1. Utilizing BioSense Integrator Technology for Electronic Laboratory Results Reporting: A Technical Perspective
W. Lane Chambers
Healthcare Systems Consultant – SAIC
BioSense Data Provisioning Project Manager for CHRISTUS Health

2. CHRISTUS BioSense Architecture

3. CDC’s BioSense
BioSense is a national program intended to improve the nation’s capabilities for conducting real-time biosurveillance, and enabling health situational awareness through access to existing data from healthcare organizations across the country.
The BioSense system collects over 1 million de-identified admission, census, emergency department, laboratory, radiology and pharmacy messages a day from healthcare providers across the US.
Data sources include:
State/regional surveillance systems
Local and regional hospitals and health care systems
National laboratories
Department of Defense (DoD)
Department of was one of the original 10 “vanguard” sites that began transmitting data real time to BioSense in Dec. 2005
Veterans Affairs (VA)

5. CHRISTUS’ BioSense Facilities
Facility
Region
BioSenseADT
Census ED
Micro
Results
To BioSense
ELR to
TX DSHS
CHRISTUS St. Michael Health System Texarkana, TX
ALTX X
CHRISTUS Coushatta Health Care Center Coushatta, LA
CLA
CHRISTUS St. Frances Cabrini Hospital Alexandria, LA
CHRISTUS St. Catherine Hospital, Katy, TX
GCTX
CHRISTUS St. John Hospital, Nassau Bay, TX
CHRISTUS Schumpert Highland, Shreveport, LA
NLA
CHRISTUS Schumpert St. Mary Place, Shreveport, LA  
CHRISTUS St. Patrick Hospital, Lake Charles, LA  
SWLA
CHRISTUS St. Elizabeth Hospital, Beaumont, TX  
SETX
CHRISTUS Jasper Memorial Hospital, Jasper, TX  
CHRISTUS St. Mary Hospital, Port Arthur, TX  

6. BioSense Message Flows
Standard Queue
Application
CDC PHIN MS
Receivers
Data Messaging
Broker
(transfers from PHINMS,
edits and parses messages, and
reformats in XML for load)
Data Warehouse and
HL7 2.5 and
vocabulary
Local vocabulary and message
formats
BioSense Integrator with LINKER and PHIN MS Sender
Interface
Engine
HIS/CIS Systems
Data Source
CDC

7. Functions of the BioSense Integrator
“Subscribe to” and receive (TCP/IP, FTP) HL7 messages from the source operational HIS/CIS systems in local format with local vocabulary
Filter data for message types of interest
De-identify messages and assign replacement BioSense patient and visit IDs (LINKER)
Maintain a cross-reference database linking BioSense IDs to Data Source IDs
Transform messages into BioSense HL7 v2.5 format and map local vocabulary to BioSense standards
Transmit messages securely to CDC via PHINMS

8. BioSense Split Feeds to Public Health
CDC
PHIN MS
Receiver
Interface
Engine
BioSense Integrator with LINKER and PHIN MS Sender
BioSense
HL7 2.5 and
vocabulary
BioSense Data Warehouse and Application
Local vocabulary and message
formats
Copy of BioSense De-identified Data
State or Local
Public Health
PHIN MS
Receiver
BioSense
Application
Public Health Database
HIS/CIS Systems
Data Source

9. New Requirements for ELR
Simple case detection algorithm for Texas’s reportable diseases
Generating output messages containing protected healthcare information (PHI) and expanded patient demographics not in hospital lab results messages
Batching and routing ELR output to a separate PHIN MS queue
Creating control reports to allow CHRISTUS Lab/Infection Control staff audit that all applicable results had been reported electronically

10. ELR Feed to Texas Public Health
CDC
PHIN MS
Receiver
Cloverleaf
Engine
BioSense Integrator with LINKER and PHIN MS Sender
Standard Feed to BioSense
BioSense Data Warehouse and Application
Outbound
Lab Interface
Installed at
6 of 11 Facilities
HL7 2.5 ELR Messages with PHI
Texas
Public Health
PHIN MS
Receiver
BioSense and NBS
Application
Meditech Lab and
HIS/CIS Systems
Texas NEDSS-Based System (NBS)
CHRISTUS

11. TX Reportable Diseases Case Detection
CHRISTUS’ laboratory organisms mapped to SNOMED codes
List of reportable SNOMED codes provided by Texas DSHS
Algorithm:
Is the result’s SNOMED code on the TX List?
Is it a positive result?
Is it a final result?

12. Recap of the Project BioSense Project Kickoff – July 24, 2007
BioSense Integrated (end to end) Testing – February 26, 2008
BioSense ADT, Census, ED Activation – 11 sites – April 2, 2008
BioSense Microbiology Results Activation – 6 sites – April 21, 2008
ELR feed to Texas DSHS Activation – 4 sites – April 23, 2008
CHRISTUS is now transmitting ~ 18,000 messages a day to BioSense, every 15 minutes, 24/7.
CHRISTUS is sending ~ 4 ELR messages a day to Texas DSHS, every 4 hours if applicable results exist.

13. Next Steps under Consideration
Add additional CHRISTUS facilities to BioSense Lab and ELR feeds as outbound Meditech results interface is implemented
Send addition non-microbiology results (HIV, Lead) of interest to Texas to BioSense for ELR feed
Establish ELR feed for Louisiana for CHRISTUS’ Louisiana facilities