The Urgent Need for ETOR by Rachel Shepherd , specialist , Informatics
The COVID-19 pandemic has underscored the need to modernize how public health data is exchanged and demonstrated the critical importance of timely and accurate information . The nation relied on these data — such as positivity rates and testing volume — to inform policy , assess risks , identify hotspots and try to mitigate spread . However , public health laboratories did not have a mature electronic messaging framework in place to communicate seamlessly with clinical care partners . Most public health laboratories had to rely on existing manual or semi-manual processes that could not scale to meet the testing demand during the height of the pandemic . Laboratories were operating around the clock to perform testing and manually enter high volumes of test order and result data .
The goal of achieving the ability to electronically exchange test orders and results ( ETOR ) is not new . Public health laboratories have struggled for more than a decade to build their information technology ( IT ) infrastructure and implement ETOR across their organizations with marginal success . When ETOR solutions can be implemented , public health laboratories often have difficulty in getting their healthcare partners to come to the table to discuss establishing connectivity . When such efforts do succeed , they are normally one-off solutions that have to be re-implemented and maintained for each unique partner .
A Member-Driven Need
In February 2021 , APHL issued a landscape analysis
to determine the current state of ETOR capabilities across public health laboratories .
Forty-six state and local laboratories participated and consistently rated informatics and IT resource management as the greatest barrier to achieving ETOR . Eighty-six percent of public health laboratories indicated that they did not have an adequate , fully qualified and dedicated staff to support their IT infrastructure to manage critical informatics-related initiatives .
Seventy-eight percent specified that their laboratories are unable to exchange transactional data between systems , such as workload and turnaround time data , inventory stats , percent positive data , etc . This is critical data that most public health laboratories are not taking advantage of .
Another 62 percent reported that they had no ongoing informatics training programs for informatics staff , or any foundational informatics instruction for other laboratory staff . Without ongoing training , informatics staff cannot effectively optimize operations and expand data exchange capabilities . Without a fundamental understanding of informatics concepts for all staff , the workforce becomes siloed and disconnected
The results also pointed to a wide disparity in capabilities across the landscape , with some laboratories excelling in areas that other laboratories have not yet begun to address . For instance :
• Sixty percent of respondents use automated validation tools to assure that messages meet structural and content standards and guidelines ; 30 percent do not use any .
• While nearly 50 percent of respondents reported the ability to generate HL7 messages directly without conversion , 25 percent said they cannot perform this function at all .
In a supplemental survey launched in July 2021 , state and local laboratories cited additional challenges specific to ETOR implementation such as :
• Partner engagement
• Funding ( difficult to use short term funding to address long term needs )
• Lack of technical capabilities
• Lack of necessary staff
• Security concerns .
Working Towards ETOR
The US Centers for Disease Control and Prevention ’ s Data Modernization Initiative
has put immediate pressure on public health laboratories , setting a requirement for laboratories to establish ETOR capabilities with hospitals in their regions . There is a risk that , in response , public health laboratories will acquire and implement multiple solutions that will continue to be inefficient , burdensome and inequitable .
To that end , APHL has convened an ETOR Taskforce to strategize around longterm comprehensive solutions that will benefit all of public health . Taskforce members represent laboratories that have successfully implemented ETOR with partners and laboratories that rely heavily on manual methods of data exchange . The taskforce aims to consider all perspectives and ensure that all laboratories , regardless of technical infrastructure and expertise , make advances forward in ETOR .
The group has outlined systemic challenges and addressed possible solutions . For instance , public health laboratories cannot be expected to implement complex and time consuming solutions without an adequate informatics workforce . The taskforce has also documented communication needs and strategies for partner engagement , legal requirements , principles of governance , minimal technical specifications and more . It has compiled implementation resources and has shared examples of multiple LIMS input and output to compare and potentially simplify collectively .
Public health data modernization hinges on the ability to electronically exchange information . Streamlining the process of ETOR implementation for all is a pressing need , and developing effective strategies for laboratories , technical experts , providers and vendors to all engage will benefit all of public health . n
22 LAB MATTERS Fall / Winter 2021