Electronic Laboratory Reporting
The Connecticut Department of Public Health's (CTDPH) Electronic Laboratory Reporting (ELR) system has been implemented. CTDPH will work with eligible hospital or commercial laboratories that currently submit laboratory test results as part of state requirements for reportable diseases and conditions. If you are a laboratory that is interested in participating in Connecticut ELR (CT ELR), the CTDPH ELR Checklist will introduce you to the process, and is summarized below. If you have questions about the process or about CT ELR, please contact the CT ELR team at email@example.com.
Step 1. Complete the CTDPH ELR Registration Form
Completion of the CTDPH ELR Registration form is required for participation in CT ELR. Follow the instructions on the form and return as indicated. If you have trouble accessing the form, contact the CT ELR team.
Completed forms will be assessed and laboratories will be prioritized based on reporting volume, reportable conditions tested by that lab, laboratory readiness to meet reporting requirements (such as use of standard codes for tests and results), and the availability of CTDPH staff to work with the laboratory. A member of the CT ELR team will reach out to the contact person identified on the completed CTDPH ELR Registration form with information on starting the ELR on-boarding process. The process will include identification of team members and setting up routine calls for communication throughout the on-boarding process.
Step 2. Obtain Necessary Documentation for ELR Implementation
To successfully participate in CT ELR, laboratory and/or laboratory information system staff should download and be familiar with the following documents:
- The HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health (US Realm) Release 1 and related errata. Also known as the national ELR HL7 2.5.1 Guide, this guide outlines the requirements for HL7 2.5.1 public health messaging.
- The CTDPH ELR Local Implementation Guide (for HL7 2.5.1). Also known as the CT ELR Local Guide, this guide outlines those additional requirements for use of ELR for messaging of reportable disease laboratory results.
- The CTDPH ELR HL7 v2.5.1 Message Validation Tool User Guide. CTDPH has worked with the National Institute of Standards and Technology (NIST) to modify the current NIST context-free ELR validation tool to reflect CT-specific ELR requirements. The User Guide has instructions on how laboratories can validate their de-identified HL7 2.5.1 test messages (i.e., those not containing any personal identifying information) before working with CT ELR on further message validation as described in Step 7.
NOTE: Laboratories that want to initiate ELR using a prior version of HL7 (e.g., 2.3.1) or a non-HL7 message format must contact the CT ELR team for additional guidance and instructions.
Step 3. Incorporate Standard Vocabulary
Laboratories must work with their laboratory information system or IT vendors to ensure that standardized vocabularies are used in messages to be processed via the CT ELR system. This is required regardless of accepted message format. The standardized vocabulary code sets are as follows:
- Use Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) for laboratory results and specimen types. You can request a free license to access the SNOMED CT browser available through the U.S. National Library of Medicine Unified Medical Language system (UMLS) Terminology Services at: https://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html. HL7 vocabulary, SNOMED CT, and National Drug file domains can also be found on the Enterprise Vocabulary Services (Bioportal) developed by the U.S. National Cancer Institute (NCI): http://bioportal.nci.nih.gov/ncbo/faces/pages/quick_search.xhtml.
- Map other codes as defined in the CTDPH ELR Local or the national ELR implementation guides, such as the HL7 defined race and ethnicity codes, and use the Unified Code for Units of Measure (UCUM) for units. A useful source for these and other vocabulary codes for use in ELR is the Reportable Condition Mapping Tables that can be accessed via the Public Health Information Network Vocabulary Access Distribution System (PHIN VADS).
Correct use of vocabulary code sets will be reviewed by the CT ELR team as part of ELR message validation. Required vocabulary codes sets are also described in the CT ELR Local Guide. If your laboratory needs assistance with vocabulary or has questions, please contact the CT ELR team.
Step 4. Develop HL7 version 2.5.1 ORU message for Public Health
CTDPH strongly recommends that laboratories that want to submit ELR develop the HL7 2.5.1 formatted unsolicited observation messages (ORU) message in conformance with the CTDPH Local and national ELR implementation guides. If laboratories are unable to currently send an HL7 2.5.1 ORU ELR message, or are in need of information for transitioning from HL7 2.3.1 to HL7 2.5.1, please note this on the ELR Registration form. It is the laboratory's responsibility to develop compliant HL7 messages that contain the required standardized vocabulary.
Step 5. Perform Internal Message Validation
Laboratories should upload a de-identified (i.e., no personal health information such as name, address, phone number, date of birth, medical record number, and the like) ELR HL7 2.5.1 message to the CT-specific NIST ELR validation tool. The validation tool will produce a report that notes any errors within the tested message (as well as other results). Errors will need to be corrected. The CT ELR team will review test reports with the laboratory. Persistent errors may impact the ability of a laboratory to continue the on-boarding process. Approval of the CT ELR team is needed to proceed with Step 7.
Step 6. Set up Secure Message Transport
Currently, the only allowed secure message transport is the CDC-developed Public Health Information Network Messaging System or PHINMS. The CT ELR team will send information to laboratories engaging in ELR on how to contact the CDC to set up PHINMS using the CDC Route not Read (RnR) hub. The CT ELR Local Guide has information to be included in message headers for successful message receipt by CTDPH. Both testing and production PHINMS routes will be set up with the laboratory for CTDPH messaging. Additional information about PHINMS and its use in Connecticut can be found on the DPH website.
NOTE: PHINMS is an approved secure message transport system that meets Protected Health Information (PHI) security standards.
Step 7. Send a Production Message to CTDPH for Initial Validation
CTDPH requires that after a laboratory has successfully tested a de-identified ELR message against the CT-specific NIST tool, they send a production level (i.e., containing complete patient and real result information) ELR message to the CT ELR team for initial message validation (Step 8).
Step 8. Structure and Content Validation.
During the "testing phase" of the laboratory's ELR implementation, CTDPH will perform additional ELR message structure and content validation to ensure conformance to the CTDPH ELR Local Guide. The CT ELR team will continue to work with the laboratory until the ELR message passes all validation requirements.
NOTE: if your laboratory is non-responsive during this review, the ELR process will cease.
Both Steps 7 and 8 must be completed and approved by personnel from both the CT ELR team and CTDPH disease surveillance program before pre-production data validation can begin.
Step 9. Pre-production Data Validation.
During this step, the CT ELR team will compare existing laboratory reports sent by non-ELR methods (e.g., fax, mailed reports, other electronic files) in parallel with reports sent by ELR. It may be necessary for the laboratory to submit non-ELR reports more frequently during the pre-production validation period. This pre-production period will be determined with each laboratory and may vary depending on several factors, such as volume of reports.
NOTE: On-boarding may take place over several iterations given resource limitations at CTDPH to fully test and validate all reportable disease results sent by a laboratory. Disease reports to be validated will be assessed during the on-boarding process. This will be discussed and determined during initial meetings with the laboratory engaging in ELR.
Step 10. Post-production ELR
Full, on-going message submission is expected once approval for production reporting has been granted. Once production ELR is achieved, the CT ELR team will discuss with the laboratory about ongoing, periodic quality control checks to ensure data quality assurance.
Meaningful Use for ELR
Please read the information on the CTDPH website about the status of Meaningful Use (MU) for ELR in Connecticut. We recommend that laboratories check this page frequently for updates.
CT ELR Team