1. 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

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

3. 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

4. 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

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

6. ELR Operational Flow

7. 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:
SNOMED code:

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

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

12. 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

13. Return on Investment Create Extract from Hospital Information System
Approximately hours of IT resource
Map Local Codes to Standard HL7 Naming Conventions
Approximately 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

14. 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

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

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

17. ELR Regulations
: Laboratory Findings Indicative of Infectious Disease Reportable Directly to the Department by Laboratories
In addition to the requirements of 105 CMR , , (A) and (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

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

19. 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
“Anyone who thinks that they are too small to make
a difference has never been bit by a mosquito."