Laboratory Interoperability Technical Assistance

Association of Public Health Laboratories (APHL)

Project Overview
The Public Health Laboratory Interoperability Project (PHLIP) involves the development of an interoperable electronic data exchange architecture using federal standards and regulations. This includes data standards development, Health IT, public health informatics, health information exchanges, privacy assessment and monitoring. The data exchange extends across the Centers for Disease Control and Prevention (CDC) to the State public health laboratories.

The Challenge
Many State public health laboratories are providing influenza laboratory results to CDC through hand-written faxes or by double-entry of data into systems outside of their Laboratory Information Management Systems (LIMS). These processes are labor-intensive, time-consuming, and subject to quality issues and concerns. There are some state laboratories that are unable to provide influenza laboratory data to CDC due to limited resources or inadequate systems. The PHLIP data-exchange electronic message definitions and related transport architecture were created as a solution to these problems. These messages allow State PHLs to send laboratory results directly to CDC in an electronic format from their LIMS.

While the States can visualize the benefit of PHLIP messaging, many State laboratories lack the technical resources to implement the PHLIP data-exchange architecture components. They are forced to utilize expensive vendor support or delay implementation until resources become available. Many must also contend with shrinking budgets and resource constraints.

The Solution
The St. John Group was contracted by the Association of Public Health Laboratories (APHL) to support the PHLIP initiative at the State level. We created an organization to provide both onsite and remote support to the State public health laboratories. This organization consists of a leadership/support team and two Technical Assistance Teams (TAT). Each TAT consists of a project manager, a terminologist, and a technical architect. These team members are experts in HL7 messaging, vocabulary and integration engines, and transport utilities. This expertise augments local knowledge that the State has of its own systems.

To facilitate this work, TSJG created a PHLIP implementation process that is reused across all State laboratories. This process improves the efficiency of the work with the limited resources of a public health laboratory. TATs provide a conduit of cooperation between States. Best practices and reusable components for implementation and testing are shared between States through the TATs. TSJG supports the PHLIP community by maintenance of a site for the distribution of key information. We also distribute a monthly newsletter and host monthly informational conferences.

The Results
The St. John Group’s TAT Teams have assisted 22 labs in the project’s first eight months, with 10 more visits scheduled over the next four months. We have seen a decrease in the time required for state public health laboratories to develop the PHLIP HL7 message from months to weeks. Furthermore, several state laboratories have successfully implemented the majority of the PHLIP solution during a single 4-day site visit. An unexpected benefit is how the TATs have improved the process at CDC. This has been done by working with the States on structural and content validation. As a result, epidemiologists at CDC save valuable time and effort - especially in the peak of the influenza season.

The Technical Assistance Team model, developed by TSJG, has been so successful that APHL returned to us to deploy it on another project that deals with State health agencies. APHL continues to evaluate how TATs can be used on other public-health informatics initiatives.

This project is on time and on budget.

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