2011 National Electronic
Laboratory Reporting (ELR)
Snapshot Survey
Summary of Results
J.A. Magnuson, PhD, RS
Oregon Health Authority, Acute and Communicable Disease Prevention
800 NE Oregon St., Ste. 772, Portland, OR 97232
Tel. 971-673-1111, FAX 971-673-1100
j.a.magnuson@state.or.us
Publicly available as download from www.coast2coastinformatics.com
J.A.Magnuson@state.or.us
May 2012
TABLE OF CONTENTS
Interpretation ........................................................................................................................................... 3
Section: State and Scope of ELR ............................................................................................................ 4
Section: ELR Data Sources ................................................................................................................... 17
Section: Use of ELR Data ..................................................................................................................... 31
Section: ELR System Info and Support .................................................................................................. 45
Section: ELR Formats ........................................................................................................................... 52
Section: LIS/LIMS ................................................................................................................................ 60
Section: Opinions and Topical Issues ................................................................................................... 61
End of Survey Results ........................................................................................................................... 82
Editorial Board ...................................................................................................................................... 83
2011NationalELRSurvey-Summary.docx
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May 2012
Interpretation
Survey questions are listed in numerical order, each followed by data presentation. In some
instances, the survey questions are abbreviated or slightly changed for readability in this summary
context. The author has appended notes to some of the tables and graphs to enhance interpretation
of data. Historic trends are included for some items.
The 2011 survey consists of data gathered from 55 invited participants, of whom 54 (98.2%)
responded:
• 49 states in the United States
• Federated States of Micronesia
• Four US Metropolitan Areas (alphabetically, by state): Los Angeles, CA; Denver, CO; Chicago,
IL; New York City, NY.
The last page of this report acknowledges the work of the Survey Editorial Board.
Historic Participation in the Annual ELR National
Snapshot Survey 2004-2011
2004 2005 2006 2007 2008 2009 2010 2011
2004 2005 2006 2007 2008 2009 2010 2011
Chicago
Michigan
Denver
Minnesota
FSM
Mississippi
Indianapolis
Missouri
Los Angeles
Montana
New York City
Nebraska
Puerto Rico
Nevada
Washington DC
New Hampshire
Alabama
New Jersey
Alaska
New Mexico
Arizona
New York
Arkansas
North Carolina
California
North Dakota
Colorado
Ohio
Connecticut
Oklahoma
Delaware
Oregon
Florida
Pennsylvania
Georgia
Rhode Island
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Section: State and Scope of ELR
Note: The “n” for each graphic indicates the number of respondents asked to answer that question.
Respondents were directed to answer questions depending upon their stage of ELR. Of the total 54
respondents in 2011, three jurisdictions self-identified as being in “Testing”, two in “Planning”, and
one in “No status”.
Q2. [All sites] Does your state/jurisdiction have formal requirements (reporting rules, mandates,
legislation, etc.) specifically requiring/regulating electronic lab reporting? (Select all appropriate
options)
Answer options:
a) Yes, for all notifiable disease conditions (check this for “almost all” as well, for instance, “All
but HIV”)
b) Yes, for some notifiable disease conditions
c) Yes, for some non-notifiable conditions
d) No, but we plan to have legislation in place within a year
e) No, but we are interested
f) No
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Legislation details, by jurisdiction
Answer options:
a) Yes, for all notifiable disease conditions (check this for “almost all” as well, for instance, “All
but HIV”)
b) Yes, for some notifiable disease conditions
c) Yes, for some non-notifiable conditions
d) No, but we plan to have legislation in place within a year
e) No, but we are interested
f) No
2011. Legislation regarding ELR, by jurisdiction.
Jurisdiction Answer option and URL
Jurisdiction
Chicago
Denver
FSM
Mississippi
Missouri
Montana
a
f
f
Nebraska
a
Nevada
e
Los Angeles
f
f
NA
*
a
http://www.leginfo.ca.gov/pu
b/11-12/bill/asm/ab_01510200/ab_186_bill_20111007_
chaptered.pdf
http://www.health.ny.gov/pro
fessionals/reportable_disease
s/eclrs/
Answer option and URL
New York
City
a
Alabama
e
New
Hampshire
f
Alaska
Arizona
Arkansas
e
f
f
New Jersey
New Mexico
New York
a
f
a
California
a
North
Carolina
b
Colorado
f
North
Dakota
f
http://info.sen.ca.gov/pub/07
-08/bill/asm/ab_26512700/ab_2658_cfa_20080321
_172233_asm_comm.html
2011NationalELRSurvey-Summary.docx
http://www.sos.state.ne.us/rule
s-andregs/regsearch/Rules/Health_an
d_Human_Services_System/Title
-173/Chapter-1.pdf
http://public.leginfo.state.ny.us/
LAWSSEAF.cgi?QUERYTYPE=LAW
S+&QUERYDATA=$$PBH576C$$@TXPBH0576C+&LIST=LAW+&BROWSER=EXPL
ORER+&TOKEN=14202664+&TAR
GET=VIEW
http://www.ncleg.net/gascripts/
statutes/statutelookup.pl?statut
e=130a
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2011. Legislation regarding ELR, by jurisdiction.
Jurisdiction Answer option and URL
Jurisdiction
Connecticut
a
Ohio
e
Delaware
f
Oklahoma
a
Florida
a
Georgia
e
http://www.doh.state.fl.us/dis Oregon
ease_ctrl/epi/topics/64D3_11-08.pdf
Pennsylvania
Hawaii
a
Rhode Island
Idaho
f
e
Illinois
a
South
Carolina
South
Dakota
Iowa
c
Tennessee
e
Texas
e
Utah
e
Kansas
http://www.cga.ct.gov/2011/
act/pa/pdf/2011PA-00242R00HB-06618-PA.pdf
http://www.ilga.gov/commissi
on/jcar/admincode/077/0770
06900B02000R.html
http://www.idph.state.ia.us/i
dph_universalhelp/MainConte
nt.aspx?glossaryInd=0&TOCId
=%7B4C7ABEB5-4B65-4BFD9B66-663E046078DF%7D
Answer option and URL
a
NA
*
d
f
Kentucky
NA
*
a
Louisiana
Maine
f
f
Vermont
Virginia
f
f
Maryland
Massachuset
ts
e
a
Washington
West Virginia
e
a
Michigan
Minnesota
f
f
Wisconsin
Wyoming
f
f
www.lrc.state.ky.us/KRS/36900/CHAPTER.HTML
http://www.mass.gov/eohhs/
provider/reporting-tostate/diseases-andconditions/rdiq/reportingdiseases-and-surveillanceinformation.html
http://www.ok.gov/health/docu
ments/Chapter_515_Final_Rules
_2010_Distribution_Copy_Final.p
df
http://arcweb.sos.state.or.us/pa
ges/rules/oars_300/oar_333/333
_018.html
apps.sos.wv.gov/adlaw/files/rule
sword/64-07.doc
* NA = Not Answered
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Q3. [All sites] If you indicated that your jurisdiction has ELR-specific legislation, rules, or mandates
currently IN PLACE, please provide the URL where the legislation is posted, and also write a brief
statement summarizing how the legislation requires/regulates ELR.
2011. URLs and Descriptions Provided for ELR Legislation. Edited for length.*
URL for ELR Legislation
Brief description of regulation
http://arcweb.sos.state.or.us/pages/rules/oars_300/oar_33
3/333_018.html
http://public.leginfo.state.ny.us/LAWSSEAF.cgi?QUERYTYPE=
LAWS+&QUERYDATA=$$PBH576-C$$@TXPBH0576C+&LIST=LAW+&BROWSER=EXPLORER+&TOKEN=14202664+
&TARGET=VIEW
http://www.cga.ct.gov/2011/act/pa/pdf/2011PA-00242R00HB-06618-PA.pdf
Labs with >30 reports/month must use ELR
[No description provided]
...A clinical laboratory that reports an
average of more than thirty findings per
month shall make such reports electronically
in a format approved by the commissioner…
[No description provided]
http://www.health.ny.gov/professionals/reportable_diseases
/eclrs/
http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_0151(LA County) Assembly Bill No. 186, CHAPTER
0200/ab_186_bill_20111007_chaptered.pdf
540, An act to amend Section 120130 of the
Health and Safety Code, relating to public
health.
(g) Commencing July 1, 2009, or within one
year of the establishment
of a state electronic laboratory reporting
system, whichever is later, a report
generated pursuant to this section, or
Section 121022, by a laboratory shall
be submitted electronically in a manner
specified by the department. The
department shall allow laboratories that
receive incomplete patient information to
report the name of the provider who
submitted the request to the local health
officer.
http://www.sos.state.ne.us/rules-andReportable disease regulations specify what
regs/regsearch/Rules/Health_and_Human_Services_System/ labs need to use ELR, what data elements to
Title-173/Chapter-1.pdf
report, what format to use
http://www.idph.state.ia.us/idph_universalhelp/MainConten IA Administrative Code 641 Chapter 1, 1.6(3)
t.aspx?glossaryInd=0&TOCId=%7B4C7ABEB5-4B65-4BFDHow to report: Blood lead testing... All other
9B66-663E046078DF%7D
analytical results shall be reported to the
department at least weekly in an electronic
format specified by the department.
http://www.mass.gov/eohhs/provider/reporting-toall laboratories, including those outside of
state/diseases-and-conditions/rdiq/reporting-diseases-andMassachusetts, performing examinations on
surveillance-information.html
any specimens derived from Massachusetts
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2011. URLs and Descriptions Provided for ELR Legislation. Edited for length.*
URL for ELR Legislation
Brief description of regulation
http://info.sen.ca.gov/pub/07-08/bill/asm/ab_26512700/ab_2658_cfa_20080321_172233_asm_comm.html
www.lrc.state.ky.us/KRS/369-00/CHAPTER.HTML
http://www.ncleg.net/gascripts/statutes/statutelookup.pl?st
atute=130a
http://www.doh.state.fl.us/disease_ctrl/epi/topics/64D3_11-08.pdf
http://www.ok.gov/health/documents/Chapter_515_Final_R
ules_2010_Distribution_Copy_Final.pdf
2011NationalELRSurvey-Summary.docx
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
(CA State) Please understand that this is a
simple description of a complicated situation.
CA has the Health and Safety Code 120130
which cites the CA Code of Regs (CCR) Title
17 Section 2505. AB 2658 modified 120130
to add language: Requires laboratories, by
July 1, 2009, or within one year of the
establishment of a state electronic laboratory
reporting system, to submit required reports
of reportable diseases electronically to the
LHO in a manner specified by the
Department of Public Health (DPH).
Medical lab results may be transmitted to a)
any health care provider who is treating the
patient; b) an electronic health information
exchange or network for the purposes of
transmitting medical laboratory results to the
ordering provider and to any other provider
for the purposes of treatment, payment, or
operations if patient consents.
Requires electronic submission (does not
specify format) of all environmental lead test
results and blood lead test results for
children less than six years of age and for
individuals whose ages are unknown at the
time of testing. Communicable disease does
not mandate electronic submission.
Rules mandate ELR once the process has
been established by the state; there is no
final date for compliance with the Rule
although thus far enough facilities have
enguaged in the process this is not a
limitation
Laboratories having greater than 400 positive
tests performed on-site per year for
reportable diseases described in 310:515-1-3,
310:515-1-4(1) and 310:515-1-4(2), or as may
be otherwise required to be reported by
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May 2012
2011. URLs and Descriptions Provided for ELR Legislation. Edited for length.*
URL for ELR Legislation
Brief description of regulation
http://www.ilga.gov/commission/jcar/admincode/077/0770
06900B02000R.html
apps.sos.wv.gov/adlaw/files/rulesword/64-07.doc
OSDH, shall begin reporting no later than
August 30, 2010 using secure electronic data
transmission.
The following link gives more detailed
information for all diseases and has the link
above from it. The link above should be
noted that section 1.2 and 1.3 is for the ELR
reporting.
http://www.ilga.gov/commission/jcar/admin
code/077/07700690sections.html
Once ELR is declared operational, requires
daily reporting of conditions specified in the
rule.
* Some of the descriptions provided were edited for length.
Q3. Continued - [All sites] If you have ELR legislation, when was this Legislation put into place?
Answer options
a) before 2000
b) between 2000-2005
c) between 2005-2010
d) 2011
e) pending
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Q4. [All sites] What is the current stage of ELR for your jurisdiction?
Answer options:
a) Not currently IN PRODUCTION, TESTING, OR PLANNING FOR ELR.
b) OPERATIONAL ELR system, with 75-100% of notifiable condition reports to your jurisdiction
being received electronically
c) OPERATIONAL ELR system, with 50-74% of notifiable condition reports to your jurisdiction
being received electronically
d) OPERATIONAL ELR system, with 25-49% of notifiable condition reports to your jurisdiction
being received electronically
e) OPERATIONAL ELR system, with 1-24% of notifiable condition reports to your jurisdiction
being received electronically
f) TESTING - ELR system is in Testing stage but not yet in production
g) PLANNING - ELR system is in Planning stage, prior to moving to Testing
Interpretation
This question was mandatory. Respondents not answering the question were followed up via email
or telephone.
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Comparison of data from 2010 ELR Survey
Data Trends since 2000
Interpretation
Data for years before 2004 were retroactively gathered in the 2010 survey.
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Q4 Details, ELR Stage by Jurisdiction
Answer options
a. Not in PRODUCTION, TESTING, OR PLANNING FOR ELR this year.
b. OPERATIONAL ELR system, with 75-100% of notifiable condition reports to your
jurisdiction being received electronically
c. OPERATIONAL ELR system, with 50-74% of notifiable condition reports to your jurisdiction
being received electronically
d. OPERATIONAL ELR system, with 25-49% of notifiable condition reports to your jurisdiction
being received electronically
e. OPERATIONAL ELR system, with 1-24% of notifiable condition reports to your jurisdiction
being received electronically
f. TESTING - ELR system is in Testing stage but not yet in production
g. PLANNING - ELR system is in Planning stage, prior to moving to Testing
2011. Current Stage of ELR, by Jurisdiction.
Jurisdiction Stage
Jurisdiction
Stage
Chicago
Operational ELR, 1-24% of reports
received electronically
Operational ELR, 75-100% of
reports received electronically
Not in production, test, or
planning
Operational ELR, 50-74% of
reports received electronically
Operational ELR, 75-100% of
reports received electronically
Operational ELR, 50-74% of
reports received electronically
Operational ELR, 75-100% of
reports received electronically
Operational ELR, 1-24% of reports
received electronically
Operational ELR, 1-24% of reports
received electronically
Testing stage of ELR
Mississippi
Testing stage of ELR
Missouri
Operational ELR, 50-74% of
reports received electronically
Testing stage of ELR
North Dakota
Operational ELR, 50-74% of
reports received electronically
Operational ELR, 25-49% of
reports received electronically
Operational ELR, 1-24% of reports
received electronically
Operational ELR, 75-100% of
Oklahoma
Operational ELR, 1-24% of reports
received electronically
Operational ELR, 50-74% of reports
received electronically
Operational ELR, 75-100% of reports
received electronically
Operational ELR, 1-24% of reports
received electronically
Operational ELR, 50-74% of reports
received electronically
Operational ELR, 75-100% of reports
received electronically
Operational ELR, 25-49% of reports
received electronically
Operational ELR, 75-100% of reports
received electronically
Operational ELR, 50-74% of reports
received electronically
Operational ELR, 1-24% of reports
received electronically
Operational ELR, 25-49% of reports
received electronically
Operational ELR, 1-24% of reports
received electronically
Operational ELR, 75-100% of reports
received electronically
Operational ELR, 75-100% of reports
received electronically
Operational ELR, 25-49% of reports
Denver
FSM
Los Angeles
New York
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
2011NationalELRSurvey-Summary.docx
Montana
Nebraska
Nevada
New
Hampshire
New Jersey
New Mexico
New York
North Carolina
Ohio
Oregon
Pennsylvania
Rhode Island
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J.A.Magnuson@state.or.us
2011. Current Stage of ELR, by Jurisdiction.
Jurisdiction Stage
Idaho
Illinois
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusett
s
Michigan
Minnesota
reports received electronically
Operational ELR, 75-100% of
reports received electronically
Operational ELR, 50-74% of
reports received electronically
Operational ELR, 25-49% of
reports received electronically
Planning stage of ELR
Operational ELR, 75-100% of
reports received electronically
Operational ELR, 25-49% of
reports received electronically
Operational ELR, 50-74% of
reports received electronically
Operational ELR, 25-49% of
reports received electronically
Operational ELR, 50-74% of
reports received electronically
Operational ELR, 50-74% of
reports received electronically
Operational ELR, 1-24% of reports
received electronically
2011NationalELRSurvey-Summary.docx
May 2012
Jurisdiction
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Stage
received electronically
Operational ELR, 50-74% of reports
received electronically
Operational ELR, 25-49% of reports
received electronically
Operational ELR, 25-49% of reports
received electronically
Operational ELR, 75-100% of reports
received electronically
Operational ELR, 1-24% of reports
received electronically
Operational ELR, 1-24% of reports
received electronically
Operational ELR, 75-100% of reports
received electronically
Operational ELR, 25-49% of reports
received electronically
Planning stage of ELR
Operational ELR, 75-100% of reports
received electronically
Operational ELR, 25-49% of reports
received electronically
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Q5. [All sites] Specifically, for 2011, what is the status of the individual components of ELR in your
jurisdiction?
• Data transport system (secure data transmission, may incorporate items such as PHINMS,
sFTP, etc.)
• Message translation and parsing
• Principal disease surveillance system/database that receives ELR data (contains case data as
well as ELR data)
• ELR repository* - integrated/interoperable data store
• Messaging/routing/access to other jurisdictions WITHIN your jurisdiction (like LHDs)
• Messaging/routing/access to other jurisdictions OUTSIDE your jurisdiction (like other states
or cities)
• Messaging to CDC or other federal entities
Answer options:
a) Design/development
b) Testing
c) Production
d) Suspended
e) Not applicable
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Q6. [All sites] Has your jurisdiction made progress in ELR over the past year? (Check as many as
apply)
Answer options:
a) Yes, we have started Planning for ELR
b) Yes, we moved from Planning to Testing stage
c) Yes, we moved from Testing to Operational stage
d) Yes, we increased the number of laboratories participating
e) Yes, we increased the number of program areas (conditions) participating
f) Not really, we are in a Maintenance stage, not a Growth stage.
g) No, we did not progress as we had hoped. If you choose this option, please indicate the
primary reason/reasons why little/no progress was made:
Followup question in Item 6 – if you selected “did not progress as hoped”, please specify
reason(s).
2011. Reasons for lack of progress. Listed answers were edited for length and privacy.
Labs we had engaged failed ELR parallel validation. One lab is in the process of upgrading their LIMS.
…in the process of upgrading our existing ELR HL7 2.4 data stream to HL7 2.5.1. (in Test) Also
preparing to develop exception handling, user interfaces, and internal capacity to add laboratories
statewide - if funded.
No new senders capable of meeting formatting requirements.
None of these fit us exactly. We have made HUGE strides in automating our system (which is currently
in prod as a pilot project but requires manual selection of condition and manual attachment) and
developing rules-based processes.
Resource constraints
Slow progress with a major hospital system implementing ELR (hospital has conflicting IT priorities).
Through a series of events (staff turnover, server space, etc.) we have not made much progress in the
testing and production environments.
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2011. Reasons for lack of progress. Listed answers were edited for length and privacy.
Waiting on ELR for hospitals to be established through the HIE.
We added two small facilities but Meaningful Use seems to have complicated ELR and for that reason I
think we didn't add as many facilities/laboratories as we had hoped to.
We ended up replacing our CD and STD surveillance system which has set back our ELR timeline
We have had problems recruiting and maintaining IT staff and have many competing objectives for
existing IT staff.
Interpretation: Listed answers were edited for length and for privacy by the author.
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Section: ELR Data Sources
Q7. [Test and Production Sites Only] Laboratory reportable condition data are being received
electronically in TEST or PRODUCTION from which of these national labs (check all that apply).
Also please indicate the format of these lab data in the drop-down boxes:
None - no data received from any national labs
Format
Standardized Coding
Quest Diagnostics* ------------------------------------------LabCorp ------------------------------------------------------------Mayo ----------------------------------------------------------------ARUP Laboratories -----------------------------------------Other (specify)
-------------------* Quest Diagnostics question should be answered for whichever regional branch supplies
the majority of your data.
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Q7 – Details on data received from national laboratories.
Answer options:
Format
a. HL7 version 2.3.Z
b. HL7 version 2.3.1
c. HL7 version 2.4.x
d. HL7 version 2.5.x
e. Non-HL7 (ex. dBASE)
f. Web Data Entry
Coding
a. LOINC only
b. SNOMED only
c. Both LOINC and SNOMED
d. No LOINC or SNOMED received
e. Not Applicable - Web data entry
2011. Data Format Received from National Laboratories, by number of
respondents, n=51.
Quest
LabCorp
Mayo
ARUP
a. HL7 version 2.3.Z
7
5
0
1
b. HL7 version 2.3.1
17
30
27
14
c. HL7 version 2.4.x
0
0
0
0
d. HL7 version 2.5.x
0
2
1
2
e. Non-HL7 (ex. dBASE)
2
1
0
5
f. Web Data Entry
0
0
0
1
Not answered
25
13
23
28
2011. Test and Result Coding Received from National Laboratories, by number of
respondents, n=51.
Quest
LabCorp
Mayo
ARUP
a. LOINC only
9
6
4
10
b. SNOMED only
0
0
0
0
c. Both LOINC and SNOMED
9
29
22
6
d. No LOINC or SNOMED received
5
0
0
6
e. Not Applicable - Web data entry
1
1
0
0
Not answered
27
15
25
29
2011NationalELRSurvey-Summary.docx
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2011. Receipt of HL7 from National Laboratories, by Jurisdictions in Test and Production, n=51.
Jurisdiction
Quest LabCorp Mayo
ARUP Jurisdiction
Quest
LabCorp
Chicago
Mississippi
Denver
Missouri
Y
FSM*
Montana
Y
Los Angeles
Y
Y
Nebraska
Y
Y
New York City
Nevada
Y
Alabama
Y
Y
Y
Y
New
Hampshire
Alaska
Y
Y
New Jersey
Y
Y
Arizona
Y
Y
Y
New Mexico
Y
Arkansas
Y
Y
Y
New York
Y
Y
California
North Carolina
Y
Colorado
Y
Y
Y
North Dakota
Connecticut
Ohio
Y
Y
Delaware
Y
Y
Oklahoma
Y
Y
Florida
Y
Y
Y
Y
Oregon
Y
Y
Georgia
Y
Y
Pennsylvania
Y
Y
Hawaii
Y
Y
Y
Rhode Island
Y
Idaho
Y
Y
Y
Y
South Carolina
Illinois
Y
Y
Y
Y
South Dakota
Iowa
Y
Tennessee
Y
Kansas*
Texas
Y
Y
Kentucky
Utah
Y
Y
Louisiana
Vermont
Y
Maine
Y
Y
Virginia
Y
Maryland
Y
Y
Y
Y
Washington
West Virginia*
Massachusetts
Y
Michigan
Y
Y
Y
Wisconsin
Y
Y
Minnesota
Y
Y
Y
Y
Wyoming
Y
Mayo
ARUP
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
* Three jurisdictions indicated a stage other than Test or Production, so were not included for this question.
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Q8. [Test and production sites only]Does your jurisdiction employ a web data-entry utility which
allows labs to enter their data into a web interface? (Yes/No)
Q8 Details: If yes, how are the data imported into your target system?
Answer options:
a) imported directly into system
b) translated to HL7 and then imported into system
c) translated into a non-HL7 format and then imported
d) data not imported
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Q9. [Test and production sites only] Are laboratory-reportable condition data being received
electronically from REGIONAL (ex., SE United States) or LOCAL commercial/hospital labs?
Answer options:
a. Yes - we are receiving data from regional labs.
b. No - but we are in PLANNING or TEST stages with regional labs
c. No - we are in PRODUCTION ELR but do not receive data from regional labs
Not answered
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Q9 Details:
If you chose "Yes", please answer the following questions:
• specify how many regional/local labs send you data:
• how many of those labs send you data in HL7 format?
• how many of those labs send you data in NON-HL7 format?
• how many enter data through a web data entry screen?
• how many regional/local labs COULD potentially send you data, i.e., either have a high
enough reporting volume to qualify for ELR or would be able to send electronically through a
manual web data-entry interface?
Answer options:
a. 0
b. 1-5
c. 6-15
d. 16-30
e. 31-60
f. 61-100
g. >100
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Q10. [Test and production sites only] For your state/regional public health lab (PHL):
Our state public health lab(s) is/are reporting to us through ELR
Answer Options
a. Yes
b. No
c. Not Applicable
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Q10 Details, if answered “yes” to Q10:
a)
text)
What LIS/LIMS is your PHL using to produce the reports it is sending your jurisdiction? (free
2011. For jurisdictions with public health laboratories reporting through ELR, what LIS/LIMS is being
used to produce reports, n=42.
No.
LIS/LIMS
Jurisdictions
13
STARLIMS
4
LabWare
4
LITS+
2
Chemware
2
EPIC systems
2
Home grown
2
Horizon
2
Open ELIS
1
ApolloLIMS
1
CERNER
1
Harvest
1
LabLIMS
1
MLAB/EE, PERKIN/ELMER
1
PHIMS
1
Psyche Systems - OUTREACH Application
1
Rhapsody
1
Sunquest
2
Not answered
b)
Is this data transfer bi-directional, i.e. can the PHL electronically import order info, specimen
info, etc. from the ELR system (from the ELR system, not from other related systems such as case
management)?
2011. For jurisdictions with public health laboratories reporting through
ELR, is public health laboratory ELR bi-directional, n=42.
Bidirectional
No. Jurisdictions
Yes
11
No
29
Not answered
2
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c)
What is your PHL sending with regard to file format and standardized codes?
Answer options:
Format
Coding
a. HL7 version 2.3.Z
a. LOINC only
b. HL7 version 2.3.1
b. SNOMED only
c. HL7 version 2.4.x
c. Both LOINC and SNOMED
d. HL7 version 2.5.x
d. No LOINC or SNOMED received
e. Non-HL7 (ex. dBASE)
e. Not Applicable - Web data entry
f. Web Data Entry
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Q11. [Test and production sites only] If you chose "NO" to the question above, then please check
all of the reasons your PHL is NOT reporting through ELR (Select all appropriate options):
Answer options:
LIMS not capable of producing HL7 message
Messaging transport not set up
No one has completed programming to be able to send HL7
Test and/or result coding is not completed or is problematic
Other, pls specify:
Q11. Details.
2011. Specified "other" reasons public health laboratory not reporting through ELR,
n=5/51.
We plan to start, but we haven't gotten this far yet.
Competing priorities with vendor & IT staff; funding for interface
In the process of upgrading LIMS.
New System. Vendor slow to implement
Sending test v2.5 message
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Q12. [Test and production sites only] What other data sources are transmitting data through your
ELR system or using your ELR transmission system? If none of these are in TEST or PRODUCTION,
skip to Q14.
Answer options:
Veterinary labs (if you select this, please specify the vet lab names)
Poison control centers
Emergency departments
Case management or EMR systems, sending case data
Immunization registries
HIE (includes state and regional HIE)
WIC
Other - specify
2011. Specified "other" data sources reporting through ELR, n=9/51.
ASCII Flat file for STD and Enteric data
Cancer EP results, NEDSS release upcoming release import/export of Public Health
Case Reports
Cancer registry
Cancer registry from LabCorp and Bostwick
Cancer, HPV, Diabetes
HIV and STDs (in early testing phase)
Newborn screening
None - we are still piloting with JUST ONE facility
Syndromic Surveillance (we use Rhapsody as the transmission system)
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Q13. [Test and production sites only] What is the overall percentage of the total data passing
through your ELR system that is attributable to the data sources in the previous question? (Q12)
Answer options:
a. No ELR data currently received - we are in Testing or Development mode
b. 0%
c. 1-10%
d. 11-50%
e. >50%
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Q14. [Test and production sites only] What percentage of hospital labs in your jurisdiction
participate in ELR?
Q15. [Test and production sites only] What percentage of hospital labs in your jurisdiction are
large enough to reasonably be considered candidates for ELR? I.e., have a large enough reporting
volume to warrant their effort in setting up ELR?
Answer options for both questions:
a. No ELR data currently received - we are in Testing or Development mode
b. 0%
c. 1-10%
d. 11-50%
e. >50%
Combined data for Q14 and Q15.
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Section: Use of ELR Data
Q16. [Test and production sites only] Does your ELR system route lab data to appropriate
county/local public health organizations (LHDs=Local Health Departments)?
Answer options:
a. Yes, to all LHDs in state
b. Yes, to some LHDs in state
c. No, our state does not have LHDs
d. No, a single distributed/shared system is accessed by all personnel/programs directly; no
need to distribute data to other systems
e. No, but we plan to in future
f. No, our state/jurisdictional policy does not require data distribution to LHDs
g. Not Applicable: there are no smaller jurisdictions within our jurisdiction
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Q17. [Test and production sites only] Which of the following state/jurisdictional public health
personnel/programs use ELR data? (Select all appropriate options)
Answer options:
None - no state/jurisdictional programs receiving ELR data
General communicable diseases
Blood lead
HIV
Immunizations
STD
TB
Enterics/foodborne
Vectorborne/Zoonotic
Other programs (pls specify)
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Q17. Details
2011. Specify "other programs" using ELR data, n=20/51.
# Jurisdictions Program specified
7
Cancer/Cancer Registry
1
Clinical chemsitry, such as glucose & cholesteral
1
Hb A1C reporting
1
Heavy Metals
2
Hepatitis incl. Maternal & Perinatal
1
Hospital Associated Infections
1
Newborn screening
1
Office of Drinking Water
1
Toxic substance exposures
3
Vaccine Preventable Diseases
1
We are still in piloting and testing.
Q17 Details: For the programs above, how are the majority receiving ELR data?
Answer options:
a. Program receives data and enters manually into their system
b. ELR data are uploaded directly into the program's system
c. ELR data are fed into a centralized data system, from which programs can view data
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Q18. [Test and production sites only] For which purposes are data received via your ELR system
currently used? Check all appropriate boxes.
Answer options:
Provide data to county/local health departments
Provide data to state program areas
Provide data to CDC or other federal agencies
Populate an integrated, centralized data store
Assist in patient care (test ordering and result posting)
Offer health care decision support
Contribute to data analysis and visualization
Contribute to public use data available on the web
Integrate ELR with NBS or similar system
Contribute to syndromic surveillance (lab test order patterns)
Detect antimicrobial susceptibility patterns
Contribute to performance metrics and/or quality control
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Q19. [Test and production sites only] Does your jurisdiction receive antimicrobial susceptibility
results via ELR?
Answer options:
a. No.
b. Yes, for reportable isolates.
c. Yes, for reportable isolates AND for selected additional organisms such as staph.
d. Yes, for ALL organisms tested by the lab.
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Q20. [Test and production sites only] If you answered "Yes" to the antimicrobial susceptibility
question above, what lab(s) is(are) sending you these data?
Answer options:
a) one or more regional labs
b) one or more national labs
c) one or more hospital labs
d) most or all labs
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Q21. [Test and production sites only] Do you have any interfaces between your ELR system and
other disease surveillance/reporting systems? (Select all appropriate options)
Answer options:
None - no state/jurisdictional programs receiving production ELR data
None - receiving production data but no interfaces with other systems
General communicable diseases
Blood lead
HIV
Immunizations
STD
TB
Enterics/foodborne
Vectorborne/Zoonotic
Other programs (pls specify)
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2011. Interfaced systems specified as "other", n=12/51.
# Jurisdictions
Systems
3
Cancer/Cancer Registry
1
ELRs are only received for infectious diseases (not including HIV/STD) directly into
NEDSS Base System
1
Hb A1C Registry
1
Heavy Metals
1
Hepatitis Maternal & Perinatal; Hepatitis C
1
Influenza- PHLIP Protocal
1
Office of Drinking water
1
Refugee Clinic
1
Toxic substance exposures
1
Vaccine Preventable, Hepatitis, Bacterial Meningitis-Invasive Respiratory Disease
Q22. [Test and production sites only] If you answered "Yes" to any of the interface options above
(Q21), then select the method that most closely matches the majority of the interfaces:
Answer options:
a) data are fed into a NEDSS-compatible, integrated disease surveillance database
b) data are fed into one or more stand-alone (silo) surveillance systems
c) both (a) and (b)
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Q23. [Test and production sites only] If you indicated a stand-alone system in the interface
question above, then please specify system names (e.g. HARS, STD*MIS, etc.) and system formats
(e.g. ASCII, CSV, XLS, HL7v?) for that stand-alone system. [Note: These answers were free text.]
2011. Stand-alone (silo) surveillance systems indicated, test and production sites, n=51.
System name
# Jurisdictions *
eHARS
20
Lead
10
STD Syphilis only
7
PRISM
5
Cancer Registry
2
NEDSS Base System
2
TB
2
CEDRS
1
HIV surveillance
1
HMS Health Monitoring System
1
Maven (Vendor: Consilience) for STD
1
MDSS
1
Merlin
1
Multiple
1
Other program specific databases
1
Refugee data system
1
SC Heavy Metal Tracking System
1
VPD
1
* Interpretation: Number of jurisdictions exceeds total number participating because some
jurisdictions named more than one stand-alone system.
2011. Format supplied for standalone (silo) systems, test and production sites, n=51.
Format
# Jurisdictions*
Delimited text (non-HL7)
11
HL7
11
Database
3
Spreadsheet
3
* Number of jurisdictions does not equal total number participating because jurisdictions named
zero-to-many formats.
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Q24. [All sites] What do you think are the biggest challenges in creating such interfaces? (Select all
appropriate options)
Answer options:
a) Data variables not comparable
b) Difficulty parsing values out of free text blocks or blobs
c) Inability to modify commercial data systems/applications
d) Lack of person-hours available to work on interfaces
e) Lack of skills available to work on interfaces
f) Other. Please specify:
2011. Specification of "other" challenges to interfaces, all sites, n=11/54.
Commercial LIS's do not always follow the rules of HL7
Constant CDC scope changes and Silo building
Cost of interfaces from commercial systems
Different/not mutually understood data models
Lack of funding for Interface projects (specifically with hospitals)
Lack of hospital labs using LOINC and SNOMED
Lack of training and software in place to accept ELR
Support at provider/facility
To avoid costs of vendor customization we sometimes have to design derivation of additional
data to embed as additional code values in the ELR before import to the integrated disease
surveillance application, in order to drive rules within the integrated disease surveillance
application.
We are working towards full integration of all infectious diseases into a single surveillance
system but limited resources have resulted in time delays.
We are working towards the goal of having only one disease surveillance system.
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Which one [challenge] do you think is the MAIN challenge?
Answer options:
a) Data variables not comparable
b) Difficulty parsing values out of free text blocks or blobs
c) Inability to modify commercial data systems/applications
d) Lack of person-hours available to work on interfaces
e) Lack of skills available to work on interfaces
(Additional “Other” textbox available)
2011. Specification of "other" main challenge to interfaces, all sites, n=7/54.
Filtering to reportable results, especially micro and serology titers is difficult
Labs that do not use standard codes or produce syntactically correct HL7 that is sematically
problematic
Lack of ability to standardization to LOINC, and failure to include SnoMed as a requirement
Lack of funding for Interface projects (specifically with hospitals)
Lack of training and software in place to accept ELR
Main ELR person at agency resigned in 2011.
Vendor support to partner hospital labs
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Q25. [Test and production sites only] Of the data received via your ELR system, what percentage is
fed into your principle surveillance/data system automatically? I.e., ELR data are not manually reentered into the surveillance system or data store – this does not preclude normal human
interaction such as data cleaning or deduplication, it just means that you have a system that
automatically imports ELR data into your main system.
Answer options:
a. 0%
b. 1-10%
c. 11-50%
d. 51-75%
e. 76-100%
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Q26. [Test and production sites only] For the previous question (Q25), what is the main problem
preventing you from automatically importing more of your ELR data into your surveillance/data
system? (choose one)
Answer options:
a. Difficulty constructing interface between ELR and the data system
b. We do not have personnel/funding to create the data import/interface
c. We do not have technical expertise to create the data import/interface
d. The ELR data are not standardized enough between labs to allow automatic importation
e. There are data quality issues with the ELR data that prevent automatic importation
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Q27. [Test and production sites only] Do all clinical laboratory-oriented surveillance programs in
your jurisdiction accept disease reports using the same data stream/coding (i.e., through your
standard ELR feed)?
Answer options:
a. Yes
b. No
c. Don't Know
If answer was "No", which are the programs that insist on some unique/different format or feed,
and what is that format?
2011. Programs insisting on separate format/ feed, test and production sites, n=51.
# Jurisdictions* Surveillance program
Format required
14 eHARS, STD, HIV
Tab-delimited, CSV, Spreadsheet
6 Blood Lead
CSV, Spreadsheets
1 Cancer
Not specified
1 Hospital Associated Infections Not specified
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Section: ELR System Info and Support
Q28. [Test and production sites only] Did you build your own ELR components/system?
Answer options:
a. No, it was purchased
b. Yes and No, it is a hybrid of purchased software and custom programming
c. Yes, it was built by In-house personnel
d. Yes, it was built by Contractors for our jurisdiction
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If you are utilizing in-house developed system/components, estimate how long it took to develop
an operational system? If purchased, how long did it take to become operational after purchase
was complete?
Answer options:
a. 0-6 months
b. 6 months to 1 year
c. 1-2 years
d. 2-3 years
e. >3 years
f. Not finalized yet
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Q29. [Test and production sites only] If you purchased your ELR components/system, please
indicate the vendor and system below. If the vendor is not included in the list, please select
'Other' for both vendor and system. If the vendor is included but you purchased a different
system, please select the vendor and choose 'Other' under system. Note: If you are working with
more than one vendor and system (for example, both Orion Rhapsody and IBM WebSphere),
please utilize the "secondary" system option. If you are working with >2, then please just choose
the top 2.
Answer options:
Vendor
a. Atlas
b. CDC
c. Consilience
d. Collaborative Software Initiative
e. DiagnosisONE
f. Eclipsys
g. IBM
h. Information Technology
International
i. Microsoft
j. NeoTools
k. Orion
l. Quovadx
m. STC
n. Sybase
o. Other - specify:
2011NationalELRSurvey-Summary.docx
System
a. BizTalk
b. Cloverleaf
c. ECMap, ECGateway
d. eLink
e. LabWorks
f. Maven
g. NBS/PHIN MS/MSS
h. NeoIntegrate
i. PHS3
j. Rhapsody
k. WebSphere IIS DataStage Enterprise
l. Other - specify:
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2011. Primary and secondary vendor and system for ELR, test and production sites, n=51.
Vendor
System
Primary Secondary
Primary Secondary
Atlas
3
0
BizTalk
2
0
CDC
8
6
Cloverleaf
0
1
Consilience
5
1
ECMap, ECGateway
1
0
Collaborative Software 0
0
eLink
2
1
Initiative
DiagnosisONE
0
1
LabWorks
0
0
Eclipsys
2
1
Maven
5
1
IBM
1
0
NBS/PHIN MS/MSS
9
5
Information
0
0
NeoIntegrate
0
0
Technology
International
Microsoft
2
0
PHS3
0
0
NeoTools
0
0
Rhapsody
12
15
Orion
12
15
WebSphere IIS DataStage 1
0
Enterprise
Quovadx
0
1
Other - specify:
5
3
STC
2
1
Not answered
14
25
Sybase
1
0
Other - specify:
4
2
Not answered
11
23
Q29 Details: Specified “other” vendors and systems.
2011. "Other" primary and secondary vendors and systems for ELR, test and production sites,
n=51.
Vendor - "other"
System - "other"
Primary
Secondary
Primary
Secondary
ASP by CSC
PerkinElmer Custom Built HL7 Interface
DOH interface, HL7
Engine
interface
In House
Sunquest
NHEDSS
Epi-Tracks
Northrup Grumman
PHIL
TB-PAM
Psyche SystemsSendSS
OUTREACH
Sentinel
vCMR, ELR, PHIL, Atlas
Connect
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Q30. [Test and production sites only] Which NEDSS/PHIN components are you currently utilizing
in your ELR system? For each, indicate Production or Test status.
Components:
ewebit
NEDSS Messaging Subscription Service (MSS)
PHIN MS
PHIN VADS
Rhapsody (Orion)
NEDSS case notification
Answer options:
a. Not Using this component
b. Production - using in our production system
c. Test - we are testing this component
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Q31. [Test and production sites only] Which of these security components are you currently
utilizing in your ELR system? For each, indicate Production or Test status.
Components:
State firewall
Partner firewall
Active Encryption (ex. PGP - ie, other than as part of a VPN or other component)
Certificates - state issued
Certificates - certifying authority
VPN
SSL
sFTP
Answer options:
a. Not Using this component
b. Production - using in our production system
c. Test - we are testing this component
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Q32. [Test and production sites only] For both Production and Test systems: In general, if you
require technical changes made to your ELR system, who designs and implements those technical
changes?
Answer options:
a. a pool of IT resources at your jurisdiction
b. dedicated ELR IT personnel
c. dedicated ELR non-IT personnel
d. a vendor
e. a contractor
f. CDC
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Section: ELR Formats
Q33. [Test and production sites only] Which of the following Health Level 7 (HL7) formats will your
ELR system ACCEPT and SEND (Only indicate those currently accepted/sent, not formats that you
COULD accept/send if you were to spend some time setting it up).
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Q33 Data tables
2011. Versions and formats accepted by ELR system, test and production sites only, n=51.
2.2
2.3.z 2.3.1 2.4
2.5
2.5.1 ORU OUL ADT ORM CDA
R1
Not working 30
13
2
28
28
9
4
30
23
27
33
with
Receiving
1
4
2
1
4
19
5
2
4
1
0
Test/Dev
Receiving
2
22
44
3
2
17
41
1
9
7
1
Production
Not
18
12
3
19
17
6
1
18
15
16
17
Answered
2011. Versions and formats sent by ELR system, test and production sites only, n=51.
2.2
2.3.z 2.3.1 2.4
2.5
2.5.1 ORU OUL ADT ORM
Not
working
with
Receiving
Test/Dev
Receiving
Productio
n
Not
Answered
CDA
R2
32
2
0
17
32
32
19
32
27
15
9
27
27
27
CDA
R1
32
1
0
2
0
1
9
4
1
1
1
0
2
0
3
22
0
6
16
31
3
3
3
1
0
18
16
8
19
17
11
7
20
20
20
18
18
2011NationalELRSurvey-Summary.docx
CDA
R2
31
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Q34. [Test and production sites only] Which of the following non-HL7 formats does your ELR
system currently accept? (Only indicate those currently accepted, not formats that you COULD
accept if you were to spend some time setting it up)
Answer options:
None - we do not have a production ELR system yet
None - only HL7 accepted
XML (not including HL7 rendered as XML)
Delimited text (tab, space, comma or other character)
MS Excel
MS Access
dBase
Other, please specify:
Q34 Details: Specification provided for “Other”.
2011. Specification of "Other" for non-HL7 formats accepted, test and
production sites, n=51.
ASCII Flat file
ASCII, in addition to HL7 versions and webentry (comes in as HL7)
ASCII converted to HL7 2.3.z prior to transmission
CSV for Blood Lead and HIV from small hospitals/labs
Paper
Simplified Message Format- a variation of HL7 2.3.1
Some very specific Excel and text file formats
WINCLR
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Q35. [Test and production sites only] What percentage of the lab reports you currently receive are
non-HL7 format?
Answer options:
a. No ELR data currently received - we are in Testing or Development mode
b. 0%
c. 1-10%
d. 11-50%
e. >50%
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Q36. [Test and production sites only] What percentage of the lab reports you currently receive are
transmitted to you through manual Web data entry?
Answer options:
a. No ELR data currently received - we are in Testing or Development mode
b. 0%
c. 1-10%
d. 11-50%
e. >50%
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Q37. [Test and production sites only] How do you receive your LOINC and SNOMED
codes/information and updates? (Select all appropriate options)
Answer options:
a. Participating labs send us their tables/files directly
b. From the CDC
c. We find them on our own
d. Other, please specify:
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Q38. [Test and production sites only] Do you support lab local codes (ie, not LN or SNM)?
Answer options:
a. Yes
b. No
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Q38 Detail: If yes, what percent of your reports contain ONLY local codes for Answer options:
a) Tests
b) Results
For each category (Tests and Results), the answer options were:
a. No ELR data currently received - we are in Testing or Development mode
b. 0%
c. 1-10%
d. 11-50%
e. >50%
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Section: LIS/LIMS
Q39. [All sites] Which of these major lab information systems / lab information management
systems* are currently sending/planning to send reportable diseases to your ELR system? The
purpose of this question is to identify vendors known to support HL7 standard messages – i.e., it is
informative only, not for data analysis.
2011. LIS/LIMS indicated as sending data to ELR, all sites, n=54.
LIS/LIMS
LabDAQ Laboratory Information System - Antek Healthware
Cerner Millennium PathNet - Cerner
Horizon - ChemWare
CIS LAB - Clinical Information Systems
CLIN1 LAB - Clinical Software Solutions
Clinlab LIS - Clinlab
ApolloLIMS - Common Cents Systems
Polytech - Comp Pro Med
CPSI System - Computer Programs and Systems
CLS2000 - Computer Service and Support
LabGEM - Diamond Computing
IntelliLab - Elekta Software
Beaker Laboratory Information System - Epic
LAB/HEX - HEX Laboratory Systems
LabTrak - J&S Medical Associates
LabNet - LabSoft
Ligolab LIS - LigoLab
Horizon Lab - McKesson
Medcom Lab Manager - Medcom Information Systems
AutoLIMS - NetLIMS NJ LLC
Orchard Harvest LIS - Orchard Software
LabWeb - Psyche Systems
LabHealth - Quality Software Systems
SoftLab - SCC Soft Computer
SchuyLab - Schuyler House
Novius Lab - Siemens Medical Solutions
STARLIMS Clinical LIMS - STARLIMS
Sunquest Laboratory - Sunquest Information Systems
TD-Synergy Suite - Technidata America
Thermo Scientific Clinicial LIMS - Thermo Fisher Scientific Informatics
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HL7
0
31
5
1
1
1
1
0
6
0
0
1
9
1
0
1
0
10
1
0
4
2
0
13
0
2
17
20
0
1
Non-HL7
0
0
1
0
0
0
0
0
1
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
1
3
0
0
0
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Section: Opinions and Topical Issues
Q40. [All sites] What are the five most important barriers to full implementation of ELR in your
jurisdiction? Please rank FIVE options from 1 (most important) to 5 (less important) by entering
numbers 1, 2, 3, 4, 5 in the corresponding cells.
Answer options:
Not enough money at health department
Not enough staff at health department
Hospitals and other Labs want reimbursement for their start-up costs
Laboratories have other/competing IT implementation priorities
Laboratory Information System vendors have not developed appropriate interface modules
Lack of technical skills and knowledge of health department staff
Variable content and format of ELR messages from labs
Lack of authority to compel compliance
Lack of incentives to encourage compliance
Not enough internal agency support
Not enough agency buy-in/prioritization/management support
Compliance with jurisdiction or agency IT and/or confidentiality standards
Other, please specify:
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Q40 Detail. Specification of “Other” on question about ELR barriers.
2011. Specification of "Other" for barriers to ELR, all sites, n=54.
Incompatible surveillance system
Insufficient staff at the State's Health Information Exchange
Meaningful use regulations do not require full conformance to the HL7 Implementation
Guide.
MU initiatives causing application upgrades at hospitals delaying their participation; Lack of
technical and vocab knowledge, i.e. mapping LOINC values on the hospital side.
No barriers or show stoppers, time needed to implement
No capable system in place at this time
No standardized or recommended transport mechanism available
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Q41. [All sites] How many staff (government or contractors) are responsible for ELR in your
jurisdiction?
Answer options:
Full-time staff
Part-time staff
Of these full-time staff, how many are IT/IS
Of these part-time staff, how many are IT/IS
designated staff?
designated staff?
Of these full-time staff, how many are
Of these part-time staff, how many are
contractors or consultants?
contractors or consultants?
For each, number options were
a. 0
b. 1
c. 2
d. 3
e. 4
f. 5 or more
Interpretation: There appears to have been some confusion about this question, as the number of
full-time IT staff was higher than the total number of full-time staff. This should be addressed in
future surveys.
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Q42. [All sites] Do any of the staff from the previous question (Q41) also have any of the following
responsibilities? (Select all appropriate options)
Answer options:
PHIN Coordinator (PHIN=Public Health Information Network)
HAN Coordinator (HAN=Health Alert Network)
BT Coordinator (BT=Bioterrorism)
ELR Coordinator
EPHT Coordinator (EPHT=Environmental Public Health Tracking)
NEDSS Coordinator (NEDSS= National Electronic Disease Surveillance System)
Meaningful Use Coordinator
HIE Coordinator (HIE=Health Information Exchange)
Other - please specify
None of the above
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Q42 Detail. Specification of “other”.
2011. Specification of "other" responsibilities of ELR staff, all sites, n=14/54.
All share responsibilities
eHARS and eMaRC Plus Support
Epidemiologist, Business Analyst
HIE Project Mgr/Informatician and ELR Vocab Specialist
Other epi and disease control activities
PH Epi, Acute Infectious Disease Chief, IT Staff
PH Lab Project Manager; Epidemiologist
PHIN, ELR, Meaningful Use Coordinator roles are not distinct, but shared at least partially by 1
of the FTE's identified in question 41.
Staff is involved with HIE and Meaningful use and Beacon as well as other informatics projects
Supervisor
Surveillance Director
Surveillance System Administrator
They are responsible for the entire HIE messaging and some configuration needs
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Q43. [All sites] Addition of what type of staff would be most useful for your jurisdiction in
implementing or maintaining ELR? Please rank your top three options from 1 (most important) to
3 (less important) by entering numbers 1, 2, 3 in the corresponding cells.
Answer options:
a. Informaticists
b. Messaging Experts
c. IT Personnel
d. Epidemiologists
e. Managers/Project Managers
f. Medical technologists
g. Clinical pathologists
h. Other, please specify
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Q43 Detail. If you selected "IT Personnel" as one of your top three options, please indicate which
type of IT skills you are looking for - check all appropriate skills.
Answer options:
Security
Database Management - DBM
Programmers
Network
Electronic Data Interchange - EDI
Other, please specify
Q43 Detail. “Other” IT skills desired.
2011. Specification of "other" IT skills, all sites, n=5/54.
Database Administrator
Experienced Business/Systems analyst
IT staff familiar with NBS, Rhapsody, HL7, etc.
Project Management
Those knowledgeable with HL7 and LOINC
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Q44. [All sites] What kind of training for existing staff would be most helpful in implementing or
maintaining ELR? (may choose >1 option)
Answer options:
Security
HL7
Coding (as in LOINC or SNOMED)
Information technology
Project management
Transport-layer training. Note: If you select this option, please specify:
Laboratory workflow/procedures
Cross-training in epi/surveillance
Public Health Informatics
Other, please specify:
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Q44 Detail – Further specification for jurisdictions selecting “Transport-layer training”.
Answer options:
a. PHINMS
b. Direct
c. sFTP
d. VPN
e. HTTP
f. Connect
2011. Specification details for Transport-layer training, all sites, n=17/54.
Training requested
No. Jurisdictions
PHINMS
4
Direct
4
sFTP
2
HTTP
2
Connect
1
VPN
0
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Q45. [All sites] What is the approximate amount your state has invested 2008-present in meeting
state and federal requirements/standards for ELR, IDR, and web-based disease surveillance
systems*? Inclusive of both program-area and IT staffing, hardware, software, maintenance,
hosting, etc. but EXCLUSIVE of any Meaningful Use funding.
* Include Blood Lead, STD, TB, HIV where appropriate. Also note, scroll to bottom of list for choices
"had not yet started ELR" and "had started ELR but this financial information no longer available".
For each year, categories were:
“For ELR ONLY” and “For ELR, IDR, and web-based disease surveillance systems together”
Answer options:
a. < $1 Million
b. $1-2 Million
c. $2-3 Million
d. $3-4 Million
e. $4-5 Million
f. $5-6 Million
g. $6-7 Million
h. $7-8 Million
i. $8-9 Million
j. $9-10 Million
k. > $10 Million
l. Had not started ELR this year
m. Had started ELR but this info not available
Interpretation: Unfortunately, due to some ambiguous wording of this question in the distributed
survey, the data for this particular question only should only be viewed as generally indicative, not
as specifically accurate.
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Q45 Detail. Data table*.
2011. Amounts invested in meeting CDC requirements, all sites, n=54.
ELR ONLY
For ELR, IDR, and web-based
disease surveillance systems
together
Amount in millions of
dollars
2008 2009 2010 2011 2008 2009 2010 2011
< $1
34
32
30
31
23
23
24
24
$1-2
1
3
6
5
8
6
5
5
$2-3
3
3
2
4
4
6
4
3
$3-4
0
0
1
1
1
1
2
4
$4-5
0
0
0
0
2
2
2
0
$5-6
0
0
0
0
0
0
1
2
$6-7
0
0
0
0
0
0
0
0
$7-8
0
0
0
0
0
0
0
1
$8-9
0
0
0
0
0
0
1
1
$9-10
0
0
0
0
0
0
0
0
> $10
0
0
0
0
0
0
0
0
Not started ELR
1
1
0
0
2
2
1
1
ELR started but no info
3
3
4
3
2
2
3
3
Not Answered
12
12
11
10
12
12
11
10
* See disclaimer above, re data for this question.
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Q46. [All sites] Of the amount identified in the previous question (Q45), which three of the
following do you feel constitute the majority of expenditures? Please rank your 3 options from 1-3
with 1 being the MOST expensive.
Answer options:
a. Program-area staff
b. IT staff
c. Hardware
d. Software
e. Maintenance
f. Hosting
g. Bundled IT services, eg, ASP
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Q47. [All sites] How could you best benefit from the experiences of those already working in ELR?
Please indicate your top three choices on a scale of 1-3, with 1 being the MOST important.
Answer options:
a. Business info, documentation - lab recruitment, QC, etc.
b. Technical info, documentation - shared code, maps, etc.
c. Contact info for other ELR specialists
d. Regional ELR in-person meetings
e. Expanded meeting opportunities at conferences
f. Increased peer-reviewed publications, successes, solns.
g. Other - Please specify:
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Q47 Detail. Specifications of “other”.
2011. Specifications of "other" on ways to benefit from the experience of others, all sites,
n=6/54.*
1st - Most
Alignment with ONC directive with laboratory reporting
important
Conference call discussions on ELR with other States have been very
helpful.
Coordinate with national reporting requirements
need to share experience of small resource poor countries
Training opportunities through ONC or other organizations for ELR, LOINC,
SNOMED, ELR/HIE project mgmt, etc.
2nd - Less
CDC technical assistance & support
important
To discuss best practices, lessons learned, and expeierences working with
regional laboratories
3rd - Less
Process for assisting labs with LOINC coding
important
Regional technical support
* Since additional responses were provided, the number of entries is greater than six.
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Q48. [All sites] What do you realistically expect your stage of ELR to be in 2013 and 2016.
(realistically, not what you’d hope or like to have). Please answer as percentage completion
towards listed mileposts (0%, 1-10%, 11-50%, or >50% complete)
Categories:
Participation of all potential data recipients
Participation of all potential sending partners
Participation of specific sending partners o Local
o Regional
o National
Elimination of paper reports from labs
Inclusion of EMR data
Receipt of data from HIEs
Establish legal mandate for ELR
Answer options:
a. 0%
b. 1-10%
c. 11-50%
d. >50%
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Q49. [All sites] What was the impact of meaningful use on ELR resources in 2011? (Select all
appropriate options)
Answer options:
a. received a one-time increase in budget in 2011
b. projected increase in annual operating budget post-2011
c. unfunded increase in workload for ELR resources
d. no change
e. can't determine at this time
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Q50. [All sites] With reference to the ARRA Meaningful Use criteria, please indicate your
jurisdiction's ability to fully support the three public health menu options. Check each year for
which the option is/will be supported: 2011-2015.
MU Criteria:
Immunization Registry reporting
Syndromic surveillance reporting
Hospital reporting of laboratory data (ELR)
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Q51. [Test and production sites only] Can your jurisdiction currently assess the proportion of
results for reportable conditions that came from each individual hospital as ELR reports (vs. paper
reports or by telephone)?
Answer options:
a. Yes
b. No
c. Plan to
d. Tried, but unsuccessful
Q51 Detail. Specification of “Other”.
2011. Specifications of "other" for assessing proportion of results, test and production sites,
n=3/51.
Not specifically categorized in our system
Ordering Facility associated with ELRs is inconsistent compared to paper report
We try to get a rough estimate comparing all reports in [system] for a given hospital vs those
received via ELR. The accuracy is limited by the fact that a lot of hospitals use reference
laboratories and it is technically difficult/labor intensive to try to systematically match
reference lab ELR results with hospital reports.
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Q52. [All sites] For your current or planned ELR system, please indicate the reporting
requirements for the following data elements:
Data elements:
Patient county of residence
Patient residence address
Patient Gender
Patient DOB
Patient telephone
Provider telephone
Facility telephone
Answer options:
a. Strictly required - a record missing this value will be REJECTED
b. "Required" - specified as required but a record missing this value will NOT be rejected
c. Preferred - element is specified as "preferred"
d. Optional - element is specified as "optional"
e. Unspecified - we don't specify any requirement for this element
f. Don't know the answer to this question
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Q53. [All sites] We are updating the annual list of contacts for ELR assistance. Please check the
areas that you/your state would be willing to discuss with other jurisdictions that might need
assistance.
Answers to this question are provided in separate file.
Q54. [All sites] What question(s) or answer option(s) do you think SHOULD have been on the
survey but was(were) not?
2011. Suggested questions for inclusion in future surveys, all sites, n=54.
1. Has your jurisdiction published an implementation guide? 2. Are you aware of the
following ELR resources (include a list of items such as the MQF, MSS, etc.) - this could also be
measure of how effective communication is nationwide.
Does your ELR mandate require that reports use LOINC and SNOMED? If so, how was this
implemented? What is the proportion of labs reporting via LOINC and SNOMED standards
among those submitting ELR?
ELR through HIE
For the LHDs filling out the survey, ask "Are you receiving ELR/responsible for the NEDSS
solution that you use, or do you utilize the systems of your state?"
What are the major barriers to onboarding Hospitals for MU ELR? A) ONC certified ELR
components can't generate a compliant 2.5.1 message.
Which vendors were very responsive, timely, proactive; in general the best to work with?
Which vendors obviously don't have a copy of the implementation guide? Which vendors
support systems that can accomodate standard vocabularies?
End of Survey Results
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Editorial Board
The contributions of the 2011 Editorial Board members are gratefully acknowledged. The 15
members listed below helped refine, define, and expand the 2011 survey.
2011 ELR Survey Editorial Board Members
Name
Representing
Nancy Barrett
CT
Gillian Haney
MA
Patricia Swartz
MD
Eileen Troutman
NJ
Hwa-Gan Chang
NY
Nick Hill
SD
John Roberts
TN
Shelley Hood
WY
Audrey Kiser
ARUP
Carmen Pugh
LabCorp
Stephen Julian
MAYO
Julie Luepke
MAYO
Arun Srinivasan
CDC
Riki Merrick
APHL
Ray Aller
USC
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