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

2. 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

3. 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
Adoption of Rhapsody
ELR “Go-Live” 2007

4. 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

5. 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

6. 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)

7. Texas ELR Route

8. 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 of the Health LevelSeven (HL7)
Standard Protocol
NEDSS ELR Interface Specifications
HL ORU Mapping to Message-In Database
NBS Production Sites (16)

9. 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)

10. 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”

11. 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

12. 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