INFORMATICS
AR Lab Network Benefits from APHL’s ETOR Solution
by Laura Carlton, senior specialist, Informatics and Rachel Shepherd, specialist, Informatics
In 2016, the US Centers for Disease
Control and Prevention (CDC) launched
the AR Lab Network to help address
the immediate need for a coordinated
response at local and national levels to
the rising number of antibiotic resistant
(AR) pathogens. This initiative links public
health laboratories with submitters—such
as hospitals—and CDC epidemiologists
through a comprehensive technical
infrastructure. The AR Lab Network
enables important AR test result data to
be exchanged quickly to ensure a timely
response and immediate intervention
when positive cases are identified.
APHL has helped lead this effort by
developing technical solutions and secure
infrastructure that makes the network
possible by employing electronic test
order and result (ETOR) capabilities on the
AIMS Platform.
How it Works
Seven state public health laboratories
have been designated regional
laboratories responsible for specialized
AR testing. For example, when a hospital
suspects an antibiotic-resistant pathogen
and sends the request to their local
laboratory for testing, that lab will send
the sample to their designated regional
laboratory. The local laboratory enters
the test request electronically through a
web portal, which is received at the AR
regional laboratory. The laboratory is able
to access the request in real-time and
make necessary preparations to receive
the specimen. Once testing is complete,
results are uploaded to the portal and are
accessible to the submitter in real-time.
Five regional laboratories are using the
Lab Web Portal, APHL’s ETOR solution
developed by iConnect Consulting and
hosted on the AIMS Platform, and two
are using their own home-grown portal
solutions. Each laboratory is able to
configure the Lab Web Portal to their
specific testing workflow and data needs.
technical infrastructure is designed so
those same results can be automatically
reported to CDC by the regional laboratory,
reducing the reporting burden on
laboratory scientists.
What’s Next
As regional laboratories and submitters
began using the Lab Web Portal, APHL
collected feedback from users to
understand functionalities that would
continue to improve ETOR and any
challenges users were experiencing. Based
on that feedback, APHL is currently rolling
out the next version of Lab Web Portal,
with some exciting new capabilities.
Version 2 introduces LIMSConnect, a
new function that allows the portal
to sync directly with the laboratory’s
information management system (LIMS).
This seamless integration eliminates
the need for the regional laboratories
to set up HL7 messaging for test orders
and results, which can be an onerous
development task. The sync function
establishes a direct line of communication
from submitter to LIMS, and reduces the
potential points of error or failure that can
slow down the data transfer. From kick-off
to production, it has taken approximately
eight months to fully onboard regional
laboratories using HL7 messages and
enable them to achieve ETOR capabilities
with their submitters. Using LIMSConnect,
laboratories will be able to stand up ETOR
for new pathogen testing faster and with
less resource time compared to HL7.
Other features that will benefit submitters
include the ability to upload batch test
orders and track the status of orders.
When hospitals or laboratories have
multiple tests that need to be processed,
they will be able to enter several requests
in one submission rather than create a
single entry for each one, which will save
data entry time for submitters. Currently,
the Lab Web Portal notifies the submitter
when the test order is received and when
the result is ready. In the next iteration,
submitters will be able to view the status
of the tests performed throughout the
testing lifecycle.
ETOR is quickly becoming a fundamental
capability for public health laboratories.
Some AR Lab Network regional
laboratories are expanding their Lab Web
Portal solution beyond the network testing
area with the goal of encompassing
all test ordering and resulting across
the laboratory, streamlining processes
for labs and their submitters. APHL is
ensuring that new enhancements and
functionalities within Lab Web Portal
can be applied, regardless of the type
of testing or lab area, so the portal acts
as an extension of LIMS rather than a
one-off solution. The sooner labs can
receive and process test orders, the faster
they can turnaround critical test result
information, ultimately leading to better
patient care. n
Through ETOR, the regional laboratory is
able to meet the mandated 48-hour turn-
around time to report test results back
to the submitter. The AR Lab Network
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LAB MATTERS Summer 2019
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