Practical Informatics Lessons Using the Language of Laboratorians

Learning Objectives• Define ‘Informatics’ and explain its relevance to Public

Health and describe the function and importance of public health laboratory informatics programs

• Understand the importance of communication between laboratory and informatics staff

• Explain technical assistance (TA) and how labs may be able to utilize it

• Describe the AIMS platform and its utility to meet laboratory or agency needs

How are different states working with lessons learned and implementing them for more success in the future?

Keith HigginbothamAL Department of Public Health

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Keith Higginbotham, IT ManagerAlabama Dept of Public Health

Practical Informatics Lessons Using the Language of Laboratorians – A State’s Perspective

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Alabama’s State PHL• Clinical and Environmental testing

– Serology, Clinical Chemistries, Mycology, Micro, Virology, NBS– Milk/Water, Beach Waters , Shellfish, Environmental Lead and

Rabies• 2 Geographically separated labs

– Montgomery/Mobile• ~1.9 million tests per year• Customers

– 90 County Health Depts in 67 Counties– Hospitals– National labs (Labcorp and Quest)– Private providers– Law enforcement

• 2 LIMS– Horizon (Chemware) – Clinical and Environmental– Neometrics (Natus) – Newborn Screening

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Definition of Laboratory InformaticsThe specialized application of information through a platform of instruments, software, and data management tools that allow scientific data to be captured, migrated, processed, and interpreted for immediate use, as well as stored, managed, and shared to support future research, development, and lab testing efforts while maximizing the efficiency of laboratory operations.

- The Complete Guide to LIMS & Laboratory Informatics, 2015 Edition

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Informatics at work in Alabama• 1st Qtr 2009 Implementation of Horizon LIMS• 1st Qtr 2009 Integration of LIMS and Billing System

–CPT, ICD9/ICD10, NPI (Oct 2014), Insurance details

• 2nd Qtr 2009 Web Portal for Test Ordering/Reporting

–Decrease in paper result reporting–More accurate, complete order info–Distributed data entry to ordering facility–Integration with CHD Encounter system (70% Orders)

• 3rd Qtr 2009 HL7 2.3.1 ELR to NEDSS–LOINC/SNOMED encoding–Orion Rhapsody Integration Engine

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Informatics at work in Alabama• 2010 PHLIP ELSM (HL7 2.3.1)

–APHL PHLIP TA–Leverage NEDSS ELR work–Orion Rhapsody Integration Engine–PHINMS/AIMS (FL RNR Hub)

• 2011 ETOR (HL7 2.6)–Bi-directional Interface–SuccessEHS – 2 counties, 20 clinics–Maintenance / Vendor Customizations–TCP/IP Message Transport –Orion Rhapsody Integration Engine

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Informatics at work in Alabama• 2012 LRN-B (HL7 2.5.1)

– CDC LRNB TA– PHINMS/AIMS Hub– Orion Rhapsody Integration Engine

• 2013 SDWIS to ADEM– XML– Manually uploaded to EPA web site

• 2013 Laboratory-base Enteric Disease Surveillance (LEDS) – CSV file– CDC LRNB TA– PHINMS/AIMS Hub– Orion Rhapsody Integration Engine

• 2015 PHLIP ELSM upgrade to HL7 2.5.1– APHL TA– Orion Rhapsody Integration Engine

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HOWEVER, IN THE BEGINNING…A conversation between a laboratorian and IT

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Learning each others lingo

• LOINC codes• SNOMED CT codes• Interface Engine• Messaging• HL7 implementation guides• Interoperability• Server Virtualization• Bandwidth• SDLC• Cloud

• Accessioning• Aliquots• CLIA• CPT codes• ICD9/ICD10 Codes• WGS• PFGE, PCR, ELISA• Reference Ranges

Information Technologist + Laboratorian = “Informatician”

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Genesis of Informatics in AL• No classification within state personnel for Informatics/Informatician

• Blend existing resources into a laboratory informatics team

–IT Manager (BCD, BCL, CEP)–1 FTE Programmer Analyst–1 FTE Senior Microbiologist –1 FTE Microbiologist

• Dedicated IT staff (Embedded Reporters)• Teach/learn each other’s business processes• Utilize TA assistance from APHL and CDC• Leverage previous informatics solutions

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WITHOUT AN INFORMATICS TEAM…The danger of not understanding the problem before developing a solution

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Develop an Informatics Roadmap• Where are you now?

–APHL Informatics SA Tool–Assess your current informatics capabilities

• Where do you want to go?–Determine where you have informatics gaps–Focus on areas to improve over the next year

• How do you get there?–Informatician or Informatics Team–Acquire new resources or redistribute existing resources–Assess funding (personnel, hardware, software, etc.)–Follow Best Practices–Leverage work performed by others–Workforce development–APHL TA–Consider participating in the APHL Informatics

Committee

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A GOOD INFORMATICIAN IS KIND OF LIKE…

As it is impossible to have all of the resources or people needed in one lab, you need to be able to pull from larger TA resources.

Jason HallCDC, Division of Preparedness and Emerging Infections

National Center for Emerging and Zoonotic Infectious Diseases

Building Public Health Laboratory Informatics Capacity

Jason HallDivision of Preparedness and Emerging Infections

2016 APHL Annual Meeting

June 7, 2016

Self Assessment Tool Document existing capacities Understand current needs Identify gaps

http://www.aphl.org/programs/informatics/Pages/Informatics-Self-Assessment-Tool.aspx

Funding

Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)

Health Information Systems program (project C)– Flexible IT/Informatics personnel– Electronic data exchange

• Electronic Laboratory Reporting (ELR)• Case Notifications (NMI)• Electronic Case Reporting (eCR) - prepare

– Integrated surveillance information systems• Sustain/maintain• Enhance• Acquire/rebuild• Hosting

Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)

Health Information Systems program (project C)– Activities for 2D: For Public Health Labs: Implement ELR with or

within the public health department• Create and send standards-based ELR for all reportable conditions

to or within health department by upgrading or enhancing LIMS system

• Map local test, results, and specimen source codes to LOINC and SNOMED

• Add capacity at PHL to fully implement ELR with/within health department

• Build upon current ELR infrastructure to explore ETOR with another public health lab or hospital

Public Health Emergency Preparedness (PHEP)

Capability Area 6– Updated to complement ELC HIS guidance– Explicit support for public health labs

• Staff/contracts/training• Electronic test ordering• ELR• LIMS

Funding Opportunity Announcement (FOA) Workgroup of the CDC Surveillance Leadership Board Evaluate language related to health IT of CDC cooperative agreement FOAs

and generate guidance to make the language more comparable across the FOAs

Identify ways in which CDC cooperative agreement programs can coordinate before, during and after awards

Identify ways to connect technical assistance (TA) resources across CDC to support grantees funded under CDC cooperative agreements

Deliverable Make recommendations to SLB on possible strategies to enhance

efficiencies in IT investments funded under CDC FOAs

Technical Assistance

APHL Technical Assistance Services Reusable/adaptable solutions Technical consultations Development and implementation assistance

An example – ELR Technical Assistance

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ELR with HIE

ELR with Regional Labs

Validating or Cleaning Data in ELR

Creating Protocol policy or process docs

ELR from Hospital/Health System

ELR with Large Labs

Evaluation of ELR Infrastructure

ELR with PHL

Transforming/filtering/routing ELR

Complete (63)Active (17)

APHL Informatics Messaging Services (AIMS) A secure, cloud-based environment that accelerates the implementation

of health messaging by providing shared services to aid in the transport, validation, translation, routing, parsing, storage, and use of electronic data.

A National Resource for Interoperability

Activities Supported by AIMS

For Public Health Agencies (epi)

Electronic Laboratory Reporting (ELR)• Quest Diagnostics• PAML• Cerner• Hospitals and other

labs

State to State Data Exchange• ELR transferring• Immunization

messaging• Syndromic

messaging

Electronic Case Reporting• Host RCKMS• Routing and

transport (planned)

Activities Supported by AIMS

For Public Health Labs

Electronic Test Ordering and Reporting (ETOR)•Standards-based messaging

(planned)

Surge capacity for pandemic flu

Web Portal for test ordering and results reporting (planned)

Activities Supported by AIMS

For CDC

Influenza ELR (PHLIP)• Message Transport

Vaccine Preventable Diseases ELR (VPD)• Message transport

NNDSS Modernization Initiative (NMI)• Message transport

for some jurisdictions

Laboratory Response Network• Message transport

for bioterrorism threats

Animal Rabies ELR• Transport, parsing

and storage• Remote access to

data using virtual desktop

Influenza Sequence First Initiative

APHL AMD Bioinformatics Hub

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Category 1 Category 2 Category 3 Category 4

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Series 1 Series 2 Series 3

For more information, contact CDC1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.