Mandating hospital and commercial laboratories to report notifiable conditions electronically in Massachusetts Scott Troppy, MPH1 , Gillian Haney, MPH1, James Daniel2, Alfred DeMaria, MD1 1Bureau of Communicable Disease Control, Massachusetts Department of Public Health, Jamaica Plain, MA , 2 Chief Information Office, Massachusetts Department of Public Health, Boston, MA

Objectives MDPH ELR Goals and Overview Current Status Benefits/ROI Challenges ELR Regulations

ELR - Goals Collect laboratory reports of notifiable conditions electronically and automatically Present a single point of contact for all communicable disease reporting Automate disease reporting process improve timeliness of reporting of notifiable conditions improve data quality Provide hospitals with tools to transmit reports to MDPH Support messaging using PHIN standards Provide a system with the flexibility to meet future needs

Legacy Data Flow MDPH BCDC SLI Mention current volumes and show forms EPI Immunization Immigrant STD TB Health ISIS Mention current volumes and show forms Fax CDC Local Board of Reference Hospital Health Laboratory

Desired Data Flow MDPH BCDC SLI Immigrant STD TB EPI Immunization Health ISIS Unified Messaging Interface CDC Local Board of Reference Hospital Health Laboratory

ELR Operational Flow

Translate local codes Hepatitis A IgM+ ELR Message Gateway translates the reported information from local coding systems into standardized LOINC, SNOMED, and HL7 equivalents Local codes: HAVIGM, POS LOINC code: 22314-9 SNOMED code: 10828004

Hepatitis Results in MAVEN ELR integration- specimens, tests and results are disease specific EVERYONE is SEEING THE SAME THING AT THE SAME TIME

ELR – current status Approximately 80 clinical laboratories (local and national) reporting notifiable conditions to MDPH Message formats - HL7 2.3.1 SMF Certified and in production: 24 hospital laboratories 1 commercial laboratory Active implementation: 20 in process

ELR - Timeliness and Completeness Hospital System X Number of reports (Nov and Dec) Median # of days process reports 2006 (paper) 108 14 2007 (ELR) 240 2 122% increase in the number of reports received 12 day decrease in the time to process reports

Return on Investment Create Extract from Hospital Information System Approximately 30-40 hours of IT resource Map Local Codes to Standard HL7 Naming Conventions Approximately 30-40 hours of Infection Control Practioner's or Micro Supervisor Time saved for ICP and Micro Supervisor No more morbidity cards Reduced follow up for missing information Savings of 80+ hours a month

Implementation Support Contracted and MDPH IT and epidemiology staff Training Technical assistance with message extract Technical assistance with web services to send messages Technical assistance with mapping

Challenges Hospital IT Resources Limited CEO/CIO not willing to allocate resources for system that is not required by MDPH

Challenges Infection Control/Microbiology Labs understand ROI and more than willing to spend time mapping ICPs Request that MDPH makes electronic reporting a requirement

ELR Regulations 300.170: Laboratory Findings Indicative of Infectious Disease Reportable Directly to the Department by Laboratories In addition to the requirements of 105 CMR 300.100, 300.171, 300.180(A) and 300.180(C) all laboratories, including those outside of Massachusetts, performing examinations on any specimens derived from Massachusetts residents that yield evidence of infection due to the organisms listed below shall report such evidence of infection directly to the Department through secure electronic laboratory reporting mechanisms, or other method, as defined by the Department, within 24 hours. No punitive measures Promulgated July, 2008

Next Steps Targeted educational efforts Phased implementation plan with continued technical assistance 2-3 year effort

T. Scott Troppy Surveillance Epidemiologist & MAVEN Project Manager Massachusetts Department of Public Health Office of Integrated Surveillance & Informatics Services Bureau of Communicable Disease Control 305 South Street , 5th Floor Jamaica Plain, MA 02130 617-983-6819 scott.troppy@state.ma.us “Anyone who thinks that they are too small to make a difference has never been bit by a mosquito."