Mandating hospital and commercial laboratories to report notifiable

Mandating hospital and commercial laboratories to report notifiable conditions electronically in Massachusetts Scott Troppy, MPH 1 , Gillian Haney, MPH 1, James Daniel 2, Alfred De. Maria, MD 1 1 Bureau of Communicable Disease Control, Massachusetts Department of Public Health, Jamaica Plain, MA , 2 Chief Information Office, Massachusetts Department of Public Health, Boston, MA

Objectives § MDPH ELR Goals and Overview § Current Status § Benefits/ROI § Challenges § ELR Regulations 2

ELR - Goals § Collect laboratory reports of notifiable conditions electronically and automatically § Present a single point of contact for all communicable disease reporting § Automate disease reporting process - improve timeliness of reporting of notifiable conditions - improve data quality § Provide hospitals with tools to transmit reports to MDPH § Support messaging using PHIN standards § Provide a system with the flexibility to meet future needs 3

Legacy Data Flow MDPH BCDC SLI EPI STD Immunization TB ISIS Immigrant Health Fax CDC Local Board of Health Reference Laboratory Hospital 4

Desired Data Flow MDPH BCDC STD TB EPI Immunization Immigrant Health SLI ISIS Unified Messaging Interface CDC Local Board of Health Reference Laboratory Hospital 5

ELR Operational Flow 6

Translate local codes Hepatitis A Ig. M+ § ELR Message Gateway translates the reported information from local coding systems into standardized LOINC, SNOMED, and HL 7 equivalents - Local codes: HAVIGM, POS - LOINC code: 22314 -9 - SNOMED code: 10828004 7

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Hepatitis Results in MAVEN 10

ELR – current status § Approximately 80 clinical laboratories (local and national) reporting notifiable conditions to MDPH § Message formats - HL 7 2. 3. 1 - SMF § Certified and in production: - 24 hospital laboratories - 1 commercial laboratory § Active implementation: - 20 in process 11

ELR - Timeliness and Completeness Hospital System X 2006 (paper) 2007 (ELR) Number of Median # of days reports process reports (Nov and Dec) 108 14 240 2 § 122% increase in the number of reports received § 12 day decrease in the time to process reports 12

Return on Investment § Create Extract from Hospital Information System - Approximately 30 -40 hours of IT resource § Map Local Codes to Standard HL 7 Naming Conventions - Approximately 30 -40 hours of Infection Control Practioner's or Micro Supervisor § Time saved for ICP and Micro Supervisor - No more morbidity cards - Reduced follow up for missing information - Savings of 80+ hours a month 13

Implementation Support § Contracted and MDPH IT and epidemiology staff - Training - Technical assistance with message extract - Technical assistance with web services to send messages - Technical assistance with mapping 14

Challenges § Hospital IT Resources Limited § CEO/CIO not willing to allocate resources for system that is not required by MDPH 15

Challenges § Infection Control/Microbiology Labs understand ROI and more than willing to spend time mapping § ICPs Request that MDPH makes electronic reporting a requirement 16

ELR Regulations § 300. 170: Laboratory Findings Indicative of Infectious Disease Reportable Directly to the Department by Laboratories In addition to the requirements of 105 CMR 300. 100, 300. 171, 300. 180(A) and 300. 180(C) all laboratories, including those outside of Massachusetts, performing examinations on any specimens derived from Massachusetts residents that yield evidence of infection due to the organisms listed below shall report such evidence of infection directly to the Department through secure electronic laboratory reporting mechanisms, or other method, as defined by the Department, within 24 hours. §No punitive measures §Promulgated July, 2008 17

Next Steps § Targeted educational efforts § Phased implementation plan with continued technical assistance § 2 -3 year effort 18

T. Scott Troppy Surveillance Epidemiologist & MAVEN Project Manager Massachusetts Department of Public Health Office of Integrated Surveillance & Informatics Services Bureau of Communicable Disease Control 305 South Street , 5 th Floor Jamaica Plain, MA 02130 617 -983 -6819 scott. troppy@state. ma. us “Anyone who thinks that they are too small to make a difference has never been bit by a mosquito. " 19