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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.


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

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 elsm

PHL 1 sends ELSM to CDC

using the RnRhubs



phlip etor

PHL 1 sends ELSM to CDC

PHL 2 can do ETOR with CDC

All are using the RnR hubs



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



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


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 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:

phin message quality framework
PHIN Message Quality Framework

PHIN MQF Validation Tool:

elr initiative what is it
ELR initiative – What is it



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


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
ELR initiative – Data flow

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

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 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 receiver side
ELR (Receiver) side

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
  • 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.

phin vads rcmt

Current list of LOINCs and SNOMED codes for reportable conditions

in summary
In Summary


Program Approach




Vocabulary & Messaging Guidance across all programs

Technical Implementation coordinated and for all programs