PHDSC session

Readiness of public health information systems to

support Meaningful Use of EHRs through health

information exchanges

Laboratory Reporting to Public Health

Steven C. Macdonald PhD, MPH

Washington State Dept. of Health

Council of State & Territorial Epidemiologists

August 2009 HIT Policy Committee recommendations

• Improve quality, safety, efficiency, & reduce health disparities

• Engage patients and families

• Improve care coordination

• Improve population & public health

• Ensure adequate privacy & security protections for personal health information

Readiness of public health information systems to support Meaningful Use

• Interoperability– Capability to receive ELR, immunization and

syndromic data

– Capability to send alerts and queries

• Capacity for data management – Scaling up for increased volume of reports

– Increased data dissemination expectations

• Capacity for clinical decision support– Current immunization schedules

ELR recommendations for 2011

• Hospitals objective “Capability to provide electronic submission of reportable lab results to public health agencies and actual submission where it can be received”

• Performance measure “% reportable lab results submitted electronically”

ELR Challenges

• Condition selection

• Methods for testing “Capability”

• Methods for identifying reportable lab results which were not submitted electronically

• Methods for monitoring hospital compliance

Condition selection for performance measures

• All reportable conditions separately for each state/jurisdiction

• Roughly 70 conditions on the CSTE Nationally Notifiable Conditions list

• Subset of the NNC list where the conditions are reportable by labs in all 50 states– Further subset to conditions where testing is

routinely done in hospital labs?

Methods for testing “Capability”

• Define "Capability to provide electronic submission" for those instances where no "actual submission" is indicated during the defined period – Small hospital– Rare condition

• Development of test protocols– Pilot before implementation?

Calculation of performance measure

• Methods for identifying reportable lab results which were not submitted electronically – necessary to calculate “% reportable lab results

submitted electronically”

– hospital EHR performance test ?

• Rely on state health agencies to document the proportion of results for reportable conditions that came from any given hospital as ELR reports vs. paper reports or by telephone ?

Methods for monitoring hospital compliance

• Attestation ? • CMS “verification” using existing auditing

mechanisms– Audit team could examine code mapping tables (e.g.,

local code to LOINC)

– Audit team could supervise capability and performance testing

• State laboratory quality assurance certification bodies

HL7 Standards

• HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting To Public Health (US Realm), Release 1

• Related standards– HL7 Version 2.5.1 Implementation Guide: Orders and

Observations; Interoperability Laboratory Result Reporting to EHR (US Realm), Release 1

– NAACCR Pathology Laboratory Electronic Reporting V3.0 (HL7 V 2.5.1 Implementation Guidelines)

– HL7 Version 2.5.1 Implementation Guide: eSurveillance; Microbiology Transactions (US Realm), Release 1

CSTE ELR Workgroup

• Annual survey since 2004