The Analyses of Statewide Laboratory Surveys for Electronic Laboratory Reporting Hwa-Gan Chang1 Dave DiCesare1 Kathryn Schmit1 Jennifer Baumgartner2 Laura Goodman2 Charles DiDonato3 Perry Smith1 1 New York State Department of Health 2 New York City Department of Health 3 Keane, Inc

New York ECLRS Development and Implementation Initiation Development Implementation Maintenance/ Mandatory Enhancement 1999 2000-01 2001-05 2005-current 2007+ ECLRS RFP & a Vendor Selected ECLRS Development ECLRS Training 1st Lab Roll out Add HIV, Lead NYCDOH, Cancer Report card Audit Law passed Add Cong Malf, Newborn

Electronic Clinical Laboratory Reporting System (ECLRS) Health Commerce Network State Program Areas Clinical Labs HL-7/ASCII/Web entry Cancer Congenital Malformation ECLRS HIV Hospital Emergency Departments Lead Internet Internet Emergency Department Public Health Lab Perinatal Hep B General Communicable STD TB Local Health Departments/ NYCDOH

New York Mandatory Electronic Laboratory Reporting Law was passed on July 18, 2007 and was posted on ECLRS home page A letter was mailed to laboratory directors (N=927) in February 2008 A lab survey was developed and posted on ECLRS web page in March 2008 A reminder was emailed to lab contacts in May 2008

Lab survey #2: Paper survey filled out by DOH investigators Materials Lab survey #1: Web survey entered by laboratory staff Lab survey #2: Paper survey filled out by DOH investigators

Lab Survey #1- Objectives To gain knowledge regarding type of tests that labs perform To identify labs that are not reporting via ECLRS To learn which LIS vendors are used To learn which reference labs are used

Survey Questions Lab location and contact information Testing of specimens from NYS residents (Y/N) Types of tests performed for: General Communicable Diseases (68) Sexually Transmitted Diseases (6) Tuberculosis HIV Heavy metals (lead, arsenic, cadmium, mercury, zinc) Pathology/Cancer Congenital Malformations Hemoglobin A1c

Survey Questions Reference labs used Laboratory Information System vendors Program area specific information NYCDOH: susceptibility testing, Hemoglobin A1c HIV: type of testing, kit Cancer: facilities served Heavy Metals: type of Metals Congenital Malformations: type of cytogenetic testing

Labs Responded to Survey (N=440), Response Rate =43% Labs Test NY Residents (N=391) Types of Labs Location of Labs

Labs Testing NYS Residents 213 labs: General Communicable Diseases Less than 10 diseases tested for: 59 10 – 30 diseases tested for: 71 31 – 60 diseases tested for: 83 202 labs: Sexually Transmitted Diseases 100 labs: Tuberculosis 46 labs: HIV 54 labs: Heavy metals 24 labs: Congenital Malformations 161 labs: Pathology / Cancer

Use of Reference Labs Yes: 159 hospital labs, 83 commercial labs No: 31 hospital labs, 118 commercial labs Most frequently used reference labs: QUEST 114 NYSDOH public health lab 64 LABCORP 62 MAYO 17 SPECIALTY 28 NYCDOHMH LAB 21 ARUP 13

Lab Information System Vendors Hospital labs: 190 MEDITECH 47 SOFT 28 CERNER 25 MYSIS 23 SUNQUEST 18 IN-HOUSE 6 Other 29 Commercial labs: 201 MEDITECH 3 SOFT 8 CERNER 11 MYSIS 8 SUNQUEST 1 IN-HOUSE 49 Other 79

Number of Labs Reporting via ECLRS by Reportable Conditions Labs that responded Labs that report to ECLRS General Communicable STDs, TB 224 195 19 in progress HIV 46 Cancer 161 36 4 in progress Heavy Metals 54 48 Congenital Malformations 24 1 2 in progress Labs that do not report to ECLRS 10 1 2 21

Lab Audit Survey #2- Objectives To validate lab contact information while visiting labs for audit To randomly select 8 general communicable, 8 STD, and 8 HIV tests from lab log for validation To evaluate labs’ completeness of reports if reporting via ECLRS

Survey Questions Lab contact information Surveyor information Type of tests certified by State Name, location, and test type of reference labs A representative sample of 8 positive test results by test type with specimen accession number, collection date, and reportable condition

Lab Survey Results for Communicable Diseases as of July 31, 2008 No. of Laboratories Surveyed N=380 No. of Labs Reporting via ECLRS N=251 No. of Labs Not Reporting via ECLRS N=129 100% Reporting N=150 Partial Reporting N=11 List not matched N=14 Enrolled / Just certified N=76 Do not test for reportable diseases N=125 Test for reportable diseases N=4

Summary Form builder utility can be easily applied to any web survey The low lab web survey response rate indicated the difficulty of obtaining information, but the responses were helpful in identifying labs not reporting via ECLRS The investigators visiting labs were valuable for evaluating the completeness of reports via ECLRS For communicable disease lab reporting, virtually 98% labs are reporting electronically