Reusable Tools for Public Health
Messaging and Vocabulary
Standards
CSTE Conference June 5th, 2012
Riki Merrick, MPH
Eric M. Haas, DVM, MS
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.
Overview
Public Health Lab Interoperability Project (PHLIP)
Introduction
Tools and Processes
Electronic Laboratory Reporting (ELR)
Program Approach
Projects
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) hubs
PHLIP 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 1 sends ELSM to CDC
PHL 1
PHL 2
using the RnR hubs
PHLIP - ETOR
PHL 1 sends ELSM to CDC
PHL 1
PHL 2 can do ETOR with CDC
PHL 2
All are using the RnR hubs
PHLIP - Big Picture
PHL 1 sends ELSM to CDC
PHL 1
PHL 2 can do ETOR with CDC
PHL 2
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 virtually
and on site since March 2010
Technical
Architecture
Project
Management
Terminology
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 SPHLs
Pilot testing of PHL to PHL ETOR for Influenza
surge capacity in 2 PHL groups
IA - NE – MN and FL - TX
PHLIP– Tools and Processes
Working Group Calls
SharePoint for all documents/resources
Data Collection Sheet
Messaging template
Encoding guideline
Specimen Cross-Mapping Table
NND harmonization Prioritization
PHLIP Technical Assistance Team (TAT)
PHLIP - Processes
Different Calls for different Use
cases and topics:
Problem solving
Core Group
Vocabulary
Implementation Issues
Formalizing Decisions
Change 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 Sets
Current 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
Project
Management
Terminology
Technical Architecture
ELR initiative – What is it
Vision
Programs
Data Flow
Program Approach
Vocabulary & Messaging Guidance
Technical Implementation
ELR initiative – Vision
Provide assistance to Public Health Labs and Public Health
Agencies
Promote 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 – Programs
2010-2012
LTIAPH: Laboratory Technical Implementation Assistance for
Public Health
ARRA HITECH grant for 10 ELC grantees plus 2 guests
Data flow from PHL to PHA
Consultative (not prescriptive/enforcer) role
ELC grantee list: Arizona, Florida, Houston, Iowa,
Massachusetts, Michigan, New York State, Philadelphia,
Rhode Island, and Virginia
LTIAPH is supported by Cooperative Agreement Number 1U50HK000105 from Centers for Disease Control and Prevention
(CDC).
ELR initiative – Programs
2011 - current
ELRTA: Electronic Lab Reporting Technical Assistance
CDC sponsored assistance to PHA to connect to PHLs AND
Commercial labs – and provide help with v2.3.1 connections,
if needed
Application process managed through CDC
Targeted Technical Assistance by APHL informatics team
ELRTA is supported by cooperative agreement #CCU303019 from the Centers for Disease Control and Prevention (CDC).
ELR initiative – Data flow
In-Scope Data Flows:
· ELR (flavors):
· PHL  PHA
· Hospital (EHR)  PHA
· Clinical labs  PHA
Out-of-scope:
1) National level flows
2) Other ELR flavors
Legend: Grey circles: Out-of-scope for LTIAPH/ELR-TA
ELR 251 Implementation Assistance Approach
Program:
Design
Prototype
Pilot
Rollout
Operations
Feedback
Loop
Grantee Projects :
Pilot
Rollout
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 plan
Schedule,
etc.
ELR initiative - Program Approach
Balance level-of-effort between providing and developing a
common framework and re-useable components and one-onone 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: LOINC
Test Results : SNOMED-CT
Specimen : SNOMED-CT
Leverage RCMT for Tier-1 and Tier-2
Vocabulary Collaboration
Framework
·
·
ELR National Taskforce
·
“Compare Notes” on Core Work
Group’s outputs
Collaboration opportunities
Core Work Group
Leverage and collaborate
on RCMT refresh work
RCMT
Workgroup
(formed out of 10 ELC ARRAHITECH grantees)
·
UT and CA as
participants
·
·
·
refresh
Serve as a body of
SMEs for questions
and clarifications
VMCoP
LabCOP
CoI-ePHI
LTIAPH
·
Collaborate to ensure approach
alignment with Hospital side
implementation.
Legend
ARRA-HITECH
projects under PHITPO
Lab Interoperability
Cooperative (LIC)
(Hospitals)
·
PHLIP
PHLISSA
·
Collaborate on common
objectives
Liaison with PHLISSA
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 message
Electronic Test Order and Results data flow: Preliminary
comparison between ELINCS and PHLIP ETOR implementation
specifications
Technical Implementation
Review existing data flows / architecture
Create prototype tooling
Conversion to ELR 251
Up convert to ELR 2 5 1 from 2. 3.1, 2.3.z and other
variations
Down convert from ELR 2.5.1 to 2.3.1
Testing framework
ELR (Sender) side
RLR: Electronic Lab Reporting to PHAs ( PHL  PHA ; Send)
Systems view
Automation
Manual
Process
Public Health Laboratory (Sender)
Capture Lab Test
Results in LIMS
1
2
Is this a
Notifiable
Disease ?
LIMS
Extract
Information
from LIMS
Notifiable
condition
lookups
LIMS – Laboratory Information Management System
RCMT - Reportable Condition Mapping Tables
PHA – Public Health Agency
PHL – Public Health Laboratory
Perform
Transformations
and Translations
Integration
Engine
3
Construct ELR
(HL7) 251
message
4
Encrypt
Message
Outbound
Gateway &
Security Tool
Route to PHA
Message
sent
To PHA
ELR (Receiver) side
Focus on:
Design / architecture
Vocabulary and HL7 message transformations
Tools:
Orion Rhapsody (mostly)
MQF Receiver profile
And other testing / validation framework
PHLIP Tools Reused in ELR initiative
 Vocabulary
 HL7 Messaging
 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)
 Project Management
 Technical Assistance Team
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 RCMT
Current list of LOINCs and SNOMED codes for reportable conditions
https://phinvads.cdc.gov/vads/ViewCodeSystemConcept.action?oid=2.16.840.1.114222.4.5.274&c
ode=RCMT
PHLIP Intangibles Reused in LTIAPH and
ELRTA
Intangibles
 Knowledge
 Experience
 Relationships
In Summary
APHLinformatics
Program Approach
PHLIP
LTIAPH
ELRTA
Vocabulary & Messaging Guidance across all programs
Technical Implementation coordinated and for all programs
Contact:
Linda.Cohen@aphl.org
Wes.Kennemore@aphl.org
QUESTIONS?
rmerrick@iconnectconsulting.com