrax.

Debra Konicek, R.N.Steps Toward MU, Reusable FrameworksBeyond the collection of real-time data, the cooperative will usher the 500 hospitals toward meaningful use. “Part of this will be advising about LOINC and coding and then figuring out how that works with their existing systems or to what systems they’re migrating to,” Konicek says. She notes that part of the recruitment phase will be assessing the hospital’s EHR capability, vendors used, and its current ability to electronically report to public health agencies. As electronic lab reporting is one of the menu item requirements for meaningful use, part of the recruitment process will also be matching up hospitals’ interest in attesting to that particular menu item.Another goal of the Lab Interoperability Collective is to create a reusable framework that will be similar to the laboratory initiative of the ONC’s Standards & Interoperability Framework. This will add value beyond the collaborative’s 500 hospital laboratories. Foldy says that “all tools will be made publicly available to the larger community of hospitals, eligible providers, and public health agencies.”Recruitment PhaseKonicek notes that the AHA will be instrumental in recruiting the C-suite leadership to make this initiative succeed, while CAPS, with the broad reach of its 17,000 members, will be responsible for recruiting laboratory leadership. As in other ONC initiatives, the CDC seeks to create standard set interfaces, instead of building one-time connections. Konicek says the cooperative will collaborate with each hospital on how to choose the best interface for them to connect to the CDC, while providing the appropriate LOINC codes and implementation guide.Heterogeneity Among StatesEven though public health reporting is mandated by law, there are many variations in requirements and the information systems state to state. Foldy notes that the CDC hopes to help reduce states’ barriers by requiring no one single front-end architecture, but instead requiring standard codes and methods to transmit the lab reports. “The heterogeneity in public health reporting requirements is one cause of complexity,” says Foldy. “The CDC hopes to produce a table that can simplify identifying the reporting requirements by jurisdiction.”Foldy also recognizes the transport layer to be another challenge of this project. He adds that the CDC will be implementing new methods of transport like the Direct Project, part of the Nationwide Health Information Network, and encouraging states to adopt the HL7 2.5.1 message standard to further aid the electronic reporting process.