Electronic Laboratory Reporting
The Connecticut Department of Public Health (DPH) Infectious Disease (ID) Informatics Program will work with clinical laboratories to implement or maintain electronic laboratory reporting (ELR). The CT DPH ELR Checklist outlines the process, and is summarized below. For questions about CT ELR please contact the ID Informatics Program at firstname.lastname@example.org.
Step 1. Complete the CT DPH ELR Registration Form
Completion of the CT DPH ELR Registration form is required and will put eligible hospital laboratories in queue per Promoting Interoperability (formerly Meaningful Use) requirements. If you have trouble accessing the form, or have questions about completing it, please email email@example.com. For more information on Meaningful Use (MU), please see the DPH MU webpage.
ID Informatics Program staff will notify the laboratory’s contact person identified on the completed Registration form with information on starting the ELR process. The process will include identification of team members (laboratory testing, laboratory information system and/or vendor, and ID Informatics staff) and setting up routine calls for communication throughout the process.
Step 2. Obtain Necessary Documentation for ELR Implementation
Laboratory and/or laboratory information system (LIS) staff should download and be familiar with the following documents:
- The HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health (US Realm) Release 1. Also known as the national ELR HL7 2.5.1 Guide, this guide outlines the requirements for HL7 2.5.1 public health messaging. Related documents for this guide include:
- The CTDPH ELR Local Implementation Guide (for HL7 2.5.1). Also known as the CT ELR Local Guide, this guide outlines additional requirements for use of ELR for messaging of reportable disease laboratory results.
- The laboratory must review the CT DPH current list of Reportable Laboratory Findings. Please be aware that using ELR to send reportable laboratory results does not negate the responsibility of the laboratory to 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 firstname.lastname@example.org for additional guidance and instructions.
Step 3. Incorporate Standard Vocabulary
Laboratories must work with their LIS 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. 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. HL7 vocabulary, SNOMED CT, and National Drug file domains can also be found on the National Cancer Institute Enterprise Vocabulary Services.
- Map other codes as defined in the CT DPH 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 ELR vocabulary codes 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 ID Informatics staff as part of ELR message validation (see Step 7). If your laboratory needs assistance with vocabulary or has questions, please email email@example.com.
Step 4. Develop HL7 version 2.5.1 ORU message for Public Health
CT DPH strongly recommends that laboratories use the HL7 2.5.1 formatted unsolicited observation message (ORU) in conformance with the CT DPH Local and national ELR implementation guides. If laboratories are unable to currently send an HL7 2.5.1 ORU ELR message, or need information about 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 (PHINMS). ID Informatics staff 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 CT DPH. Both testing and production PHINMS routes will be set up with the laboratory for CT DPH messaging.
NOTE: PHINMS is an approved secure message transport system that meets Protected Health Information (PHI) security standards.
Step 6. Perform HL7 Message Validation
To verify HL7 2.5.1 ELR messages meet standards for message conformance, laboratories will be required to send an HL7 2.5.1 ELR message generated from their LIS to ID Informatics staff. It can be a test message (de-identified with dummy or no patient information) or a production message sent via PHIN MS. ID Informatics staff will use an HL7 ELR validation tool that will produce a message validation report that will note any errors in the message (as well as other results). The 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 ID Informatics staff is needed to proceed with Step 7.
Step 7. Structure and Content Validation
During the initial validation phase of ELR implementation, ID Informatics staff will perform additional ELR message structure and content validation to ensure conformance to the CT DPH ELR Local Guide. ID Informatics staff will work with the laboratory until the ELR message passes all validation requirements.
Step 8. Pre-production ELR Validation
ID Informatics staff 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 results sent by ELR. It may be necessary for the laboratory to submit non-ELR reports more frequently during the pre-production validation period. The start date and length of the pre-production period will be decided with each laboratory and may vary depending on several factors, such as volume of reports.
During this process, a method for frequent feedback between ID Informatics staff, DPH program staff, and the laboratory will be set up. ID Informatics staff will discuss any issues found with the laboratory so that corrections can be made. Once DPH program staff sign off that issues have been resolved, ELR will be moved to production.
Step 9. Production ELR
Laboratory ELR reports will be transitioned to production, including using the PHINMS production feed. The ID Informatics staff will work with the laboratory to set a date for this transition. Staff will also discuss stopping paper reporting for reports sent via ELR, including stopping paper reporting to Connecticut local health departments and districts.
Step 10. Post-production ELR
Full, on-going message submission is expected between the laboratory and CT DPH once approval for production reporting has been granted. To ensure data quality, ID Informatics staff will discuss performing ongoing, periodic quality control checks with the laboratory.
Meaningful Use for ELR
As mentioned above, this is now termed Promoting Interoperability. Hospital laboratories are encourage to check the Meaningful Use (MU) for ELR in Connecticut webpage for updates.
ID Informatics Program
ID Informatics Program staff look forward to working with your laboratory on this project and appreciates your cooperation. Please contact us at firstname.lastname@example.org with any questions.
Page last updated 5/26/2019.