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Reusable Tools for Public Health Messaging and Vocabulary Standards. CSTE Conference June 5 th , 2012. Riki Merrick, MPH Eric M. Haas, DVM, MS.

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Reusable tools for public health messaging and vocabulary standards

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 Standards

Public Health Lab Interoperability Project (PHLIP)


Tools and Processes

Electronic Laboratory Reporting (ELR)

Program Approach


Laboratory Technical Implementation Assistance for Public Health (LTIAPH)

Electronic Lab Reporting-Technical Assistance (ELR-TA)

Tools and Processes re-used

Phlip who and what
PHLIP – Who and What Standards

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 what1
    PHLIP – Who and What Standards

    • Standards Used

      • Transport

        • PHIN-MS

      • Messaging

        • ELSM – HL7 v2.3.1ORU^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 – … and Why Standards


    Phlip elsm
    PHLIP Standards- ELSM

    PHL 1 sends ELSM to CDC

    using the RnRhubs

    PHL 1

    PHL 2

    Phlip etor
    PHLIP Standards- ETOR

    PHL 1 sends ELSM to CDC

    PHL 2 can do ETOR with CDC

    All are using the RnR hubs

    PHL 1

    PHL 2

    Phlip big picture
    PHLIP - Big Picture Standards

    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

    PHL 1

    PHL 2

    Phlip elsm current activities
    PHLIP Standards– 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

    Phlip elsm map june 2012
    PHLIP - ELSM Map June 2012 Standards

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

    Phlip etor current activities
    PHLIP – ETOR Current Activities Standards

    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
    PHLIP– Tools and Processes Standards

    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
    PHLIP - Processes Standards

    Different Calls for different Use cases and topics:

    Problem solving

    Core Group


    Implementation Issues

    Formalizing Decisions

    Change Control Board

    Aphl informatics sharepoint
    APHL Informatics SharePoint Standards

    • 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 - Data StandardsCollection Sheet

    Phlip messaging template
    PHLIP - Messaging StandardsTemplate

    Phlip encoding guideline
    PHLIP - Encoding Guideline Standards

    Working Group Calls

    Phin vads value sets
    PHIN VADS Value Sets Standards

    Current value sets for ELSM, ELR HL7 v.2.5.1, and many other message guides:

    Phin message quality framework
    PHIN Message Quality Framework Standards

    PHIN MQF Validation Tool:

    Elr initiative what is it
    ELR initiative – What is it Standards



    Data Flow

    Program Approach

    Vocabulary & Messaging Guidance

    Technical Implementation

    Elr initiative vision
    ELR initiative – Vision Standards

    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
    ELR initiative – Programs Standards


    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 Standards

    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
    ELR initiative – Data flow Standards

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

    Elr initiative program approach
    ELR initiative - Program Approach Standards

    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, LabMCoP, S&I Framework lab related initiatives and PH reporting)

    Vocabulary messaging guidance
    Vocabulary & Messaging Guidance Standards

    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 messaging guidance continued
    Vocabulary & Messaging Guidance (continued….) Standards

    Position statement clarifying ELR specs around Results

    §170.207 (c) Laboratory test results. Standard. Logical Observation IdentifiersNames 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
    Technical Implementation Standards

    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 receiver side
    ELR (Receiver) side Standards

    Focus on:

    Design / architecture

    Vocabulary and HL7 message transformations


    Orion Rhapsody (mostly)

    MQF Receiver profile

    And other testing / validation framework

    Phlip tools reused in elr initiative
    PHLIP Tools Reused in ELR initiative Standards

    • Data Collection Sheet

    • Encoding guideline

    • Working Group Call

    • Vocabulary Harmonization for Nationally Notifiable Diseases (NNDs)

    • Mapping and Terminology Conventions

    • Specimen Cross-Mapping Table

     Vocabulary

     HL7 Messaging

     Project Management

     Technical Assistance Team

    • Messaging template

    • Mapping Conventions (EPI info and specimen)

    • ETOR guide v2.6 for interested labs

    • Message Validation Tools (MQF)

    Elr tier groupings
    ELR Tier Groupings Standards

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

    Constrained profile message guide
    Constrained Profile Message Guide Standards

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

    Phin vads rcmt
    PHIN VADS RCMT Standards

    Current list of LOINCs and SNOMED codes for reportable conditions

    Phlip intangibles reused in ltiaph and elrta


    • Knowledge

    • Experience

       Relationships

    PHLIP Intangibles Reused in LTIAPH and ELRTA

    In summary
    In Summary Standards


    Program Approach




    Vocabulary & Messaging Guidance across all programs

    Technical Implementation coordinated and for all programs

    Contact: [email protected]

    [email protected]

    QUESTIONS? Standards

    [email protected]