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The Public Health Laboratory Perspective: readiness to support “meaningful use”. PHDSC Annual Meeting November 12th 2009 Mary Shaffran, MPA Senior Director, Public Health Programs Association of Public Health Laboratories. APHL’s NEW Mission Statement.

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The public health laboratory perspective readiness to support meaningful use

The Public Health Laboratory Perspective: readiness to support “meaningful use”

PHDSC Annual Meeting

November 12th 2009

Mary Shaffran, MPA

Senior Director, Public Health Programs

Association of Public Health Laboratories

Aphl s new mission statement
APHL’s NEW Mission Statement support “meaningful use”

“To promotethe role of public health laboratories in shaping national and global health objectives, and to promote policies, programs, and technologies which assure continuous improvement in the quality of laboratory practice and health outcomes.”

Meaningful use general objectives 2011 2013 and 2015
*Meaningful use general objectives (2011, 2013, and 2015)

  • Improve quality, safety, and efficiency

    • Capture Data in coded format

      • Incorporate lab test results into EHR

  • Engage patients

  • Improve care coordination

  • Reduce health disparities through public & population health data-sharing

  • Ensure privacy and security

*Health Information Technology Policy Committee June 16th 2009

The phl e health domain
The PHL e-health domain 2013, and 2015)

Test Order / Result (ETOR) and Lab Result to local EHR/EMR

RHIO etc..

Flavors of electronic messaging
Flavors of Electronic Messaging 2013, and 2015)

  • Electronic Lab Reporting (ELR):

    • Reportable disease related result from labs to state EPI & NND related results to CDC

  • Electronic Case Reporting (ECR):

    • Reportable disease related patient information from physician to state EPI (includes lab results) – NND related de-identified cases on to CDC (from state EPI)

  • Electronic Laboratory Messaging (ELM):

    • Lab electronic data exchange between partners

      • test requests and results to submitter (local)

      • test requests and results to submitter intra state for:

        • COOP, Surge, Reference tests

      • Reportable disease related results to state and federal EPI

As we wait for a definitive definition
As we wait for a “definitive” definition….. 2013, and 2015)

“The concept of meaningful use is simple and inspiring, but we recognize that it becomes significantly more complex at a policy and regulatory level.  As a result, we expect that any formal definition of “meaningful use” must include specific activities health care providers need to undertake to qualify for incentives from the federal government.”

10.01.09 Quote from a Message from Dr. David Blumenthal, National Coordinator for Health Information Technology-

And see the problems that are arising
And see the problems that are arising 2013, and 2015)

“We’re not going to be able to make a lot of progress on any higher level ambitions until we can get our arms around some of the nitty-gritty details, like the exchange of lab results and greater standardization”

  • Micky Tripathi, co-chairman, Health IT Policy Committee

Experts call for widening scope of lab test exchange

Phl putting their house in order
PHL: Putting their House in Order- 2013, and 2015)

  • Increasing data exchange capacity & expertise

  • Taking control of their vocabularies-

  • Reviewing and tracking pertinent federal standards development

  • Working with LIMS vendors-

    • Defining the best solutions to meet data exchange

  • Participating in the Public Health Laboratory interoperability project (PHLIP)- 22 states, CDC-CCID & CDC-NCPHI working collaboratively

Phlip advancing lab data exchange
PHLIP- advancing lab data exchange 2013, and 2015)

PHLIP includes components related to:

  • laboratory data vocabulary

  • messaging

  • security and architecture

  • building community and collaboration around the critical issue of laboratory data messaging

Phlip current use cases
PHLIP Current Use Cases 2013, and 2015)


Route not Read (RnR) Hubs

  • Direct Send: Currently in place (will transition to RnR Hub when Phase 3 is complete)

  • Phase 1: Implement RnR Hubs in FL and NE

  • Phase 2: Develop Hub-to-Hub Interoperability

  • Phase 3: CDC develop capability to exchange messages with RnR Hubs



RnR Hub FL

RnR Hub NE




  • Status:

  • Direct Send: In Production (used for H1N1 and seasonal surveillance)

  • Phase1: In Production

  • Phase 2: In Production

  • Phase 3: Available- not yet in full production- CDC can poll the hubs.

Future of PHLIP- ETOR with clinical partners 2013, and 2015)

  • Release PHLIP harmonized lab order and result terminology

  • Forge stronger collaborations with private sector

  • Work with the ONC NHINConnect technical staff and the CDC to establish the mechanism for the RnR hubs to be used as a pilot for NHIN architecture for the PHL to Clinical Lab use case.

Phlip in action h1n1 response what s in a name
PHLIP in Action- H1N1 response 2013, and 2015)What’s in a Name?

A pig by any other name….

Influenza A unsubtypeable 2013, and 2015)Novel Influenza A H1N1Swine Influenza VirusInfluenza A H1N1 swine-likeNovel Influenza A H1N1 swine-likeInfluenza A H1, porcineswine-origin influenza virusSwine-origin Influenza A (H1N1)SO-IVFlu A/SW H1………………………………………

The result
The result.. 2013, and 2015)

  • PHLIP Outbreak Response

    • States utilizing PHLIP

    • Impact on daily operations

  • PHLIP Role

    • Lead in determining LOINC and SNOMED codes for new Influenza assays

    • Collaborating with ELR, LIMSi, and other partners to harmonize data elements..

Recommendations- 2013, and 2015)

  • Evidence that we NEED clear direction on test names and procedures AS the test protocols are developed.

    • a terminologist should participate at the outset in the naming of new tests and determination of the results

  • Assays should go to FDA with standardized codes already submitted…messaging cannot be an afterthought!

Obstacles for ph to address if they are to remain relevant in hit
Obstacles for PH to address if they are to remain relevant in HIT

  •  State/Local Relationships – not working well together

  • Public Health has to be perfect over practical

  • Funding problems have decimated Public Health Departments, especially knowledgeable informatics workforce

    • Siloed funding is a huge obstacle


For More Information


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