Reusable Tools for Public Health Messaging and Vocabulary Standards

Riki Merrick, MPH

Eric M. Haas, DVM, MS

CSTE Conference June 5th, 2012

The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of CDC or the Agency for Toxic Substances and Disease Registry.

OverviewPublic Health Lab Interoperability Project

(PHLIP)IntroductionTools and Processes

Electronic Laboratory Reporting (ELR)Program ApproachProjects

Laboratory Technical Implementation Assistance for Public Health (LTIAPH)

Electronic Lab Reporting-Technical Assistance (ELR-TA)Tools and Processes re-used

PHLIP – Who and What Actors and Use Cases

Electronic Lab Surveillance Message (ELSM)

• Public Health Lab (PHL) to Centers for Disease Control and Prevention (CDC) WHO Global Influenza Surveillance Network

Electronic Test Order and Result (ETOR)

• PHL to CDC Lab and back• PHL to PHL and back

Route-not-Read (RnR) hubsPHLIP is supported by cooperative agreement #CCU303019 from the Centers for Disease Control and Prevention (CDC).

PHLIP – Who and What Standards Used

Transport• PHIN-MS

Messaging• ELSM – HL7 v2.3.1 ORU^R01• ETOR – HL7 v2.6 OML^O33 and OUL^R22

Vocabulary• LOINC for ordered and resulted tests• SNOMED for results• SNOMED and HL7 for specimen terms• UCUM for units• HL7 elsewhere in the message

PHLIP – … and Why

PHLIP

PHLIP - ELSM

PHL 2

PHL 1

PHL 1 sends ELSM to CDC

using the RnR hubs

PHLIP - ETOR

PHL 2

PHL 1

PHL 1 sends ELSM to CDC

PHL 2 can do ETOR with CDC

All are using the RnR hubs

PHLIP - Big Picture

PHL 2

PHL 1

PHL 1 sends ELSM to CDC

PHL 2 can do ETOR with CDC

PHL 1 and PHL 2 can do ETOR with each other

All are using the RnR hubs

PHLIP – ELSM: Current Activities

Data exchange requirements developed and released

PHLIP Workgroup (PHLs and CDC) collaboratively build knowledge and improve process

Technical Assistance Team (TAT) supports implementation virtuallyand on site since March 2010

Project Manage-mentTerminologyTechnical Archi-tecture

PHLIP - ELSM Map June 2012

As of June 1, 2012: 36/57 PHLs sending production data

PHLIP – ETOR Current Activities

Pilot implementation for Salmonella orders from 3 SPHLs to CDC and result messages back to SPHLsPilot testing of PHL to PHL ETOR for Influenza surge capacity in 2 PHL groupsIA - NE – MN and FL - TX

PHLIP– Tools and ProcessesWorking Group CallsSharePoint for all documents/resourcesData Collection SheetMessaging templateEncoding guidelineSpecimen Cross-Mapping TableNND harmonization PrioritizationPHLIP Technical Assistance Team (TAT)

PHLIP - ProcessesDifferent Calls for different Use cases and topics:

Problem solvingCore GroupVocabularyImplementation Issues

Formalizing DecisionsChange Control Board

APHL Informatics SharePoint

APHL Informatics SharePoint: - Messaging guidelines- Vocab Resources- Definitions/conventions- Contact Information- Helpful Links- Project Management- Information about other

APHL Informatics programs

PHLIP - Data Collection Sheet

PHLIP - Messaging Template

PHLIP - Encoding Guideline

Working Group Calls

PHIN VADS Value SetsCurrent value sets for ELSM, ELR HL7 v.2.5.1, and many

other message guides: https://phinmqf.cdc.gov/default.aspx

PHIN Message Quality Framework

PHIN MQF Validation Tool: https://phinmqf.cdc.gov

Specimen Cross-Mapping Table

PHLIP - Meet the TAT

TerminologyTechnical ArchitectureProject Management

VisionProgramsData FlowProgram ApproachVocabulary & Messaging GuidanceTechnical Implementation

ELR initiative – What is it

ELR initiative – Vision

Provide assistance to Public Health Labs and Public Health AgenciesPromote interoperability

Promote adherence of messaging and data standards amongst data exchange partners including LOINC, SNOMED and HL7 messages

Enable state public health labs (SPHLs) to exchange laboratory data with public health agencies (PHAs) building the data exchange infrastructure for other use cases

One-on-one tailored technical assistance, while developing a common baseline/framework and reusable components.

Collaborate with each other as well as other national efforts

ELR initiative – Programs2010-2012LTIAPH: Laboratory Technical Implementation Assistance for Public HealthARRA HITECH grant for 10 ELC grantees plus 2 guestsData flow from PHL to PHAConsultative (not prescriptive/enforcer) roleELC grantee list: Arizona, Florida, Houston, Iowa, Massachusetts, Michigan, New York State, Philadelphia, Rhode Island, and VirginiaLTIAPH is supported by Cooperative Agreement Number 1U50HK000105 from Centers for Disease Control and Prevention (CDC).

2011 - currentELRTA: Electronic Lab Reporting Technical AssistanceCDC sponsored assistance to PHA to connect to PHLs ANDCommercial labs – and provide help with v2.3.1 connections, if neededApplication process managed through CDCTargeted Technical Assistance by APHL informatics teamELRTA is supported by cooperative agreement #CCU303019 from the Centers for Disease Control and

Prevention (CDC).

ELR initiative – Programs

ELR initiative – Data flow

Out-of-scope:

1) National level flows2) Other ELR flavors

In-Scope Data Flows:

· ELR (flavors): · PHL PHA· Hospital (EHR) PHA· Clinical labs è PHA

Legend: Grey circles: Out-of-scope for LTIAPH/ELR-TA

ELR 251 Implementation Assistance Approach

Design Prototype Pilot Rollout Operations

Grantee 1 SOW Project mgmt plan

Schedule, etc.

Grantee 2 SOW Project mgmt plan

Schedule, etc.

….. SOW Project mgmt plan

Schedule, etc.

Grantee 10 SOW Project

mgmt planSchedule,

etc.

Pilot

Rollout

Program:

Grantee Projects :

Feedback Loop

ELR initiative - Program Approach

Balance level-of-effort between providing and developing a common framework and re-useable components and one-on-one assistance by building Menu of Services

Leverage “webinar” concept to plan milestones and share the knowledge with broader audience

Conduct Current State Assessment

Collaborate with other national efforts (ELR Taskforce, RCMT update, LabM CoP, S&I Framework lab related initiatives and PH reporting)

Vocabulary & Messaging Guidance

Formed Vocabulary Core Work Group

Developed “ELR 251 Constrained Profile”Disease/agent prioritization (Tier-1, Tier-2, etc)

Pilot group : Chlamydia, Gonorrhea, Salmonellosis, Hep C, Pertussis and HIV

Map vocabulary for ‘Pilot Group’Tests and Resulted Tests: LOINCTest Results : SNOMED-CTSpecimen : SNOMED-CT

Leverage RCMT for Tier-1 and Tier-2

Vocabulary Collaboration Framework

LTIAPH

Lab Interoperability Cooperative (LIC)

(Hospitals)

Workgroup (formed out of 10 ELC ARRA-

HITECH grantees)

UT and CA as participants

PHLIP

PHLISSA

ELR National Taskforce

· VMCoP· LabCOP· CoI-ePHI

RCMT refresh

· “Compare Notes” on Core Work Group’s outputs

· Collaboration opportunities

· Serve as a body of SMEs for questions and clarifications

· Leverage and collaborate on RCMT refresh work

· Collaborate to ensure approach alignment with Hospital side implementation.

· Collaborate on common objectives

· Liaison with PHLISSA

ARRA-HITECH projects under PHITPO

Legend

Core Work Group

Vocabulary & Messaging Guidance (continued….)

Position statement clarifying ELR specs around Results

§170.207 (c) Laboratory test results. Standard. Logical Observation Identifiers Names and Codes (LOINC®) version 2.27, when such codes were received within an electronic transaction from a laboratory (incorporated by reference in §170.299).

Webinar on ELR Implementation guide (§170.205(c) Electronic submission of lab results to public health agencies. Standard) and comparison between 2.3.1 and 2.5.1 messageElectronic Test Order and Results data flow: Preliminary comparison between ELINCS and PHLIP ETOR implementation specifications

Technical ImplementationReview existing data flows / architectureCreate prototype toolingConversion to ELR 251

Up convert to ELR 2 5 1 from 2. 3.1, 2.3.z and other variationsDown convert from ELR 2.5.1 to 2.3.1

Testing framework

ELR (Sender) side

RLR: Electronic Lab Reporting to PHAs ( PHL è PHA ; Send)

Aut

omat

ion

Sys

tem

s vi

ewM

anua

l P

roce

ss

LIMS

Is this a Notifiable Disease ?

Extract Information from LIMS

Perform Transformations and Translations

Integration Engine

Construct ELR (HL7) 251 message

Outbound Gateway &

Security Tool

Encrypt Message Route to PHA

Message sent

To PHA

Public Health Laboratory (Sender)

Capture Lab Test Results in LIMS

LIMS – Laboratory Information Management SystemRCMT - Reportable Condition Mapping TablesPHA – Public Health AgencyPHL – Public Health Laboratory

Notifiable condition lookups

1 2 3 4

ELR (Receiver) side

Focus on:Design / architectureVocabulary and HL7 message transformations

Tools:Orion Rhapsody (mostly)MQF Receiver profileAnd other testing / validation framework

PHLIP Tools Reused in ELR initiative

Vocabulary

HL7 Messaging

Project Management Technical Assistance Team

Data Collection Sheet Encoding guideline Working Group Call Vocabulary Harmonization for Nationally Notifiable Diseases (NNDs) Mapping and Terminology Conventions Specimen Cross-Mapping Table Messaging template Mapping Conventions (EPI info

and specimen) ETOR guide v2.6 for interested

labs Message Validation Tools (MQF)

ELR Tier Groupings

In the tier groupings, diseases have been grouped into tiers for implementation based on complexity and volume.

Constrained Profile Message Guide

The Implementable Profile can be customized to meet the needs of the PHA.

Constrained Profile Message Template

PHIN VADS RCMTCurrent list of LOINCs and SNOMED codes for reportable

conditionshttps://phinvads.cdc.gov/vads/ViewCodeSystemConcept.action?

oid=2.16.840.1.114222.4.5.274&code=RCMT

PHLIP Intangibles Reused in LTIAPH and ELRTA

Knowledge

Experience

Relationships

Intangibles

APHLinformaticsProgram Approach

PHLIPLTIAPHELRTA

Vocabulary & Messaging Guidance across all programsTechnical Implementation coordinated and for all programsContact: Linda.Cohen@aphl.org

Wes.Kennemore@aphl.org

In Summary

QUESTIONS?

rmerrick@iconnectconsulting.com