Electronic Laboratory Reporting

The Connecticut Department of Public Health's (CTDPH) Electronic Laboratory Reporting (ELR) system has been implemented. CTDPH will work with eligible hospital or commercial laboratories that currently submit laboratory test results as part of state requirements for reportable diseases and conditions. If you are a laboratory that is interested in participating in Connecticut ELR (CT ELR), the  CTDPH ELR Checklist will introduce you to the process, and is summarized below. If you have questions about the process or about CT ELR, please contact the CT ELR team at dph.elr@ct.gov.
Step 1. Complete the CTDPH ELR Registration Form
Completion of the CTDPH ELR Registration form is required for participation in CT ELR. Follow the instructions on the form and return as indicated. If you have trouble accessing the form, contact the CT ELR team.
Completed forms will be assessed and laboratories will be prioritized based on reporting volume, reportable conditions tested by that lab, laboratory readiness to meet reporting requirements (such as use of standard codes for tests and results), and the availability of CTDPH staff to work with the laboratory. A member of the CT ELR team will reach out to the contact person identified on the completed CTDPH ELR Registration form with information on starting the ELR on-boarding process. The process will include identification of team members and setting up routine calls for communication throughout the on-boarding process.

Step 2. Obtain Necessary Documentation for ELR Implementation
To successfully participate in CT ELR, laboratory and/or laboratory information system staff should download and be familiar with the following documents: 

    • The CTDPH current list of Laboratory Reportable Findings. Please be aware that using ELR to send laboratory reports does not negate the responsibility of the laboratory to completely report results that may not be captured or included in the ELR messages. 
Laboratories that need to initiate ELR using a prior version of HL7 (e.g., 2.3.1) or a non-HL7 message format must contact the CT ELR team for additional guidance and instructions.
Step 3. Incorporate Standard Vocabulary
Laboratories must work with their laboratory information system or IT vendors to ensure that standardized vocabularies are used in messages to be processed via the CT ELR system. This is required regardless of accepted message format. The vocabulary code sets to be used and sources of searchable sets are listed below:  
    • Use the Logical Observation Identifiers Names and Codes (LOINC) for laboratory orders and tests. Use of local laboratory test codes is not acceptable. For information on LOINC go to the LOINC website. A useful tool to search for LOINC terms can be found at search.loinc.org.
    • Use the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) for laboratory results and specimen types. You can request a free license to access the SNOMED CT browser available through the U.S. National Library of Medicine Unified Medical Language system (UMLS) Terminology Services at:  https://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html. HL7 vocabulary, SNOMED CT, and National Drug file domains can also be found on the National Cancer Institute Enterprise Vocabulary Services: https://evs.nci.nih.gov/.
    • Map other codes as defined in the CTDPH ELR Local or the national ELR implementation guides, such as the HL7 defined race and ethnicity codes, and use the Unified Code for Units of Measure (UCUM) for units. A useful source for these and other vocabulary codes for use in ELR is the Reportable Condition Mapping Tables that can be accessed via the Public Health Information Network Vocabulary Access Distribution System (PHIN VADS).
Correct use of vocabulary code sets will be reviewed by the CT ELR team as part of ELR message validation. If your laboratory needs assistance with vocabulary or has questions, please contact the CT ELR team.
Step 4. Develop HL7 version 2.5.1 ORU message for Public Health
CTDPH strongly recommends that laboratories that want to submit ELR develop the HL7 2.5.1 formatted unsolicited observation messages (ORU) message in conformance with the CTDPH Local and national ELR implementation guides. If laboratories are unable to currently send an HL7 2.5.1 ORU ELR message, or are in need of information for transitioning from HL7 2.3.1 to HL7 2.5.1, please note this on the ELR Registration form. It is the laboratory's responsibility to develop compliant HL7 messages that contain the required standardized vocabulary.

Step 5. Set up Secure Message Transport
Currently, the only allowed secure message transport is the CDC-developed Public Health Information Network Messaging System or PHINMS. The CT ELR team will send information to laboratories engaging in ELR on how to contact the CDC to set up PHINMS using the CDC Route not Read (RnR) hub.

The CT ELR Local Guide has information to be included in message headers for successful message receipt by CTDPH. Both testing and production PHINMS routes will be set up with the laboratory for CTDPH messaging. Additional information about PHINMS and its use in Connecticut can be found on the DPH website.

NOTE: PHINMS is an approved secure message transport system that meets Protected Health Information (PHI) security standards.  

Step 6. Perform Internal Message Validation 
To assist laboratories to be certain their HL7 2.5.1 ELR messages meet standards for message conformance, the CT ELR team will request that laboratories send an HL7 2.5.1 ELR message generated from their laboratory information system to the CT ELR team. This can be either a test message (de-identified with dummy or no patient information) or a production message sent via PHIN MS. The CT ELR team will use a NIST-based validation tool that will produce a validation report that will note any errors in the message (as well as other results). The validation report will be reviewed with the laboratory and the laboratory will be responsible for correcting any errors. Persistent errors may impact the ability of a laboratory to continue the on-boarding process. Approval of the CT ELR team is needed to proceed with Step 7. 
Step 7. Structure and Content Validation.
During the "testing phase" of the laboratory's ELR implementation, CTDPH will perform additional ELR message structure and content validation to ensure conformance to the CTDPH ELR Local Guide. The CT ELR team will continue to work with the laboratory until the ELR message passes all validation requirements.
Please be aware that if your laboratory is non-responsive during this review, the ELR process will cease. Too long of a delay may impact MU credit for eligible hospitals.
Both Steps 6 and 7 must be completed and approved by personnel from both the CT ELR team and CTDPH disease surveillance programs before pre-production data validation can begin.
Step 8. Pre-production ELR Validation.
During this step, the CT ELR team will work with DPH program staff to compare existing laboratory reports sent by non-ELR methods (e.g., fax, mailed reports, other electronic files) in parallel with reports sent by ELR. It may be necessary for the laboratory to submit non-ELR reports more frequently during the pre-production validation period. This pre-production period will be determined with each laboratory and may vary depending on several factors, such as volume of reports.
During this process the CT ELR team will set up a method for frequent feedback with the laboratory to make corrections to any issues found. Once all critical issues are resolved and signed off by DPH program staff and the laboratory, ELR will move to production.  
Step 9. Production ELR
CTDPH transitions your ELR reports to production, including switching PHINMS to using the production data feed. The CT ELR team will work with the laboratory to set a date for this transition.

Step 10. Post-production ELR
Full, on-going message submission is expected once approval for production reporting has been granted. Once production ELR is achieved, the CT ELR team will discuss with the laboratory about ongoing, periodic quality control checks to ensure data quality assurance.

Meaningful Use for ELR
Please read the information on the CTDPH website about the status of Meaningful Use (MU) for ELR in Connecticut. We recommend that laboratories check this page frequently for updates. 

The CTDPH looks forward to working with your laboratory on this project and appreciates your cooperation. Please contact our CT ELR team by email (dph.elr@ct.gov) with any questions.