Robert W. Pinner, M.D.

June 4, 2012

Update on ELR in the U.S. 2012 CSTE Annual Conference

Omaha, Nebraska

2

CSTE – APHL – CDC ELR Task Force Prevention and Public Health Fund (PPHF) of

the Affordable Care Act (ACA) has provided resources and focused attention. ELC ACA funding (approximately $15 M for ELR and

related work) Communications, Implementation Support &

Monitoring ELR Technical Assistance

Update on ELR in the U.S.

ELR Implementation Support and Monitoring Purpose

Be responsible stewards of ELR investments in ELC

Monitor ELR implementation more thoroughly and precisely

Focus and improve support for ELR implementation

Assess and understand ELR’s impact on public health practice

Make a clear case for sustained ELR efforts and support

Enhancing collaboration and coordination for efficiency

3

ELR Monitoring Process

• Total number of labs and ELR targeted Labs• Received from 57 of 57 jurisdictions• Late Nov. 2011 – Dec. 2011

Step 1 - Denominator Information

• Format and status of ELR or direct web entry by disease category

• Received from 57 of 57 jurisdictions• Jan. 2012 – Feb. 2012

Step 2 - Laboratories Sending ELR

• Total lab report volume and ELR volume by Disease Category

• Held meetings with 56 of 57; received from 52 of 57• Early Feb. 2012 – April 2012

Step 3 - Laboratory Reporting Volumes

• How ELR are Received, Managed and Used• Scheduled calls with 48 of 57; Held calls with 19 of 57• May – June 2012

Step 4 - Surveillance Information Systems &

Infrastructure• HIE Progress• Status of other Electronic Messaging• July – Aug 2012

Step 5 - HIE and Other Electronic

Messaging

Current Step

4

ELR* in ELC Jurisdictions

5

RI

AK WA

OR

CA

MT

ID

WY

NEN

V

NM

TX

AR

TN

ME

VT

NY

FL

GA

AL

NC

VA

MI

PA NJ

DE

NH

CT

MA

HI

AZ

LA

OK

KSCO

UT

SD

MN

WI

IA

MO

IL WV

MS

KY

OHIN

MD

SC

Receiving ELR any format =51 (45 states, 6 cities)

Not Receiving ELR =6 (5 states, 1 territory)

ND

DC

NYC

LAC

HOU

CHI

PHIL

N=57PR

*Production ELR for 1 or more conditions for 1 or more labs via

any messaging format or direct web entry; MS is testing ELR;

% of Lab Report Volume Sent via ELR

6

RI

AK WA

OR

CA

MT

ID

WY

NEN

V

NM

TX

AR

TN

ME

VT

NY

FL

GA

AL

NC

VA

MI

PA NJ

DE

NH

CT

MA

HI

AZ

LA

OK

KSCO

UT

SD

MN

WI

IA

MO

IL WV

MS

KY

OHIN

MD

SC

ND

DC

NYC

LAC

HOU

CHI

PHIL

PR

Unknown Total of 7 (7 states) (vol was reported but incomplete)

> 75% Total of 7 (6 states, 1 city)

50 – 75% Total of 13 (12 states, 1 city)

25 – 49% Total of 10 (9 states, 1 city)

< 25% Total of 15 (11 states, 1 territory, 3 cities)

No Data Total of 5

% of Total LabsSending ELR

N=57

% of ELR Targeted LabsSending ELR

N=50

% of VolumeSent via ELR

N=42

0%

25%

50%

75%

100%

23%

47% 50%

Total

ELR

7

Estimated National Status of ELR

Ente

ric

Genera

l C...

Hepatitis

HIV

Influenza

Lead/T

oxi

c

STD

TB

/Myc

o

VPD

Zoonotic

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

50%77%

68%

45%

67%

62%

29%

35% 70%60%

Total Volume

Step 3: Volume of Lab Reports and % via ELR, by Disease Category

N=42

8

# o

f La

b R

eport

s fo

r 12

month

peri

od

Large Hospital VA Federal Public Health

Other0%

10%

20%

30%

40%

50%

60%

46%

9%

0% 0%

26%

19%

4%

52%

1% 1%4%

38%

% of AllELR VolumeN=47

% of AllLabsN=57

Steps 1 & 3: ELR Volume and Total Labs By Lab Type

9

ELR HL7 2.3.1/z ELR HL7 2.5.1 Other message format

Web Entry0

10

20

30

40

50

60

50

14

27

15

Step 2: ELR Production Formats SupportedN=57

10

# o

f Ju

risd

icti

ons

ELR Technical Assistance

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• CDC made ELR Technical Assistance (ELR TA) available– Began receiving requests in Winter 2011

• Delivered by Skilled Personnel (through APHL) • Project (request) requirements:

– Advances ELR Implementation– Well-defined – Relatively short in duration (1-4 weeks)

• Evaluation Criteria:– ELR from PH lab to PH agency– New, high volume ELR into the PH agency– Enables consumption by a surveillance system– Enables broader adoption of ELR in jurisdiction– Leverages work already done for other

jurisdictions

Advancing

ELR

Requests

Skilled Personn

el

“Current” ELR Technical Assistance Activities

ELR TACategorie

s

ELR from Public

Health Labs

ELR from Large Labs

ELR from Regional

Labs or HIE

ELR from Hospitals

Transform/ Filter /

Route ELR for Use

Other

Validate or Clean Data

in ELR

Evaluate Infrastructu

re

Create Protocol or

Process documentsTechnical Assistance Metrics

• Received 45 Request• Representing 22 Jurisdictions• Status:

1 - Completed 8 - Work Underway 10 - Detailed Scoping

Began 18 - In Queue 8 - Out of Scope/Closed

ELR TA – Current Examples

• PH Lab to Arkansas Department of Health– Working with Arkansas PH lab to map LOINC and SNOMED codes for the

reportable conditions ELRs.

• Regional Lab to Virginia Department of Health– Assisting Solstas, a regional lab that provides reports to parts of

Virginia, North Carolina, Georgia, Alabama and Florida, with mapping of LOINC and SNOMED codes as well as the implementation of Rhapsody Connect.

• Large Lab to Kansas Department of Health– Kansas will be implementing their 1st ELR feed from any lab with

LabCorp. Assisting them with the receipt, routing and validation of the messages using Rhapsody.

14

www.cste.org

Surveillance/Informatics

ELR

• Task Force overview• Organization and membership• Products and Activities

CSTE/CDC ELR Task Force Website

Robert W. Pinner, M.D.

June 4, 2012

Update on ELR in the U.S. 2012 CSTE Annual Conference

Omaha, Nebraska