Impact of a Third-Party Public Health Reporting Service on the Implementation of Electronic Laboratory Reporting

BACKGROUND: Over the last decade, state and local health departments have endeavored to implement comprehensive electronic laboratory reporting (ELR) for their jurisdictions through direct feeds with individual laboratories.  As a result of the 2009 Health Information Technology for Economic and Clinical Health Act, third-party entities (e.g., electronic health record vendors, health information exchanges) have increasingly become sources for ELR. We outline the challenges and opportunities that public health agencies have encountered when working with third-party reporting services to onboard ELR. 

METHODS: We defined the following three distinct phases from the complex steps of the ELR onboarding process:  1) evaluation of laboratory results, 2) message transmission, and 3) testing and data validation.  For each phase, we describe how the implementation of an ELR feed established through a third-party reporting service differs from a feed established directly between the laboratory and public health.  We also consider issues that could potentially arise over time as a result of maintaining third-party ELR feeds. 

RESULTS: During the evaluation phase, third-party reporting services work directly with laboratories to identify reportable conditions and map those tests and results to standard vocabularies (i.e., LOINC, SNOMED), dramatically reducing the public health resources that are required to develop and validate the mapping documents.  During message transmission, connectivity between the reporting service and the public health agency need only be established once, which results in a gain in efficiency for future ELR implementations through the same reporting service.  In subsequent connections, a decreased effort would be required on the part of public health staff to review message formatting.  Testing and validation remains a similar process.  However, ensuring data security and troubleshooting during ongoing transmission are not as straightforward when dealing with a third-party service.  Furthermore, the concept of a single reporting service ‘owning’ the ELR feeds for multiple labs might cause concerns regarding the potential for increased costs of maintenance in the future. 

CONCLUSIONS: When implementing an ELR feed via third-party reporting services, efficiencies in public health resources are gained with a majority of the initial phase activities shifting from public health to the reporting service.  However, there are concerns surrounding data security, data transmission troubleshooting, and financial sustainability.  ELR implementation teams, both from public health and from the laboratories, should therefore be aware of and prepared to adjust to new ELR business models that result from working with a third-party reporting service.