Implementation of Public Health Laboratory Interoperability Project (PHLIP) Electronic Laboratory Surveillance Message (ELSM) for Influenza Reporting in Washington State

BACKGROUND:  The Washington State Public Health Laboratories (WAPHL) partnered with the Association of Public Health Laboratories (APHL) to establish a system of sending electronic transmissions of laboratory results data. WAPHL participates in virologic surveillance for influenza, with the legacy system consisting of laboratory staff manually tallying the numbers of respiratory specimens tested and positive influenza tests and then entering the data through the online reporting system for Centers for Disease Control and Prevention (CDC) on a weekly basis. The objective of the current work is to describe the implementation of a new process for sending influenza laboratory test results electronically from WAPHL to CDC.

METHODS:  The informatics team built an influenza module in our laboratory information management system (LIMS) in order to create a database for all influenza samples. The integration engine Rhapsody was used to create a customized route for electronic laboratory data exchange. First, demographics and laboratory test result data were exported out of our LIMS as an XML file and imported into Rhapsody. Rhapsody mappers were then created to generate HL7 v2.5.1 messages, which were then downconverted to HL7 v2.3.1 messages. This method has only been utilized in WA and NY. These messages were sent electronically through the APHL hub using PHINMS and picked up by CDC’s Influenza Division.

RESULTS:  WAPHL has been successful in implementing PHLIP ELSM and has been in parallel production since late December 2012. To date, 224 near real-time automated electronic messages of influenza laboratory test results have been sent to CDC, and initial reports show good consistency between numbers reported online and through PHLIP ELSM. We are currently collecting metrics data for pre- and post-implementation of PHLIP ELSM in order to evaluate its efficiency, timeliness, and accuracy. This project has provided a greater knowledge of Rhapsody and its functionalities and has developed HL7 v2.5.1 messages meeting meaningful use requirements for electronic transmission of laboratory test data.

CONCLUSIONS:  WAPHL’s collaboration with APHL and CDC demonstrates the advantages of making data sharing more efficient. Automated data feeds not only remove the intensive manual data compilation by laboratory staff, but also give local, state, and federal epidemiologists more timely access to these data to enhance their disease surveillance efforts. The tools and skills acquired by WAPHL through this project will be transferred to future informatics projects, such as sending laboratory results for notifiable conditions to Washington State Department of Health’s Public Health Reporting of Electronic Data (PHRED).