Quality Assurance Tools Used in New York's Electronic Laboratory Reporting

BACKGROUND: New York has implemented a statewide Electronic Clinical Laboratory Reporting System (ECLRS) for clinical laboratories to submit laboratory test results electronically for reportable conditions.  A communicable Disease Electronic Surveillance System (CDESS) was integrated with ECLRS to enable state and local health departments (LHDs) to conduct case investigations, monitor and identify possible outbreaks early for implementing prevention and control measures.  However, the high volume of lab reports submitted to ECLRS (~15,000/day) makes it challenging to ensure that staff does not miss reports that require immediate attention to prevent the spread of diseases.  Tools and performance measures have been developed to assure data quality of surveillance systems. The objectives are to describe the tools used in improving the timeliness and completeness of reporting from laboratories, and to evaluate the quality of data reported for communicable diseases.

METHODS: Tool 1. Laboratory report card: this allows labs, LHDs and the State to monitor monthly/daily records submitted by labs for missing information. Tool 2.  Monitoring report: matching ECLRS against CDESS to identify ECLRS positive test reports that haven’t been  investigated by LHDs. Tool 3. Auto populating patient, provider and laboratory information from ECLRS to CDESS to reduce data entry. Tool 4. All labs licensed by the Clinical Laboratory Evaluation Program (CLEP) were audited for non-compliant reporting. Tool 5. Performance measure reports: measure timeliness and completeness of reporting for LHDs to review. 

RESULTS: As of December 2013, 488 labs (99% compliant) were reporting via ECLRS with over 3.5 million records annually. A total of 352 labs were reporting communicable diseases, and the median duration from specimen collection date to the ECLRS submission date was 4 days.  Patient’s birthdate were missing 1% of the time, gender 0%, patient addresses 6%, and provider’s phone number 10%.   During 2013, there were 166,608 patients reported with general communicable diseases (CD) and 50,729 patients with sexually transmitted diseases (STD).  Of those, 3,198(2%) CD and 407 (1%) STD reports were not investigated. CLEP staff audited 732 labs and 4 labs were not compliant.  

CONCLUSIONS: The laboratory report card is a helpful tool to evaluate data quality. The ECLRS monitoring report improves timeliness of reporting by LHD. The on-site auditing of laboratories can identify reporting problems that are missed by passive quality assurance activities.  Performance measure reports improve the completeness of reporting. Continuous use of these tools is necessary to assure the quality of laboratory reporting data.