improving your understanding of electronic lab reporting (elr) lauren dibiase, ms north carolina...

NC Center for Public Health Preparedness/UNC-CH/May 2009

Improving Your Understanding of Electronic Lab Reporting (ELR)

Lauren DiBiase, MSNorth Carolina Center for Public Health Preparedness


Agenda

How ELR determines NC County of Residence for an Event

Timeframes and how they impact the way ELR works

ELR and Workflows

State Lab vs. LabCorp

Your Questions


Geocoding

Process of finding latitude & longitude from other geographic data, such as street address, or zip codes

With geographic coordinates, features can be mapped & entered into Geographic Information Systems (GIS)

Geocoding is never correct 100% of the time


How ELR determines NC County of Residence for the Event

County listed becomes NC County of Residence for the Event

The county in the person’s existing record becomes NC County of Residence for the Event

1. The ELR has a county listed as part of patient’s address

IF THEN

2. The ELR does not have a county listed, but the person was already in NC EDSS with the county field filled out in the Persons tab

IF THEN


Attempt to geocode is made

3. No county, but patient street address is filled in and looks valid

IF THEN

THENNo geocoding attempt is made and best county determined by patient city and/or zip

Best county is determined by the ordering facility city and/or zip

4. The patient street address is missing or otherwise does not look valid

IF

THEN5. There is no patient city and/or zip

IF

Events will appear in the Verification of Reporting County is Needed WF

How ELR determines NC County of Residence for the Event


ELR may route to your county if facility in your county ordered the lab

If there are no previous events in NC EDSS with an address for this patient & lab doesn’t enter address, ELR may route to your county if a facility in your county ordered the lab

1. Correct NC County of Residence

2. Assign to your group in Investigation Trail

3. Enter any info (clinical/treatment) you have

4. Update patient address if have it

5. Reassign to correct county in Investigation Trail


What you need to do when your LHD provided services but ELR not in your workflows

Once there is a value in NC county of residence for the event (no matter how it was entered – via ELR, manually entered), ELR routes to that county

Subsequent ELRs can’t override this value

You provided services, but ELR does not appear in your LHD’s workflows…

If attempted to enter event, would see Potential Match screen with existing event, but would not be able to access the event

If your LHD needed to enter treatment info,

would need to request a share


Timeframes

Used to determine whether an event is a new event or a duplicate of an existing event

Devised by DPH

No hard & fast or perfect way to devise the rules

Apply to any 2 events in system

Calculated by:

Difference between create date for two events or for ELR imports difference between specimen collection date and create date.


ELR could fold into an existing event when really a new event

What do you need to do?

1. Print out lab from Event ‘x’ (the existing event)

2. Create new event ,Event ‘y’

3. Manually enter Lab Result into Event ‘y’

4. Update Admin QP Disease Report Info section

5. Add event note in both events that ELR attached to Event ID ‘x’, but it signifies a new event, Event ID ‘y’


Timeframes make searching for an event critical

Example: you manually create an STD event (from back logged lab or card) today & ELR already created the event ≥ 30 days ago

If you search before creating the event Existing event shows up in your search results, so able to review the event

If you do NOT search before creating the event When you click Add on the Create Event screen, the system will not flag this

event as a potential duplicate (because it is outside the timeframe) No one can merge the events later


What do you need to do when you create a 2nd event instead of using the existing event

1. Need to check that info in the 2nd Event agrees with the info in the 1st Event

Reconcile any differences

Add any additional data from 2nd event into 1st event

2. Add event note in each event cross-referencing the other

3. In Admin Question Package, mark ‘Classification Status’ of 2nd Event as ‘unspecified’

• Do not select ‘Does not meet case criteria’

4. Call Help Desk and ask them to mark the 2nd event as ‘invalid’

5. Resubmit the 1st event to DPH


ELR could create the 2nd event instead of folding into existing event

E.g. Person has an existing Chlamydia event in the system, but was never treated. The person continues to test positive and a lab creates a new event because outside 30 day timeframe instead of merging to existing event

What do you need to do?

1. Print out lab from 2nd Event

2. Open 1st Event & manually enter lab result from 2nd Event

3. Add note in the Lab Results Screen of 1st Event

4. In Admin Question Package of 2nd Event, mark “Classification Status” as Unspecified

Do no select ‘Does not meet criteria’

5. Add an event note in both Events cross-referencing the other Event

6. Call Help Desk ask them to mark 2nd event as ‘Invalid’

7. Resubmit 1st Event to DPH


How ELR Impacts Your Workflows

Lab Result Review Required (local)

Verification of County Residence Needed

Person/Event Deduplication


Lab Result Review Required (local)

Electronic Lab Report for any disease that is fed into system

Manually entered CD & VPD labs

Manually entered STD & TB labs do not appear in this WF

When reviewing a manually entered lab click on Cancel if you didn’t make any edits (if you click Save, event gets put back in this WF)


How do I find the newest lab that got added to the event?

Event History Tab

All users will now have access (LDE role previously did not)

Specimen # for a manually entered lab will display

Specimen # for ELR may display in future


Verification of Reporting County Needed

NC EDSS sets the field ‘verification of reporting county is needed’ (in Demographic QP) to ‘yes’ when county determined by system without full patient address

If do not have full patient street address, system will try to use the city and/or zip of patient to determine county

Field added let LHD know reporting county may be wrong & verification is needed

When county is verified and/or corrected, change answer in this field to ‘no’


Person/Event Deduplication

If ELR does not have enough matching information to find an existing person in NC EDSS, will create a duplicate person

A state-level user will need to resolve duplicate people

All users will see notification on Dashboard that person is pending deduplication (don’t click on the link!)

After persons are merged, the events will now appear in the Event Deduplication Workflow

All users will see notification on Dashboard that event is pending deduplication

LHC II will resolve event duplicates


State Lab vs. LabCorp

State Laboratory LabCorpTime Lag No lag

Example = report finalized on Monday is available in NC EDSS on Tuesday morning

1 day lagExample = report finalized on Monday is not available in NC EDSS until Wednesday morning

Report Status

May send preliminary results No preliminary results sent May send ≥ 1 ELR report per specimen

Sends only 1 ELR report ever per specimen, only when final

Non-positive results may be updated to existing events depending on disease

Only sends if report contains a reportable positive, other non-reportable results on same report not sent

May send corrections via ELR Subsequent corrections are sent only as retraction letter on paper, not via ELR

Specimen Source

Entered in specimen source field on Lab Results Screen

Displayed only as free text in the notes at the bottom of the lab results screen


Wrap - Up

No Hepatitis coming from State LabHepatitis B webinars offered this

summerBrief evaluation survey & slides will be

emailed to youHelp Desk

919-715-5548 or (877)-625-9259 [email protected]

Use Event ID only – no names or SS #s Available 8 am – 5 pm, M-F

improving your understanding of electronic lab reporting (elr) lauren dibiase, ms north carolina...

Documents

event county

event existing event

event slide

nd event

new event

event timeframes

event y

event x