Laboratory Result Messaging into the NBS Doug Hamaker Division for Prevention and Preparedness Texas Department of State Health Services August 25, 2008

Topic Outline Overview of the Texas ELR system Intersection with NBS Mechanics and Flow Collaboration Opportunities Examples according to category National System State to State State to Local Programmatic and Technology

NBS and ELR NBS implemented in 2004 Standards-based ELR Initial acceptance criteria did not include ELR Electronic data exchange already in place within some programmatic areas Standards-based ELR Standardize and streamline the data exchange process Participation in CDC’s MSS alpha project - 2006 Adoption of Rhapsody ELR “Go-Live” 2007

ELR Message Mechanics Message Creation Message Transport Messaging Guide Message Creation Message Transport Message Consumption Message Creation Message Transport Message Consumption Message Creation Message Transport Message Consumption Message Creation Message Transport Message Consumption PHINMS sFTP Texas ELR System

Texas ELR Messaging Flow ELR message is received from Laboratory Native format is transformed to HL7 v2.3.1 Vocabularies are validated and/or used to transform local codes to standard codes, which are dependent on HL7 specification ELR Implementation Guide PHIN VADS Program Area addendums

Texas ELR Routing Message payload is interrogated and routed to appropriate systems according to matching criteria HIV/STD test results to HIV/STD system Core communicable disease results to NBS Further transformation may occur immediately prior to final routing in order to meet individualized requirements of each system (STD*MIS, NBS, etc.), such as Format (HL7 versus ASCII) Content (Use of standard versus local codes)

Texas ELR Route

Collaboration: National System Tools NBS in 16 States Rhapsody in vast majority of States PHINMS/sFTP for electronic data exchange Standards Use of the CDC-developed NBS promotes use of the core NEDSS standards Standardizing on HL7 v2.3.1 for laboratory result reporting Guides ELR Implementation Guide using Version 2.3.1 of the Health LevelSeven (HL7) Standard Protocol NEDSS ELR Interface Specifications HL7 2.3.1 ORU Mapping to Message-In Database NBS Production Sites (16)

Collaboration: State to State Interoperable and sharable Rhapsody routes and maps “Notes” that appear as string “Results” Multiple results within a single message Rhapsody scripting in general What to do with spreadsheets! Excel to tab delimited vbscript NBS message consumption “How do you…?” references to the NBS mapping to message-in database Maintenance, Enhancements, and Issues NBS User Group (NUG) bi-weekly calls User Interface for administration of system reference tables (SRTs)

Collaboration: State to Local Focuses local/regional efforts on disease investigation, analysis, and intervention Relieves burden of technology development NBS jurisdiction assignment/security Rollout Plans Impact on business process NBS user guidance significantly influenced roll-out plans Start with a smaller volume lab Allow shift in business process to occur during parallel testing Remainder of labs on a staggered roll-out schedule Incoming ELR’s will first appear in the Observations Needing Review Queue. This will happen in real-time as the ELR’s are processed into the NBS. “labs are getting to the locals much quicker and efficiently this way” What is the response to ELR in the NBS? “a much better mechanism for getting the reports”

Collaboration: Programmatic and Technology Cross-cutting strategy Message management individualized according to target system requirements Format (HL7 versus ASCII) Content (Use of standard versus local codes) Strengthens partnerships with labs PH Lab developing HL7 result reporting Partnership opportunity in developing standardized data exchange Beneficial to NBS users as well as other target systems utilizing ELR service Expands automated reporting of lab results indicative of notifiable conditions

NBS, ELR, and System Standards Use of the CDC-developed NBS promotes use of the core NEDSS standards Development of ELR using the Rhapsody foundation promotes use of Industry standards In combination, these emphasize the adoption and promotion of standards-based Electronic Laboratory Reporting Collaboration and Partnerships develop and have prospered when aligned on common standards and toolsets