Electronic Laboratory Reporting (ELR)

In accordance with Conn. Gen. Stat. §19a-215 and Conn. Agencies Regs. §19a-36-A2, the Commissioner of the Department of Public Health (DPH) shall issue a list of reportable laboratory findings on an annual basis. Laboratory reporting is required under Conn. Agencies Regs. §19a-36-A3 and Conn. Agencies Regs. §19a-36-A4 and Conn. Gen. Stat. §19a-2a and §19a-215. In addition, 19a-215 (c) specifies "a clinical laboratory that reports an average of more than thirty findings per month shall make such reports electronically in a format approved by the commissioner."

Reportable tests performed at a CLIA-certified laboratory or at a provider location under CLIA certificate of waiver can use one of two methods to report results electronically to DPH: HL7 v2.5.1 messages or flat files. Both methods require the use of certain standard codes and compliance with the message or file format specified. To enroll in either method, please email DPH.InformaticsLab@ct.gov. The overall process for each type of reporting is outlined below.

HL7 v2.5.1 ELR General Protocol

1. Contact the DPH Infectious Disease Informatic Program at DPH.InformaticsLab@ct.gov. Program staff will set up calls as needed for this process.
2. Obtain the CT ELR Local Guide for HL7 v2.5.1 ORU^R01 messages. This Guide outlines how ELR works in Connecticut, describes the various standards needed to implement an ELR HL7 message (HL7, LOINC, SNOMED CT, etc.), outlines which data is required to be reported, and describes how the HL7 messages should be structured. Additional information for the lab on specific reporting requirements will also be shared as well as a template to assist in LOINC and SNOMED mapping.
3. Download the official list of reportable laboratory findings.
4. Review your laboratory's codes sets for test methods and test results, specimen sources, and race, ethnicity, sex and other code sets. Cross reference these to the list of reportable lab results. Some helpful links are LOINC: http://loinc.org use the search LOINC function; review SNOMED CT codes from any browser – use the US Edition; use UCUM codes for result values if quantitative.
5. Develop the HL7 v2.5.1 ELR message. This will require working with your technical team. Send a test message to DPH Informatics for review of message structure and content criteria. These should be test messages without real information.
6. Set up a secure transport method with DPH. The preferred method is by SFT – Informatics and ELR technical staff can help get a specific SFT folder for your location in place.
7. Once actual lab results are incorporated into the HL7 ELR message, set up sending production level messages to DPH to the location provided. These will be processed and tested in our staging environments. Informatics staff will review these initial messages for data quality and accuracy and send the lab any feedback for changes needed.
8. Once this initial validation has been passed, pre-production validation will begin. Informatics staff will work with DPH program staff to compare results received in ELR messages to the current reporting method your lab is using (faxes, flat files). Informatics staff will set up a method to communicate issues to the lab.
9. Once pre-production messages are considered accurate and complete, Informatics and ELR technical staff will work with your lab to transition sending messages to production ELR. Prior methods of reporting will be turned off.

Flat file (e.g., CSV or XLSX) ELR Protocol

1. Contact DPH.InformaticsLab@ct.gov to obtain the information on how to set up the flat file to meet the reporting requirement. A 'universal' template will be shared.
2. Informatics staff will set up a meeting to review the process using the Casetivity application. This is a secure, cloud hosted, vendor supported application. Result reporting staff at your location will be given secure access to the application.
3. The Casetivity User's guide will be shared and reviewed with your staff. This guide outlines what each column in the flat file should contain and any formatting requirements.
4. Send a test flat file to be reviewed and/or upload a test file into Casetivity as directed. Informatic staff will review and make changes as needed. Depending on the extent of testing required, several test files may need to be sent. These files may contain real data.
5. Once testing is complete, follow instructions to upload files to the production system in Casetivity.

CMS Promoting Interoperability Requirements

For Connecticut-based eligible hospitals, enrollment to report using HL7 messages is required under CMS Promoting Interoperability Requirements. Specifics on these requirements can be found at Promoting Interoperability.

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