Reusable tools for public health messaging and vocabulary standards
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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

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

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 what1

    PHLIP – Who and What

    • 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

    PHLIP


    Phlip elsm

    PHLIP - ELSM

    PHL 1 sends ELSM to CDC

    using the RnRhubs

    PHL 1

    PHL 2


    Phlip etor

    PHLIP - 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

    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 – 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

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


    Phlip etor current activities

    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

    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

    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

    • 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 Collection Sheet


    Phlip messaging template

    PHLIP - Messaging Template


    Phlip encoding guideline

    PHLIP - Encoding Guideline

    Working Group Calls


    Phin vads value sets

    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 Message Quality Framework

    PHIN MQF Validation Tool: https://phinmqf.cdc.gov


    Reusable tools for public health messaging and vocabulary standards

    Specimen Cross-Mapping Table


    Phlip meet the tat

    PHLIP - Meet the TAT


    Elr initiative what is it

    ELR initiative – What is it

    Vision

    Programs

    Data Flow

    Program Approach

    Vocabulary & Messaging Guidance

    Technical Implementation


    Elr initiative vision

    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

    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).


    Reusable tools for public health messaging and vocabulary standards

    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

    ELR initiative – Data flow

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


    Elr 251 implementation assistance approach

    ELR 251 Implementation Assistance Approach


    Elr initiative program approach

    ELR initiative - Program Approach

    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

    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

    Vocabulary Collaboration Framework


    Vocabulary messaging guidance continued

    Vocabulary & Messaging Guidance (continued….)

    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

    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

    ELR (Sender) side


    Elr receiver side

    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

    PHLIP Tools Reused in ELR initiative

    • 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

    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

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


    Constrained profile message template

    Constrained Profile Message Template


    Phin vads rcmt

    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&code=RCMT


    Phlip intangibles reused in ltiaph and elrta

    Intangibles

    • Knowledge

    • Experience

       Relationships

    PHLIP Intangibles Reused in LTIAPH and ELRTA


    In summary

    In Summary

    APHLinformatics

    Program Approach

    PHLIP

    LTIAPH

    ELRTA

    Vocabulary & Messaging Guidance across all programs

    Technical Implementation coordinated and for all programs

    Contact: [email protected]

    [email protected]


    Questions

    QUESTIONS?

    [email protected]


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