Public Health Electronic Laboratory Reporting Network: Leveraging Existing ELR Technology to Achieve a National Surveillance Network

Iowa is taking electronic laboratory reporting (ELR) Redirect technology a step further to serve as an ELR broker for United Clinical Laboratories (UCL) which serves many healthcare providers in Iowa, Illinois, and Wisconsin. Using the UCL to Iowa ELR connection with ELR Redirect technology to Illinois and Wisconsin eliminates the need for Wisconsin and Illinois to establish costly ELR connections directly with UCL; Iowa redirects ELR from UCL to Illinois and Wisconsin in real time with little effort. If widely adopted, ELR Redirect means that a laboratory that has established an ELR connection with one public health jurisdiction could send ELR to any state public health jurisdiction.  BACKGROUND:   The majority of state public health jurisdictions have or are in the process of establishing ELR.  The majority of state public health jurisdictions have implemented case notification to the Centers for Disease Control and Prevention (CDC) using the PHIN MS protocol. This means that the infrastructure is in place to both receive in-bound electronic messages from laboratories and send out-bound electronic messages. By leveraging this infrastructure and linking it to other widely adopted technologies, it is possible to both reduce the time and cost needed to establish ELR as well as greatly improve disease surveillance through all of the benefits that ELR delivers:

• a new Rhapsody software component developed by the Iowa Department of Public Health (IDPH) with federal funds – so it is freely available to other state public health agencies
• HL7 standards for ELR to public health agencies
• the AIMS Hub supported by the Association of Public Health Laboratories and the CDC offers a transport mechanism to facilitate interstate communication

Iowa and Nebraska have implemented “ELR Redirect” in production. Iowa has begun working with Illinois, Wisconsin, and UCL to expand this public health network. METHODS:   Direct observation, collaboration with partners, and measurement of specific metrics related to redirect volume and reduction in reporting lag. RESULTS:   Electronic laboratory reporting improves timeliness (reporting lag reduced from 7.32 days to 1.20 day) and accuracy of initial laboratory reporting. During the period July 15, 2015-January 3, 2016, 778 ELR messages qualified for ELR Redirect from Iowa. Both measures improve public health effectiveness.  CONCLUSIONS:   ELR Redirect can be used to greatly improve communication between state public health jurisdictions, speed up ELR implementation nationwide, improve timeliness and accuracy of disease surveillance, and reduce costs associated with establishing point-to-point connections between laboratories and public health agencies: faster, better, cheaper.