10 years of electronic test ordering and reporting: the florida … · 2018. 6. 3. · tampa –...
TRANSCRIPT
10 Years of Electronic Test Ordering and Reporting:The Florida Experience
Susanne Crowe, MHABureau of Public Health Laboratories (BPHL)
APHL Annual MeetingJune 3, 2018
Objectives
• Describe Florida Electronic Test Ordering and Reporting
• Describe challenges and successes• Discuss future directions
Jacksonville – Established 1903
Tampa – Established 1910
Miami – Established 1914
Florida’s Public HealthLaboratories
BPHL – By the Numbers
Pre-2007 Information Systems • Massachusetts General Hospital Utility Multi-
Programming System (MUMPS) system (1995-2007)
• Several partial implementations between 2000-2005 (LabLynx, LITS Plus, BOLIMS)
• Electronic data transfer was by text or flat file
2007-LIMS Implementation
• 2007 The Bureau of Public Health Laboratories implemented LabWare Laboratory Information Management System (LIMS)
• All clinical testing except for HIV and Newborn Screening (NBS)
• Phased implementation
2007-LIMS Implementation
• Initially no Electronic Ordering (ELO)• 2-D Barcode county health department Health
Management System (HMS)
• Electronic Laboratory Reporting (ELR)• Health Level Seven International (HL7)• Extensive testing with providers and epidemiology
Electronic Laboratory Reporting (ELR)
HL7 Standards• Florida Department of Health
• Currently using 2.5.1 Messages
ELR Messages
• HL7 Messages• Created by the LIMS• Data Integration Team forwards to ELR Database• Messages are retrieved by various systems
• Multiple templates• ELR 2.5.1 messages• Biological Threat (BT) messages/LIMS• Public Health Laboratory Interoperability Project
(PHLIP) messages
Electronic Reporting-LabWare
Jacksonville
Miami
Tampa
Citrix Servers Data Integration
Team (Mirth, Cloverleaf)
67 Counties (HMS)
STD (Prism)
Epi (Merlin)
Env Health
CDC
ELR Database
LabWare
Electronic Reporting to Centersfor Disease Control and Prevention (CDC)
• Foodborne Microbial Diseases• Modified the HL7 message to include a flag for
organisms of interest to the DFBMD at CDC • Data Integration Team creates CSV files for
reporting to the CDC• In production
• Influenza reporting to the CDC• Via AIMS
ELR Challenges
• Stakeholder Cooperation• Testing!• Retrieving results from system rather than calling
lab• Educating staff
• Up front work before implementing new analyses• Getting all the required codes- 2009 H1N1
• Awareness when correcting reports- not just paper!
ELR Benefits
• Results go out electronically within an hour after release
• Reduces turnaround time• Eliminates need to mail/fax additional reports
to program offices (TB, STD, etc…)• Providers can ‘opt-out’ from receiving paper
results• “Greener Operation”
Electronic Laboratory Ordering (ELO)
Electronic Laboratory Ordering
• Implemented in 2008• Receive Electronic Laboratory Orders for clinical
laboratory tests• Eliminates the need for paper requisitions• Originally HMS (county health system) order• Now generated by third party vendor (Change
HealthCare)• Same message going to Quest for ELO
LabWare ELO Workflow• Provider generates order• Provider affixes barcode label to sample• Order sent as HL7 message through the Data
Integration• Data Integration performs any needed
translations• Data Integration deposits ELO in the incoming
HL7 table • When sample arrives at lab, barcode on sample
is scanned to link with ELO• Lab accession number is assigned
Samples with ELO Labels
Scan Tube ID On Sample
Assign Laboratory Accession Number
Electronic Ordering-LabWare
Jacksonville
Miami
Tampa
Citrix Servers
Data Integration Team
(Mirth, Cloverleaf)
67 Counties (HMS)
Hospital
Hospital
LabWare
Challenges with ELO
• Project timeline• Test Data
• Testing updates• Regression testing
• Provider errors• Orders not sent• Identifying sending clinic
Benefits of ELO
• Reduces accessioning errors (correct test ordered!)
• Eliminates patient demographic entry errors• Reduces turnaround time• Expedites triage of samples (no unwrapping/re-
wrapping, copying, etc…)• Eliminates need for paper requisitions
• “Greener”
Other ELO/ELR Projects
• Pan Flu Project- data exchange between PHL (Florida and Texas)
• ELO/ELR exchanged with non-county health department providers
• Baycare• Working with LabWare to create standard
template• HIV System
Newborn Screening (NBS)
ELO/ELR Newborn Screening
• Based on National Library of Medicine (NLM) NBS Guide
• Currently in production with 1 hospital system• 6 Hospitals• 400-500 samples per week
• Card label contains minimal essential information
NBS CardPre-Printed kit # = Order ID
ELO Newborn Screening
• Hospital system generates HL7 ELO• ELO is converted to flat file by Data Integration
Team • Flat file is placed in table in database• Order is retrieved when the kit ID is scanned
Electronic Ordering-NBS
NBS Lab
NBS Servers
Hospital
Hospital
Hospital
HL7Flat File
Kit IDScanned
Data Integration Team
(Mirth, Cloverleaf)
ELR Newborn Screening
• When results are reported, NBS Software generates a flat file
• Data Integration Team converts file to HL7 ELR message
• ELR message sent back to hospital• Includes a PDF of paper report
Electronic Reporting-NBS
NBS Lab
NBSServers
Data Integration Team
(Mirth, Cloverleaf)
Hospital
Hospital
Hospital
HL7 & PDF
Flat File & PDF
NBS ELO/ELR Challenges
• ELO requires a lot of work on part of ordering provider
• Competing priorities
• NBS Software vendor not compatible with HL7• Testing issues
• Provider verifying what is received• CLIA
• New disorders• Incomplete information
ELO/ELR Benefits
• Eliminates data entry errors in lab • Decreased turnaround times• Results can automatically go into patient record
NBS Web Portal
• Third party vendor• Currently in production
• One hospital: 100-125 samples per week• One birthing center: 3-5 samples per week
• Additional sites scheduled or in validation phase• Card comes with label with minimal essential
information
Web Portal Ordering-NBS
NBS Lab
NBS Servers
Web Portal
Hospital
Hospital
Hospital
Kit IDScannedFlat File
Web Portal Benefits
• Limited investment for providers• Eliminates data entry errors in lab • Decreased turnaround times• Ability to make fields mandatory (hard stops)
Other Lessons Learned
ELO ELR Lessons from Zika
• Staff time to enter/approve/release results in LIMS• Staff time to enter and review demographics in
LIMS• Quality Assurance
• Measures to ensure work was done in a timely manner
• ELO or Web Portal would be beneficial!• Incomplete or illegible requisitions• Time for data entry• Multiple providers wanted copies of results
ELO ELR Lessons from Zika
• Results to LRN Results Messenger • Epidemiology approval of orders• Epidemiology review of positive results before
release
Future Projects
• Continue to expand ELO/ELR LabWare• Continue to expand hospitals using NBS Web Portal• LabWare Web Portal • Web Portal-ELR Hybrid• Chemical Threat
Questions?
Thank you!Susanne Crowe, MHADirector, Bureau of Public Health Laboratories - Jacksonville Email: [email protected]