Iowa is leading a nationwide effort in the adoption of Electronic Laboratory Reporting (ELR) in public health. Among its many benefits, electronic transmission of test results allows for reduced manual input, greater accuracy, and enhanced timeliness.

The motivation behind this effort is the American Recovery and Reinvestment Act (ARRA). This legislation, passed in 2009, launched the Meaningful Use initiative, which promotes the use of information technology to improve patient healthcare by establishing programs to encourage the adoption and meaningful use of certified Electronic Health Record (EHR) technology.

For the last four years, the State Hygienic Laboratory has worked with John Satre and Swathi Ramasahayam of the Iowa Department of Public Health to implement the electronic exchange of public health information. Among the information transmitted are test results from infectious and communicable diseases.

Before electronic transmission of patient data between public health departments and laboratories could become a reality, however, the ELR system needed to be developed. The development of this set of standardized codes and messaging was the focus of a 12-state consortium, of which the Iowa team was a leading member.

ELR is built on HL7, a set of standards for transmitting patient data. “The ELR is the closest thing to a national standard for HL7 messaging that exists in public health,” said John Satre, IDPH Information Technology Manager. “The ELR laboratory side from the Hygienic Lab informed those leading the project at the national level of significant gaps in the Meaningful Use initiative and in the tools that were being developed.”

Completion of the project was three years in the making and creates a common electronic language between hospitals, laboratories and public health agencies. On the surface, this may seem logical and straightforward, but the successful interface relies on many complex communication concepts.

To overcome barriers preventing electronic transmission, the Iowa-led team created standardized processes for sending results, developed uniform fields to input information and created structures that defined the makeup of the data. One of the major hurdles was to define terms that have the same meaning for all participants; for example, a hospital may label a result “positive” while the Hygienic Lab may label a similar result “detected”.

“The road has been long,” said Dari Shirazi, Hygienic Lab director of Information Technology, who with Jim Sartain, HL7 data exchange Specialist, and Brian Cook, ELR application developer, worked extensively on the collaboration. “We used national standards and codes to create an infrastructure whereby we send our lab data to IDPH and to hospitals accurately, timely and with no manual entry.”

Efficient, precise reporting of information is an essential part of the Hygienic Lab’s mission. ELR will help ensure such a critical response, particularly during an environmental or public health emergency. “We need to be able to communicate tests and results of public health significance immediately,” Shirazi said. “We have to be able to share data from the first moment of an outbreak.”

While the development of ELR presented the opportunity to standardize the codes that describe tests and results for public health use, key elements of the project’s success were the ability to access national resources, such as the Centers for Disease Control and Prevention and the Association of Public Health Laboratories (APHL), as well as the ability to collaborate with partnering agencies, most notably IDPH.

The IDPH and SHL have a close working relationship in many areas, but this is particularly true in the area of electronic data exchange. This partnership has formed the basis for Iowa’s approach to statewide ELR implementation. It is a challenge to meaningfully communicate with 118 hospitals and a number of independent laboratories. The close working relationship between IDPH and SHL has provided practical knowledge that has guided all that IDPH is doing to assist Iowa hospitals to meet the Meaningful Use objectives as well as connect with several national laboratories serving Iowa healthcare providers.

Adoption of ELR means that reporting test results will be “more complete – because more reportable lab results will be delivered to public health [agencies] – more accurately and, in most cases, will be available to public health investigators days earlier than before ELR,” Satre said. “This means that public health intervention can begin sooner, which should reduce ongoing exposure and thereby minimize infection and the illness that follows."