meaningful use - hl7 version 2 - himss

Meaningful Use -HL7 Version 2

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Electronic Lab Reporting To Public

Health

Your Ambassador Today

Austin Kreisler� Technical Fellow – Science Applications International

Corporation

� Consultant to National Healthcare Safety Network/CDC

� Co-chair, Orders and Observations Work Group


� Co-chair, Orders and Observations Work Group

� Technical Steering Committee Representative –Domain Experts Steering Division

� Modeling Facilitator – Public Health and Emergency Response Work Group

What we will cover

� A hospital lab testing “story”

� How public health fits into the story

� How Meaningful Use fits into the story


� How Meaningful Use fits into the story

� How HL7 is essential to the story

� How public health lab reporting

requirements fit in the story

� The end of our story

Lab tests are ordered to assist

in diagnosing the patientThe lab performs the tests

and produces a lab report

which is returned to the

ordering clinician

Here we have a sick patient being examined in a hospital

Diagnosing and Treating Hospital Patients


Typical Modern Hospital Laboratory

Lab

Result

Lab

Report

Lab

Report

HL7

A Closer Look At Those Lab Reports

� Only interested in laboratory

results reported electronically!

� On closer examination, that

Lab Report is probably an

HL7


HL7HL7 result transaction

Where’s Public Health in This Story?

� Let’s imagine the lab

result is for a sick infant

� The Lab Result identifies

the E. coli 0157:H7


the E. coli 0157:H7

organism

� Clinician Diagnosis: E. coli Infection

� This lab result needs to

be reported to public

health

On With Our Story

Lab

Report

HL7

The lab result is transmitted from

the hospital to public health

ELR


HL7

Public Health

ELR

Reporting Lab Results to Public Health

� Commonly referred to as “ELR” or “Electronic Laboratory Reporting” in the Public Health Community

� Involves transmitting “reportable” laboratory results to public health


results to public health� Reportable results are typically but not exclusively

Microbiology related

� Each US state, territory or independent jurisdiction have requirements for the reporting of certain laboratory results to public health officials

� Traditional ELR has been sent from the originating Laboratory to public health

ELR And Meaningful Use

� Inclusion of an ELR option in Meaningful Use is a significant step in taking ELR to Public Health to the next level

� Meaningful Use ELR option applies to hospital EHR’s, including:


� A large single vendor application suite

� A mix of departmental systems from multiple vendors

� A home grown system

� No electronic systems whatsoever

� And everything in-between

� Meaningful Use allows hospitals to determine exactly what system at the hospital will be doing the ELR reporting

� State law may or may not dictate the source of ELR

So We’re Done, Right?

� Not quite

� Yes, you have an HL7 result message

� It's likely that result message, or more


� It's likely that result message, or more

properly the data within that result message,

is in a form that isn't particularly useful for

public health purposes

Lab

Report

HL7

Lets take a closer look at that Result

Lab

ReportWe can see some

Let’s zoom in and

see what's in that

HL7 Lab Report


Report

HL7

We can see some

additional level of detail

is present.

Lets take a closer look

at that detail

Ooops,

This looks like a

text report!

HL7 Lab Report

Text Report Lab Results

� Are very common

� Are meaningfully used by care providers to

treat patients


� Are lousy for Meaningful RE-USE by public

health!

To Answer Why -

� We need to examine ELR to Public Health

requirements

� ELR reporting requirements are rooted in

regulatory requirements from states and other


regulatory requirements from states and other

jurisdictions in the US

� The following two groups have been involved in

gathering requirements for ELR:

� Council of State and Territorial Epidemiologists (CSTE)

� Centers for Disease Control and Prevention (CDC)

Council of State and Territorial Epidemiologists

� CSTE conducts a yearly survey of states

regarding ELR adoption and implementation

� The survey provides useful information

regarding how states are using ELR data


regarding how states are using ELR data

� Also provides useful information about

barriers to ELR adoption

CSTE Survey - Use of ELR Data


Public Health Use of ELR Data

� Contribute to data analysis and visualization

� Contribute to syndromic surveillance

� Detect antimicrobial susceptibility patterns

� Provide data to county/local health departments


� Provide data to county/local health departments

� Provide data to CDC or other federal agencies

� Contribute to public use data available on the web

� Offer health care decision support

� Populate an integrated, centralized data store

� Provide data to state public health program areas

Key Data Elements Supporting Various Uses Of ELR

� Patient information including identifiers, name,

address and contact information

� Ordering provider information including identifiers,

name and contact information


name and contact information

� Test Order information

� Structured test results including

� Type of test

� Result of testing

� Interpretation of test result

� Performer of testing

Text

Results� Require a human to

interpret them

� Are difficult to reuse for

automated processing

because:

Structured

Results� Can still be rendered

for human

interpretation

� Are much easier to RE-

USE for automated


because:

� Format of the text varies

from site to site

� Content of the text varies

from site to site

USE for automated

processing

Public Health Requirements

� ELR comes from many different sources to

public health

� Many sources with many formats cause

serious resource problems for public health


serious resource problems for public health

� To cope with the volume of transactions,

public health needs a standard format for

ELR data

Solution:


History Of ELR IG to Public Health

� The first ELR Implementation Guide dates back to 1997 and was based on HL7 v2.3 plus Z-segments� Produced externally to the HL7 organization

� Quickly updated to HL7 v2.3.1


� Quickly updated to HL7 v2.3.1� Went through several subsequent revisions

� HL7 v2.4 and v2.5 versions of the Implementation Guides were also produced

� None of these versions of the ELR received broad review outside of the public health ELR community nor were they balloted through HL7

HL7 v2.5.1 ELR Implementation Guide

� Based on HL7 v2.5.1 result message (ORU^R01)

� Harmonized with the HL7 v2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR, Release 1� HL7 standard, adopted for use in Healthcare Informatics

Standards Panels first Implementation Specification (IS01,


Standards Panels first Implementation Specification (IS01, component C36)

� Aligned with and extends the existing externally developed HL7 v2.3.1/v2.4/v2.5 ELR IG’s developed by CDC and its public health partners

� Balloted through HL7 and released as an HL7 standard in February 2010

� Specifically identified in the MU rule in July, 2010 for reporting lab results to public health

Key Features of the ELR IG

� Uses strong, interoperable identifiers for key

information objects

� Compatible with identifier usage in CDA/CCD

Uses standard vocabularies such as


� Uses standard vocabularies such as

LOINC® and SNOMED-CT®

� Uses a standard format for reporting of

microbiology-related results

ELR – Barriers To Adoption

� States have been implementing ELR for 10+

years

� Key features of the ELR IG are tied to some

lessons learned in previous ELR


lessons learned in previous ELR

implementations

� The CSTE Survey identifies a number of

barriers to ELR adoption

Barriers To ELR From CSTE Survey


Top 4 Barriers To ELR Adoption

� Not enough staff at health department� We will show how the HL7 ELR IG indirectly addresses this

� Labs have other/competing IT implementation priorities

� The MU rule addresses this, not the HL7 ELR IG


� The MU rule addresses this, not the HL7 ELR IG

� Not enough money at health department� We will show how the HL7 ELR IG indirectly addresses this

� Variable content and format of ELR messages from labs

� The HL7 ELR IG address this by:

� identifying specific content to be supported

� specifying the format for that content

PH Staffing and Funding

� HL7 ELR IG impact on this is indirect, but very important

� Standard implementations are simpler for states, custom one-off implementations are expensive

� HL7 ELR IG requires a single format, requiring the use of standard vocabularies


standard vocabularies

� HL7 ELR reduces the burden on public health staff to manage custom formats and vocabularies from all the hospitals and other data sources within their jurisdictions

� Staff and funding resources can be focused on adding additional HL7 ELR IG based data exchanges instead of on managing fewer custom data exchanges

Study After Study

� Have shown that compared to paper reporting:� ELR increases the timeliness of reporting

� Timeliness is key when trying to intervene in a


� Timeliness is key when trying to intervene in a potential outbreak

� ELR increases the completeness of reporting

� Studies have also shown that lab reports using standardized coding (in the Lab system) as opposed to free text increases completeness of reporting

Back To Our Story

Lab


Public Health Data Center

Lab

Report

HL7 2.5.1

ELR IGA timely, fully encoded ELR transaction arrives

Based on the fully coded result, a local public health worker

is alerted of a new case that needs investigation

Our Story Continues

Public Health conducts its investigation

The source of infection is identified and cleaned up

The sick infant is treated by

HL7 ELR Saves The Day!


The sick infant is treated by the hospital, recovers and goes on to live a healthy happy life

Public has protected children in the community from further infection!!!

Links To More Information

� HL7 2.5.1 ELR IG: http://www.hl7.org/implement/standards/hhsifr.cfm

� CSTE Public Health Informatics:http://www.cste.org/dnn/ProgramsandActivities/PublicHealthInformatics/tabid/346/Default.aspx

� CSTE National ELR Group:


� CSTE National ELR Group:http://www.coast2coastinformatics.com/

� PHIN Vocabulary Access and Distribution System ELR View:http://phinvads.cdc.gov/vads/ViewView.action?id=7F008CA6-33A9-DF11-9BDD-0015173D1785

� HL7 PHER Work Group Change Requests for ELR IG:http://wiki.hl7.org/index.php?title=Category:Change_Requests_for_PHER_Standards

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