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NC Center for Public Health Preparedness/UNC-CH/May 2009
Improving Your Understanding of Electronic Lab Reporting (ELR)
Lauren DiBiase, MSNorth Carolina Center for Public Health Preparedness
NC Center for Public Health Preparedness/UNC-CH/May 2009
Agenda
How ELR determines NC County of Residence for an Event
Timeframes and how they impact the way ELR works
ELR and Workflows
State Lab vs. LabCorp
Your Questions
NC Center for Public Health Preparedness/UNC-CH/May 2009
Geocoding
Process of finding latitude & longitude from other geographic data, such as street address, or zip codes
With geographic coordinates, features can be mapped & entered into Geographic Information Systems (GIS)
Geocoding is never correct 100% of the time
NC Center for Public Health Preparedness/UNC-CH/May 2009
How ELR determines NC County of Residence for the Event
County listed becomes NC County of Residence for the Event
The county in the person’s existing record becomes NC County of Residence for the Event
1. The ELR has a county listed as part of patient’s address
IF THEN
2. The ELR does not have a county listed, but the person was already in NC EDSS with the county field filled out in the Persons tab
IF THEN
NC Center for Public Health Preparedness/UNC-CH/May 2009
Attempt to geocode is made
3. No county, but patient street address is filled in and looks valid
IF THEN
THENNo geocoding attempt is made and best county determined by patient city and/or zip
Best county is determined by the ordering facility city and/or zip
4. The patient street address is missing or otherwise does not look valid
IF
THEN5. There is no patient city and/or zip
IF
Events will appear in the Verification of Reporting County is Needed WF
How ELR determines NC County of Residence for the Event
NC Center for Public Health Preparedness/UNC-CH/May 2009
ELR may route to your county if facility in your county ordered the lab
If there are no previous events in NC EDSS with an address for this patient & lab doesn’t enter address, ELR may route to your county if a facility in your county ordered the lab
1. Correct NC County of Residence
2. Assign to your group in Investigation Trail
3. Enter any info (clinical/treatment) you have
4. Update patient address if have it
5. Reassign to correct county in Investigation Trail
NC Center for Public Health Preparedness/UNC-CH/May 2009
What you need to do when your LHD provided services but ELR not in your workflows
Once there is a value in NC county of residence for the event (no matter how it was entered – via ELR, manually entered), ELR routes to that county
Subsequent ELRs can’t override this value
You provided services, but ELR does not appear in your LHD’s workflows…
If attempted to enter event, would see Potential Match screen with existing event, but would not be able to access the event
If your LHD needed to enter treatment info,
would need to request a share
NC Center for Public Health Preparedness/UNC-CH/May 2009
Timeframes
Used to determine whether an event is a new event or a duplicate of an existing event
Devised by DPH
No hard & fast or perfect way to devise the rules
Apply to any 2 events in system
Calculated by:
Difference between create date for two events or for ELR imports difference between specimen collection date and create date.
NC Center for Public Health Preparedness/UNC-CH/May 2009
NC Center for Public Health Preparedness/UNC-CH/May 2009
ELR could fold into an existing event when really a new event
What do you need to do?
1. Print out lab from Event ‘x’ (the existing event)
2. Create new event ,Event ‘y’
3. Manually enter Lab Result into Event ‘y’
4. Update Admin QP Disease Report Info section
5. Add event note in both events that ELR attached to Event ID ‘x’, but it signifies a new event, Event ID ‘y’
NC Center for Public Health Preparedness/UNC-CH/May 2009
Timeframes make searching for an event critical
Example: you manually create an STD event (from back logged lab or card) today & ELR already created the event ≥ 30 days ago
If you search before creating the event Existing event shows up in your search results, so able to review the event
If you do NOT search before creating the event When you click Add on the Create Event screen, the system will not flag this
event as a potential duplicate (because it is outside the timeframe) No one can merge the events later
NC Center for Public Health Preparedness/UNC-CH/May 2009
What do you need to do when you create a 2nd event instead of using the existing event
1. Need to check that info in the 2nd Event agrees with the info in the 1st Event
Reconcile any differences
Add any additional data from 2nd event into 1st event
2. Add event note in each event cross-referencing the other
3. In Admin Question Package, mark ‘Classification Status’ of 2nd Event as ‘unspecified’
• Do not select ‘Does not meet case criteria’
4. Call Help Desk and ask them to mark the 2nd event as ‘invalid’
5. Resubmit the 1st event to DPH
NC Center for Public Health Preparedness/UNC-CH/May 2009
ELR could create the 2nd event instead of folding into existing event
E.g. Person has an existing Chlamydia event in the system, but was never treated. The person continues to test positive and a lab creates a new event because outside 30 day timeframe instead of merging to existing event
What do you need to do?
1. Print out lab from 2nd Event
2. Open 1st Event & manually enter lab result from 2nd Event
3. Add note in the Lab Results Screen of 1st Event
4. In Admin Question Package of 2nd Event, mark “Classification Status” as Unspecified
Do no select ‘Does not meet criteria’
5. Add an event note in both Events cross-referencing the other Event
6. Call Help Desk ask them to mark 2nd event as ‘Invalid’
7. Resubmit 1st Event to DPH
NC Center for Public Health Preparedness/UNC-CH/May 2009
How ELR Impacts Your Workflows
Lab Result Review Required (local)
Verification of County Residence Needed
Person/Event Deduplication
NC Center for Public Health Preparedness/UNC-CH/May 2009
Lab Result Review Required (local)
Electronic Lab Report for any disease that is fed into system
Manually entered CD & VPD labs
Manually entered STD & TB labs do not appear in this WF
When reviewing a manually entered lab click on Cancel if you didn’t make any edits (if you click Save, event gets put back in this WF)
NC Center for Public Health Preparedness/UNC-CH/May 2009
How do I find the newest lab that got added to the event?
Event History Tab
All users will now have access (LDE role previously did not)
Specimen # for a manually entered lab will display
Specimen # for ELR may display in future
NC Center for Public Health Preparedness/UNC-CH/May 2009
Verification of Reporting County Needed
NC EDSS sets the field ‘verification of reporting county is needed’ (in Demographic QP) to ‘yes’ when county determined by system without full patient address
If do not have full patient street address, system will try to use the city and/or zip of patient to determine county
Field added let LHD know reporting county may be wrong & verification is needed
When county is verified and/or corrected, change answer in this field to ‘no’
NC Center for Public Health Preparedness/UNC-CH/May 2009
Person/Event Deduplication
If ELR does not have enough matching information to find an existing person in NC EDSS, will create a duplicate person
A state-level user will need to resolve duplicate people
All users will see notification on Dashboard that person is pending deduplication (don’t click on the link!)
After persons are merged, the events will now appear in the Event Deduplication Workflow
All users will see notification on Dashboard that event is pending deduplication
LHC II will resolve event duplicates
NC Center for Public Health Preparedness/UNC-CH/May 2009
State Lab vs. LabCorp
State Laboratory LabCorpTime Lag No lag
Example = report finalized on Monday is available in NC EDSS on Tuesday morning
1 day lagExample = report finalized on Monday is not available in NC EDSS until Wednesday morning
Report Status
May send preliminary results No preliminary results sent May send ≥ 1 ELR report per specimen
Sends only 1 ELR report ever per specimen, only when final
Non-positive results may be updated to existing events depending on disease
Only sends if report contains a reportable positive, other non-reportable results on same report not sent
May send corrections via ELR Subsequent corrections are sent only as retraction letter on paper, not via ELR
Specimen Source
Entered in specimen source field on Lab Results Screen
Displayed only as free text in the notes at the bottom of the lab results screen
NC Center for Public Health Preparedness/UNC-CH/May 2009
Wrap - Up
No Hepatitis coming from State LabHepatitis B webinars offered this
summerBrief evaluation survey & slides will be
emailed to youHelp Desk
919-715-5548 or (877)-625-9259 ncedsshelpdesk@ncmail.net
Use Event ID only – no names or SS #s Available 8 am – 5 pm, M-F
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