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A​​​PHL collaborates with CDC, public health laboratories and health agencies to develop viable options for electronic transmission of laboratory test data and vital epidemiological information. Below are some of the initiatives supported by the Informatics technical assistance (TA) team.​

Electronic Laboratory Reporting for the Antimicrobial Resistance Lab Network

 The AR Lab Network provides nationwide laboratory capacity to rapidly detect antimicrobial resistance and inform local responses to prevent spread and protect people from AR threats. Early case detection and rapid intervention facilitate the containment of drug-resistant pathogens. Electronic data exchange is a foundational component of AR public health monitoring, decision-making and response, and federal funding models include key informatics initiatives that ensure interoperability of testing data.

 The AR Lab Network leverages data to:

  • drive response and prevent infections.
  • detect new resistance and provide better big-picture trend tracking to create pathogen-specific solutions and support national public health strategies.
  • inform outbreak response when AR threats are reported.
  • prevent and combat future AR threats.
  • support innovations in antimicrobial and diagnostic development.

 APHL Informatics supports the AR Lab Network through several major initiatives:

  • Technical Assistance: Deliver assistance to develop messaging guidelines and implement national AR reporting with regional, state, and local public health laboratories to CDC AR Programs (via DAART).
  • DAART: Develop and maintain Data for Action on Antimicrobial Resistance Threats (DAART). DAART is an interoperable repository for AR data and is hosted on the AIMS platform.
  • Lab Web Portal (LWP): Support regional ARLN informatics needs and reliable result reporting between originating submitters and ARLN PHLs using an Electronic Test Order and Result (ETOR) web portal solution.

Electronic Laboratory Reporting Technical Assistance (ELRTA)

APHL is collaborating with CDC to offer technical assistance to public health agencies and laboratories to implement and advance electronic laboratory reporting with diverse messaging partners. ELR allows laboratories and public health agencies to exchange data using a fast and potentially more streamlined process. ELRTA enables ELR capability on a larger scale, supporting commercial labs with a HL7 lab results message in addition to public health agencies and public health laboratories. This program is providing technical assistance to many jurisdictions and more are in the pipeline. TA requests are still being accepted.

Electronic Laboratory Surveillance Message for Vaccine-Preventable Diseases

APHL, in conjunction with the CDC National Center for Immunization and Respiratory Diseases' Division of Viral Diseases and Division of Bacterial Diseases, is supporting four public health laboratories to conduct VPD diagnostic testing on specimens from state public health laboratories. Results are submitted to CDC.

Electronic Test Orders and Results

The exchange of Electronic Test Orders and Results (ETOR) between public health laboratories and medical providers allows them to bidirectionally share critical information in near real-time, increasingly considered a core public health need. ETOR eliminates the need for manual data entry, thereby reducing errors and improving data quality. ETOR also allows laboratory staff to anticipate and prepare for incoming samples. The sooner laboratories receive and process test orders, the faster they can return results, which is essential for improving public health surveillance as well as direct patient care.

However, public health laboratories have had limited success with implementing ETOR to date as building the IT infrastructure is consuming, expensive, and requires dedicated staff. Additionally, each instance of ETOR with a provider has been a one-off solution, needing to be re-implemented and maintained for each partner making widespread ETOR largely unachievable in public health.

APHL has developed a national ETOR solution on AIMS called Detor. This centralized approach takes the onus off of labs to develop their own disparate technical solutions, and instead allows each laboratory to plug-in to existing infrastructure, leveraging and sharing tools, resources, and technical expertise to achieve ETOR nationwide. The AIMS intermediary approach to ETOR substantially reduces the need for data exchange expertise at the laboratory and removes the burden from PHLs. And as the translation and mapping happens in AIMS, this solution allows providers and laboratories to submit and receive orders and results in each of their native and preferred formats. This model also comes with dedicated technical assistance from APHL and CDC to help facilitate the onboarding process. Read more about this initiative from CDC. 

Lab Web Portal for Tuberculosis Testing

 The National PHL Drug Susceptibility Testing (DST) Reference Center for Mycobacterium tuberculosis (MTBC)  provides quality-assured drug susceptibility testing for eligible US public health laboratories with low volumes of testing. The Reference Center serves as an extension of CDC's Division of TB Elimination Laboratory Branch providing services that are harmonized with and complementary to those available at CDC. California Department of Public Health's Microbial Diseases Laboratory serves as the Reference Center.

 APHL Informatics supports the DST Reference Center through the following initiative:

  • Lab Web Portal (LWP): Ongoing support of the DST Reference Center at CDPH and informatics needs through reliable result reporting between originating submitters and the DST Reference Center using an Electronic Test Order and Result (ETOR) web portal solution.

 Learn more about the National PHL DST Reference Center including enrollment, available testing and workflows.

NNDSS Modernization Initiative (NMI)

The TA Team is collaborating with CDC and the Council of State and Territorial Epidemiologists to deliver technical assistance to state and local jurisdictions to modernize surveillance systems and processes used to receive nationally notifiable disease data to provide more comprehensive, timely and higher quality data for public health decision making. The TA Team is providing virtual and on-site technical assistance to jurisdictions implementing the newly revised case notification message. Work includes development of tools and resources to facilitate these implementations and build a knowledge management repository.

PHLIP Electronic Laboratory Surveillance Message for Influenza

The Public Health Laboratory Interoperability Project (PHLIP) Electronic Laboratory Surveillance Message (ELSM) for influenza utilizes the HL7 messaging standard to facilitate automated influenza data exchange between CDC and state public health laboratories. Standardized messaging improves data quality and accessibility, allowing laboratorians to transmit granular data in a compatible format. PHLIP terminologists collaborate with local laboratorians and with regulatory and standards-developing organizations to harmonize laboratory tests and results, and to represent these consistently using standard vocabularies and terminology.

Currently the TA team is working with partners to incorporate epidemiological, immune response, antiviral susceptibility and genetic characterizations as well as data from the CDC's National Respiratory and Enteric Virus Surveillance System (NREVSS) into the HL7 data feed. These additions will improve response to disease outbreaks, allowing authorities to base decisions on more timely and complete data. 

Rabies

APHL supports CDC, state and local public health agencies, and public health, agriculture, veterinary and contract laboratories to establish surveillance of rabies in animals to inform disease emergence and spread. The project hones ELR surveillance work and explores cloud-based processing approaches and storage via the APHL Information Messaging Services (AIMS) environment to allow secure, direct connection from CDC program areas. Technical assistance is offered to laboratories to assist with data extracts, integration broker work, vocabulary mapping, message creation and message transport. Specifically, the project designs and implements approaches related to animal rabies surveillance including:

  • Documents ELR data requirements for animal rabies using the HL7 2.5.1 constrained profile
  • Identifies a message structure to be used and constrain it for non-human subjects
  • Examines options for streamlining data sent to CDC for non-human surveillance, looking at both the transport and message structure
  • Designs and implements processing and storage of received data, including evaluating cloud options
  • Implements HL7 ELR for animal rabies at reporting laboratories through APHL technical assistance
  • Evaluates web mapping and analysis options in use at CDC​