BACKGROUND: The Virginia Department of Health (VDH) receives approximately 1,000 messages a day for electronic lab reporting (ELR). Because VDH has two surveillance systems, MAVEN for HIV and STIs, and the NEDSS Base System, VEDSS, for general communicable diseases, a filter is applied in the Rhapsody messaging platform to identify ELRs by their LOINC and SNOMED combinations and route them to the correct system for public health response. Historically, programmatic staff developed requirements and documented them in a LifeCycle Management application while messaging staff implemented these requirements in Rhapsody. VDH wanted to automate filter decisions through enhancement of the Rhapsody platform.
METHODS: The VDH Messaging Team worked in collaboration with ELR stakeholders to develop the ELR Automation application. The application was developed using the .net framework.
RESULTS: The ELR Automation application went live in March 2016 and is currently in use. The application provides a master list of all unique code combinations received by Rhapsody and their surveillance system assignment, along with a list of combinations received by all reporting laboratories. Code combinations identified by Rhapsody as new are assigned a status of Pending Assignment until programmatic staff representing MAVEN and VEDSS documents the agreed-upon assignment. Assignments include VEDSS, MAVEN, VEDSS + MAVEN (for Mycobacteria-related findings), and UNWANTED for combinations that are incorrect. Once a new combination has been assigned by programmatic staff, Rhapsody is automatically updated and the ELR message is retriggered and passes through the updated filter. The application also allows programmatic staff to proactively upload LOINC and SNOMED combinations and their assignments, if vocabularies are provided in advance by laboratories. The application allows unprecedented consistency for Test and Production system assignments, and gives programmatic staff the ability to query combinations to perform quality assurance.
CONCLUSIONS: The new ELR Automation application adopted by VDH significantly improved the timeliness and accuracy of code combination assignments for ELR messages. The application represents an automation of past processes, leading to increased efficiencies for messaging and programmatic staff. Expediting receipt of mission-critical messages ensures more timely and reliable disease control and prevention, ultimately benefitting public health.