Lab Matters Winter 2017 | Page 19


Iowa Uses AIMS to Enhance Electronic Laboratory Reporting

by John Satre , informatician , Public Health Informatics Information Management , Division of Administration & Professional Licensure , Iowa Department of Public Health

The Iowa Department of Public Health ( IDPH ), in collaboration with APHL , multiple state and metropolitan public health jurisdictions and various public health program areas ( infectious disease , HIV , and STD ) conceived , designed , built , tested and shared an innovative software component that enhances electronic laboratory reporting ( ELR ) and plays an integral role in a process that IDPH calls ELR Redirect .

ELR Redirect evaluates each inbound electronic laboratory message ; calculates the most appropriate public health jurisdiction ( s ) based on the condition , patient address , ordering provider address , and ordering healthcare facility and routes the message to the qualifying public health jurisdiction ( s ) in real-time . While this seems like a solution to a fairly mundane administrative task , establishing interstate public health connectivity can also be used to facilitate national electronic data exchange eliminating the need to continue establishing costly pointto-point electronic connections . If a facility can send ELR to one public health jurisdiction , they can send ELR to any public health jurisdiction via ELR Redirect through a nationwide public health network . The software component , designed using the Orion Health Rhapsody integration engine , can be obtained via http :// www . gggllc . com /
ELR Redirect organically sprang out of the electronic disease surveillance landscape that existed in 2014 and leverages several developments that created that environment : technology guidance through the National
Electronic Disease Surveillance System ( NEDSS ) initiative ; use of standard HL7 messaging structures ; use of standard LOINC , SNOMED , and HL7 vocabularies ; HITECH Act support , education , work products and technical assistance ; and significant infrastructure components like APHL ’ s AIMS Platform .
AIMS ( formerly the RNR Hub ) provides a reliable , secure , central communication node , capable of handling nationwide disease surveillance traffic . Most public health jurisdictions already use AIMS to report disease information to the Centers for Disease Control and Prevention ( CDC ). Iowa and other jurisdictions employing ELR Redirect use AIMS in a fashion similar to a post office as it operates in a small rural town : mail gets dropped off and picked up at the post office in locations where home delivery is not supported . Each jurisdiction actually pushes qualifying data to AIMS and polls AIMS for data dropped off for their jurisdiction by other public health jurisdictions ; any data available for the polling public health jurisdiction is pulled back from AIMS and dropped into existing ELR channels for further processing .
ELR Redirect has been implemented at the production level between Iowa & Nebraska as well as Iowa & Wisconsin public health jurisdictions . There are also open test ELR Redirect projects between Iowa & Illinois , Iowa & South Dakota , and Michigan & Wisconsin .

2017 Reboot : The Informatics Self-Assessment Tool by Rachel Shepherd , associate specialist , Informatics

In June 2013 , APHL , in partnership with the US Centers for Disease Control and Prevention ( CDC ), developed a paper-based Laboratory Efficiencies Initiative , identifying key areas of measurement for public health laboratories ( PHLs ) to evaluate themselves . Nineteen skill areas were identified as crucial capabilities for comprising a successful PHL , including specimen and sample tracking , contract and grant management , quality control and core information technology services .

The Informatics Self-Assessment ( SA ) Tool brought that paper test to life in September 2014 . The web-based interactive application and automated tool provides laboratories a streamlined way to not only evaluate capabilities by performing an assessment , but also to longitudinally track progress towards increasing those capabilities over time . The unique visualization module provides a built-in mechanism to easily highlight areas of excellence , as well as areas in need of improvement .
2017 will see a re-launch of the SA Tool with increased functionality , a more intuitive design and a new capability area in cloud computing . By design , the SA Tool paints a comprehensive picture of PHL informatics capabilities . When labs complete an assessment , their data is compiled into the national aggregate . The more labs that participate , the stronger and more precise that aggregate becomes . Participating laboratories can see how they compare against a national standard . This allows labs to prioritize areas on which to focus efforts , and develop a roadmap to improve processes .
The ability of the SA Tool to compare similar laboratories in a standardized assessment will facilitate cross-collaboration and an increase in knowledge sharing and best practices . It also will provide an avenue through which emerging leaders and potential peer mentors can emerge . Over time , as public health labs share their assessments , the SA Tool will enable them to identify gaps in performance , which APHL and CDC can prioritize and address with targeted support .
Laboratories that have used the tool internally have found it to be insightful and engaging . The Alabama State Public Health Lab has said , “ It is the first tool that I have seen that allows an SPHL director to evaluate the maturity of their LIMS across all functional areas of their lab .” And the Kentucky State Public Health Lab called it a “… comprehensive and informative informatics measuring tool , as well as a great ' workshop ' style document for lab leaders .”
As technology changes , APHL will continue to adapt and improve the SA Tool for ease of use . To find out more about the tool , please contact Rachel Shepherd , associate specialist , Informatics at Rachel . Shepherd @ aphl . org .
APHL . org
DIGITAL EXTRA : Read more about the APHL Informatics Self-Assessment Tool
Winter 2017 LAB MATTERS 17