Lab Matters Spring 2024 | Page 24


The Use of Intermediaries to Facilitate ETOR for Public Health

By Rachel Shepherd , senior specialist , Informatics
The nation depends on public health laboratories to conduct critical and complex tests to keep our country safe from emergent threats , environmental contaminants and food-borne illnesses . Electronic Test Orders and Results reporting ( ETOR ) allows laboratories and health care providers to exchange information across different facilities and information systems using agreed upon standards . Accurate data and efficient turnaround time for results is crucial . The sooner laboratories receive and process test orders , the faster they return results . This timeliness is essential for surveillance , outbreak and public health emergency response , and early intervention , improving patient care .
The US Centers for Disease Control and Prevention ( CDC ) identified ETOR as a priority for public health laboratories and is facilitating the use of two ETOR intermediaries — APHL ’ s Informatics Messaging Services ( AIMS ) and CDC ’ s ReportStream — to support this effort . The intermediary approach takes the burden off laboratories to develop their own disparate technical solutions and allows them to plug into existing infrastructure — leveraging and sharing the tools , resources and technical expertise to achieve ETOR nationwide . 2023 marked the first year of initial implementations via an intermediary , establishing ETOR for newborn screening between selected public health laboratories and their healthcare partners .
A Centralized and Shared Solution
The core tenet of the ETOR intermediary approach emphasizes reusability and agility , relying on centralization of infrastructure , technical tools , partner connectivity , accessible knowledge and expertise . This solution reduces the need for data exchange expertise at the laboratory and removes the burden from public health laboratories , with technical architects developing the routes and connections that a laboratory would otherwise have to independently build over time . It allows the provider and laboratory to send and receive orders and results in their preferred or native formats , with the mapping and translation happening in the intermediary . ETOR will shift the burden and cost of hiring and retaining
specialized implementation experts , securing , monitoring and maintaining infrastructure , and 24 / 7 / 365 support from each individual public health laboratory to an intermediary for centralized management . The suite of services available to users will greatly reduce manual processes like vocabulary mapping and terminology maintenance .
Public health laboratories have struggled for decades to build IT infrastructure to implement ETOR . Typically , laboratories adopt one-off solutions that must be re-implemented and maintained for each unique partner . Laboratories must independently procure the right tools and services , build and maintain the infrastructure , and engage partners and vendors . Currently , every time a public health laboratory wants to bi-directionally exchange data with another entity they must create a unique connection . This involves setting up transformations and translations to accommodate their partner ’ s specific requirements , essentially recreating the wheel each time .
The ETOR intermediary approach addresses the challenges faced by public health laboratories : limited
22 LAB MATTERS Spring 2024
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