Lab Matters Spring 2026 | Page 27

INFORMATICS

By Melanie Kourbage, lead specialist, Informatics

The pandemic taught many lessons about public health infrastructure. Among them, that rapid scale-up in response to emergencies is only sustainable when paired with a platform that can agilely connect public health systems and healthcare providers across the country. And this national network generates massive volumes of data, which translates into substantial operational costs.

Growth in Monthly eICR Volume Processed on AIMS( 2020 – 2024)

A Robust Foundation

The APHL Informatics Messaging Services( AIMS) Platform has long served as the backbone of national public health data exchange, processing more than 40 million messages per month across laboratories, federal partners, hospitals, and other public health collaborators. Think of it as a high-speed interstate transporting critical information— surveillance messages, electronic case reporting( eCR), immunization data, vital statistics, electronic laboratory results( ELR), electronic test orders and results( ETOR), and other public health reporting— from one point to another. By centralizing these intermediary services into a single platform instead of replicating efforts across every public health jurisdiction, AIMS saves money, time and lives.

But with great success comes great operational complexity. When COVID-19 hit, the platform scaled dramatically to meet demand. For example, in late 2020 AIMS processed about 2.15 million initial electronic case reports( eICR) per month. But by the end of 2024, AIMS was processing more than 26 million eICR per month, with numbers continuing to increase. Other use cases saw similar increases in activity during the same period. That exponential increase in message volume brought a corresponding spike in operational costs in the form of monthly bills from Amazon Web Services( AWS).

After the emergency ended, the volume of data continued to increase as more conditions and healthcare organizations onboard and as AIMS evolved to handle more use cases. For example, the platform recently assumed responsibility for reporting ELR to jurisdictions from the US Centers for Disease Control and Prevention’ s( CDC’ s) ReportStream and SimpleReport. CDC also commissioned APHL to build and operate Detor, a centralized, fast and secure system to transmit ETOR between healthcare systems and public health collaborators. Already, more than 100,000 newborn screening, sexually transmitted infection( STI) and tuberculosis( TB) orders and results have been exchanged through Detor since the service went live in August 2024, saving hundreds of hours for both hospitals and laboratories, reducing turnaround time by days and potentially saving lives. These expansions to AIMS demonstrate its versatility and CDC ' s continued reliance on and trust in the platform.

AIMS gets the job done, but at a cost. As funding tightens across public health, APHL is trying to find ways to reduce expenses. This public health intermediary will only be sustainable if it can streamline its operations and make the investment more cost-effective.

The Stabilization Initiative

This past year, APHL focused on stabilizing and streamlining operations across the AIMS Platform. The association overhauled how messages are processed and routed without disrupting services to users— no small feat when the platform is handling 480 million annual messages that healthcare organizations, laboratories and agencies depend on at the local, state and federal level. Through careful process improvement efforts, the platform achieved considerable reductions in operating costs while maintaining the same level of service reliability.

The work began with comprehensive analysis. The team leveraged AWS tools including Cost Explorer, Compute Optimizer and Trusted Advisor to generate data-driven insights about where resources were being consumed. They established a semi-permanent governance structure to continue process

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