Refining the Electronic Laboratory Reporting Onboarding Process

BACKGROUND:   North Carolina has been on the leading edge of implementing Electronic Laboratory Reporting since 2008 with a defined multistep process to onboard reporting laboratories. An assessment of the participating laboratories revealed that many of the facilities were struggling to complete the mapping of the local codes to the standard vocabularies of Logical Observation Identifier Names and Codes (LOINC) and Systematized Nomenclature of Medicine--Clinical Terms (SNOMED), a challenge frequently encountered by other states.  A quality improvement initiative was launched in an attempt to decrease the amount of time required by each facility to complete the mapping process.

METHODS: In the original process, each laboratory was required to use an Excel spreadsheet to map the local codes to standardized vocabularies. NC DPH reviewed the information submitted for accuracy and either approved the spreadsheet or worked with the laboratory to correct the information. Because participants often completed the sheet with incorrect or incomplete information, leading to a significant amount of time required for NC DPH and the laboratories to iteratively modify worksheets, the tool was revised. In the new process, additional instructions were added and the tabs were aligned with each step in the pre-defined process. If it is determined that the laboratory does not have the expertise needed to complete the mapping, on-site technical assistance is conducted. 

RESULTS: Preliminary results show that participants find the new mapping tool easier to use and the state received more accurate and timely information from the sites. For sites with limited staffing resources, on-site technical assistance was associated with successful completion of the mapping in a much shorter amount of time than when using the Excel template alone. Because a limited number of sites contributed to the initial findings, additional investigation of the revised mapping tool with on-site technical assistance as needed is currently being conducted with a larger pool of facilities.

CONCLUSIONS:   Many laboratories, especially medium to small facilities, lack the resources to accurately map local codes to standard vocabularies.  By implementing relatively simple and low cost interventions, the state can reduce the overall time spent with a site implementing ELR.