1. Improving Your Understanding of Electronic Lab Reporting (ELR) Lauren DiBiase, MS North Carolina Center for Public Health Preparedness

2. NC Center for Public Health Preparedness/UNC-CH/May 2009 Agenda How ELR determines NC County of Residence for an Event Timeframes and how they impact the way ELR works ELR and Workflows State Lab vs. LabCorp Your Questions

3. NC Center for Public Health Preparedness/UNC-CH/May 2009 Geocoding Process of finding latitude & longitude from other geographic data, such as street address, or zip codes With geographic coordinates, features can be mapped & entered into Geographic Information Systems (GIS) Geocoding is never correct 100% of the time

4. NC Center for Public Health Preparedness/UNC-CH/May 2009 How ELR determines NC County of Residence for the Event County listed becomes NC County of Residence for the Event The county in the person’s existing record becomes NC County of Residence for the Event 1. The ELR has a county listed as part of patient’s address IF THEN 2. The ELR does not have a county listed, but the person was already in NC EDSS with the county field filled out in the Persons tab IF THEN

5. NC Center for Public Health Preparedness/UNC-CH/May 2009 Attempt to geocode is made 3. No county, but patient street address is filled in and looks valid IF THEN No geocoding attempt is made and best county determined by patient city and/or zip Best county is determined by the ordering facility city and/or zip 4. The patient street address is missing or otherwise does not look valid IF THEN 5. There is no patient city and/or zip IF Events will appear in the Verification of Reporting County is Needed WF How ELR determines NC County of Residence for the Event

6. NC Center for Public Health Preparedness/UNC-CH/May 2009 ELR may route to your county if facility in your county ordered the lab If there are no previous events in NC EDSS with an address for this patient & lab doesn’t enter address, ELR may route to your county if a facility in your county ordered the lab 1. Correct NC County of Residence 2. Assign to your group in Investigation Trail 3. Enter any info (clinical/treatment) you have 4. Update patient address if have it 5. Reassign to correct county in Investigation Trail

7. NC Center for Public Health Preparedness/UNC-CH/May 2009 What you need to do when your LHD provided services but ELR not in your workflows Once there is a value in NC county of residence for the event (no matter how it was entered – via ELR, manually entered), ELR routes to that county Subsequent ELRs can’t override this value You provided services, but ELR does not appear in your LHD’s workflows… If attempted to enter event, would see Potential Match screen with existing event, but would not be able to access the event If your LHD needed to enter treatment info, would need to request a share

8. NC Center for Public Health Preparedness/UNC-CH/May 2009 Timeframes Used to determine whether an event is a new event or a duplicate of an existing event Devised by DPH No hard & fast or perfect way to devise the rules Apply to any 2 events in system Calculated by: Difference between create date for two events or for ELR imports difference between specimen collection date and create date.

9. NC Center for Public Health Preparedness/UNC-CH/May 2009

10. ELR could fold into an existing event when really a new event What do you need to do? 1. Print out lab from Event ‘x’ (the existing event) 2. Create new event,Event ‘y’ 3. Manually enter Lab Result into Event ‘y’ 4. Update Admin QP Disease Report Info section 5. Add event note in both events that ELR attached to Event ID ‘x’, but it signifies a new event, Event ID ‘y’

11. NC Center for Public Health Preparedness/UNC-CH/May 2009 Timeframes make searching for an event critical Example: you manually create an STD event (from back logged lab or card) today & ELR already created the event ≥ 30 days ago If you search before creating the event Existing event shows up in your search results, so able to review the event If you do NOT search before creating the event When you click Add on the Create Event screen, the system will not flag this event as a potential duplicate (because it is outside the timeframe) No one can merge the events later

12. NC Center for Public Health Preparedness/UNC-CH/May 2009 What do you need to do when you create a 2 nd event instead of using the existing event 1. Need to check that info in the 2 nd Event agrees with the info in the 1 st Event Reconcile any differences Add any additional data from 2 nd event into 1 st event 2. Add event note in each event cross-referencing the other 3. In Admin Question Package, mark ‘Classification Status’ of 2 nd Event as ‘unspecified’ Do not select ‘Does not meet case criteria’ 4. Call Help Desk and ask them to mark the 2 nd event as ‘invalid’ 5. Resubmit the 1 st event to DPH

13. NC Center for Public Health Preparedness/UNC-CH/May 2009 ELR could create the 2 nd event instead of folding into existing event E.g. Person has an existing Chlamydia event in the system, but was never treated. The person continues to test positive and a lab creates a new event because outside 30 day timeframe instead of merging to existing event What do you need to do? 1. Print out lab from 2 nd Event 2. Open 1 st Event & manually enter lab result from 2 nd Event 3. Add note in the Lab Results Screen of 1st Event 4. In Admin Question Package of 2 nd Event, mark “Classification Status” as Unspecified Do no select ‘Does not meet criteria’ 5. Add an event note in both Events cross-referencing the other Event 6. Call Help Desk ask them to mark 2 nd event as ‘Invalid’ 7. Resubmit 1 st Event to DPH

14. NC Center for Public Health Preparedness/UNC-CH/May 2009 How ELR Impacts Your Workflows Lab Result Review Required (local) Verification of County Residence Needed Person/Event Deduplication

15. NC Center for Public Health Preparedness/UNC-CH/May 2009 Lab Result Review Required (local) Electronic Lab Report for any disease that is fed into system Manually entered CD & VPD labs Manually entered STD & TB labs do not appear in this WF When reviewing a manually entered lab click on Cancel if you didn’t make any edits (if you click Save, event gets put back in this WF)

16. NC Center for Public Health Preparedness/UNC-CH/May 2009 How do I find the newest lab that got added to the event? Event History Tab All users will now have access (LDE role previously did not) Specimen # for a manually entered lab will display Specimen # for ELR may display in future

17. NC Center for Public Health Preparedness/UNC-CH/May 2009 Verification of Reporting County Needed NC EDSS sets the field ‘verification of reporting county is needed’ (in Demographic QP) to ‘yes’ when county determined by system without full patient address If do not have full patient street address, system will try to use the city and/or zip of patient to determine county Field added let LHD know reporting county may be wrong & verification is needed When county is verified and/or corrected, change answer in this field to ‘no’

18. NC Center for Public Health Preparedness/UNC-CH/May 2009 Person/Event Deduplication If ELR does not have enough matching information to find an existing person in NC EDSS, will create a duplicate person A state-level user will need to resolve duplicate people All users will see notification on Dashboard that person is pending deduplication (don’t click on the link!) After persons are merged, the events will now appear in the Event Deduplication Workflow All users will see notification on Dashboard that event is pending deduplication LHC II will resolve event duplicates

19. NC Center for Public Health Preparedness/UNC-CH/May 2009 State Lab vs. LabCorp State LaboratoryLabCorp Time LagNo lag Example = report finalized on Monday is available in NC EDSS on Tuesday morning 1 day lag Example = report finalized on Monday is not available in NC EDSS until Wednesday morning Report Status May send preliminary results No preliminary results sent May send ≥ 1 ELR report per specimen Sends only 1 ELR report ever per specimen, only when final Non-positive results may be updated to existing events depending on disease Only sends if report contains a reportable positive, other non- reportable results on same report not sent May send corrections via ELR Subsequent corrections are sent only as retraction letter on paper, not via ELR Specimen Source Entered in specimen source field on Lab Results Screen Displayed only as free text in the notes at the bottom of the lab results screen

20. NC Center for Public Health Preparedness/UNC-CH/May 2009 Wrap - Up No Hepatitis coming from State Lab Hepatitis B webinars offered this summer Brief evaluation survey & slides will be emailed to you Help Desk 919-715-5548 or (877)-625-9259 ncedsshelpdesk@ncmail.net Use Event ID only – no names or SS #s Available 8 am – 5 pm, M-F

21. NC Center for Public Health Preparedness/UNC-CH/May 2009 Password Expiration Passwords Expire Every 90 Days Warning the 15 days prior to expiration User Information vs. Password Reset Link Need to have entered a security question & answer in order to use Password Reset Link When you type in your security answer it must match exactly what you originally entered