Lab Matters Winter 2020 - Page 25

INFORMATICS helps develop and implement the AIMS platform. Through this project, the APHL and Ruvos teams learned how to work with protected health information from a private-sector company and built stronger connections with the public health agencies, setting the stage for new kinds of AIMS initiatives. They are now working with private hospitals and clinics to use the platform for electronic case reporting (eCR) to public health agencies. When a healthcare provider adds relevant information to an electronic health record (EHR), the EHR will generate and send an electronic Initial Case Report (eICR) to AIMS. There, a decision support tool called the Reportable Conditions Knowledge Management System (RCKMS) evaluates the eICR for issues such as reportable diseases and shares them with the relevant public health agencies. “Right now, a lot of doctors have to write things on various paper forms and send them into a health department. eICR is all about collecting that information electronically without the physician having to do it,” explained Shirazi. EHR systems have the capability to create and send reports. “But if every hospital wanted to do it alone, they would have to connect to every public health agency. AIMS is able to help with that. This is a huge project that is going to have a large impact on public health.” With a few hospitals now in production and a handful more in the onboarding process, Loumiet’s team is working with APHL on efficient ways to scale up eCR. Ideally, he said, someday all 5,500-plus private hospitals and clinics in the US will be connected to public health agencies via the AIMS platform. Eliminating the Middleman These types of efforts by APHL to standardize and automate reporting can be a boon for public health agencies, said Keith Higginbotham, information technology systems manager of the Alabama Department of Public Health. “More electronic interchanges typically result in data that are more accurate, more complete and more timely,” he said. PublicHealthLabs @APHL Higginbotham and his team maintain multiple electronic test orders and results (ETOR) interfaces for different customers in Alabama. “Everyone does it just a little bit differently,” he said, so each customer’s interface and each electronic medical record (EMR) vendor requires extra work to customize the order and result messages. If APHL could work with EMR vendors to develop a standard ETOR interface within AIMS, “that would take a lot of work off of my staff.” Loumiet believes that facilitating these connections—with as much automation as possible and little hands-on involvement from the AIMS staff—is the future of cloud-enabled public health data exchange. He envisions a streamlined experience for users, where “with a few clicks, you’ll be able to exchange data with anyone else on the AIMS platform,” he said. “The AIMS team will focus on the security, making sure the numbers are being reported to the appropriate people. But two states will be able to collaborate with little or no effort from us.” The AIMS staff are also working on new applications to help the exchange of ELR messages between states and even among multiple users within a single jurisdiction. We’re one airplane flight away from a disease entering the US. Thanks to cloud computing, we now have the beginning of an international data exchange.” Eduardo Gonzalez Loumiet Looking Ahead With so many new capabilities on the horizon, it’s critical to ensure that labs and agencies are able to benefit from cloud-based services. “I would say five years ago, state agencies were very against cloud platforms,” said Higginbotham, who was a member and past chair of the APHL Informatics Committee. “Utilizing a vendor that has their product in the cloud means the data is essentially outside your personal control, so there was a lot of fear.” Policy decisions broadly imposed on agencies by state information technology offices may limit labs’ abilities to leverage cloud-based products. For example, Higginbotham has been eyeing a cloud-based laboratory information management system that looks promising but is not currently an option for them. But he has seen greater acceptance over time as the uses and benefits of cloud- based initiatives—including those on AIMS—become clearer, he said. “State agencies have started to realize it’s not as scary as they originally thought, and it seems like more and more states are moving to cloud-based technology,” Higginbotham said. The flexibility of server capacity on the cloud, while advantageous, also brings additional responsibilities. Changing use patterns can complicate planning and budgeting, Loumiet said. What’s more, the ease of tapping into seemingly unlimited computing resources can sidestep important questions about whether a planned activity is necessary or appropriate. “The argument is cloud computing is cheaper—and it can be. But it takes effort, it takes work and monitoring to make sure that you leverage the services appropriately,” said Loumiet. Those efforts also extend to considering a “reusability factor” when the AIMS team designs new capabilities, Loumiet said. Building on recently expanded connections through AIMS, the team is looking beyond the US. The first international trading partner, a laboratory in Chile, connected with the AIMS platform in fall 2019 and will be able to send influenza data to CDC, which can be useful when planning for the next flu season in the US. Although such a connection might have been possible without cloud computing, Loumiet says, it happened much more quickly and with fewer meetings and less equipment by using the cloud. “We’re one airplane flight away from a disease entering the US,” Loumiet says. “Thanks to cloud computing, we now have the beginning of an international data exchange.”n Winter 2020 LAB MATTERS 23