2016 Strategies to Advance ELR: Quest Diagnostics and Hospitals

BACKGROUND:  The current national percentage of ELR is 69%.  This figure is within striking distance of CDC’s goal of 80% ELR nationally.  Three of the four large national labs — LabCorp, Mayo and ARUP — contribute approximately 26% of the volume of ELR.  The fourth, Quest, accounts for 17% of ELR, but has ELR less than 50% implemented.  A 2016 project with Quest will increase the national ELR percentage.  However, to reach a target of 80% ELR, large labs alone are not enough; hospital labs — which individually handle less volume but together number over 5,000 labs — must also make progress, moving from test into production.

METHODS: 1. To increase the percentage of ELR from large labs, CDC, Quest, and the Association of Public Health Laboratories (APHL) will collaborate to implement a single HL7 2.5.1 ELR message at all Quest facilities which will be routed to jurisdictions through the APHL Informatics Messaging Services (AIMS) Hub.  Work has already begun on this project, with phase one involving the largest Quest facilities (facilities using Quest’s QSuite LIMS); the next phase will address Quest facilities using other LIMS. 2.To increase the percentage of ELR from hospital labs, CDC is working with jurisdictions to identify issues affecting many hospitals “stalled” in a test status or failing to reach testing.  Methods established by jurisdictions who’ve moved hospitals to production, technical assistance (TA) and a detailed analysis of projects by jurisdictions and CDC will be used to match challenges within a jurisdiction, with a vendor, or with a specific implementation to solutions that result in production ELR.

RESULTS:  If successful, by the end of 2016 multiple Quest facilities will be sending ELR 2.5.1 messages through the AIMS Hub to public health jurisdictions, increasing national ELR volume by an estimated 8 percentage points, and a large percentage of the almost 3,000 hospitals currently in test status or in queue will transition to routinely sending production ELR 2.5.1 messages to their respective jurisdictions.

CONCLUSIONS:  In 2016, projects with Quest and hospitals will increase the volume of ELR, bringing the U.S. even closer to a national goal of 80% ELR.  Sufficient progress on the volume of ELR would give jurisdictions bandwidth to focus on new goals, like increasing the percentage of electronic laboratory reports that are automatically populated into surveillance information systems (currently, only a third of ELRs go into surveillance information systems automatically), and beginning work on electronic case reporting (eCR).