Lessons Learned from Validating Electronic Laboratory Reports in Florida

BACKGROUND:  Florida began receiving electronic laboratory reporting (ELR) results in their surveillance system, Merlin, in 2004. Meaningful Use incentives have encouraged more hospitals to send all reportable diseases via ELR. ELR should be more timely, efficient and accurate than receiving paper results. Receiving both paper laboratory results and ELR results from a laboratory is an unnecessary waste of resources. Florida is currently validating ELR results against paper results to ensure data are complete and consistent so that paper results can be eliminated.

METHODS:  In June 2013, Florida implemented an internal protocol to validate data received via ELR and eliminate the receipt of paper laboratory reports. For each facility, every paper result is compared to the corresponding ELR for a minimum of 90 days in the ELR validation stage. Traditionally, national laboratories send paper reports directly to the state; local hospital laboratories send paper reports to local health departments who then forward paper results to the state for final validation. State-level staff compare paper results to the ELR message to identify missing data or discrepancies.

RESULTS:  More than 24 laboratories are in the process of ELR validation. Errors identified for national laboratories include inconsistent specimen received dates, missing ordering provider name and phone number, and social security numbers received as repeating numbers or characters instead of real patient data. Errors identified for local hospitals include missing or inconsistent race, patient address, patient phone number and gender. Florida’s highest priority problem is that for the 24 facilities currently in the process of ELR validation, 17% of results sent via paper are not sent via ELR. The second highest priority is the timeliness of reporting. Some facilities have ELR results arriving after the faxed paper results.  Reporting delays are usually due to hospitals waiting to receive confirmation from reference laboratories before sending to public health.

CONCLUSIONS: While many states struggle with paper validation problems, there is no one best practice. Most state regulations require similar information to be reported to public health, such as patient demographics, provider information, laboratory results and reference ranges. It would be useful to assemble a national “errors” list of issues identified during the paper validation process.  This could facilitate resolving errors at a national level and assist each state with their own internal validation steps. Additionally, information sharing about what to expect could reduce resources needed and prepare states for this resource intensive process.