Towards Unified Data Exchange Formats for Reporting Molecular Drug Susceptibility Testing

Background: With the rapid development of new advanced molecular detection methods, identification of new genetic mutations conferring pathogen resistance to an ever-growing variety of antimicrobial substances will generate massive genomic datasets for public health and clinical laboratories. Keeping up with specialized standard coding for these immense datasets will be extremely challenging. This challenge prompted our effort to create a common molecular resistance Logical Observation Identifiers Names and Codes (LOINC) panel that can be used to report any identified antimicrobial resistance pattern. Objective: To develop and utilize a common molecular resistance LOINC panel for molecular drug susceptibility testing (DST) data exchange in the U.S. National Tuberculosis Surveillance System using California Department of Public Health (CDPH) and New York State Department of Health as pilot sites. Methods: We developed an interface and mapped incoming molecular DST data to the common molecular resistance LOINC panel using Health Level Seven (HL7) v2.5.1 Electronic Laboratory Reporting (ELR) message specifications through the Orion Health™ Rhapsody Integration Engine v6.3.1. Results: Both pilot sites were able to process and upload/import the standardized HL7 v2.5.1 ELR messages into their respective systems; albeit CDPH identified areas for system improvements and has focused efforts to streamline the message importation process. Discussion: The common molecular resistance LOINC panel is designed to be generalizable across other resistance genes and ideally also applicable to other disease domains. Conclusion: The study demonstrates that it is possible to exchange molecular DST data across the continuum of disparate healthcare information systems in integrated public health environments using the common molecular resistance LOINC panel. Keywords: Data Exchange Formats, Electronic Laboratory Reporting, Health Information Exchange, LOINC, Health Level Seven, Public Health Surveillance.

Digital Data Exchange Between Health Care and Public Health: Lessening the Burden

This chapter seeks to provide an overview of automated data exchange between public health and health care, highlighting cases which use electronic laboratory reporting (ELR) and electronic case reporting (ECR) and how health data is standardized and messaged. It also provides the example of the West Nile Virus (WNV). This example demonstrates how health data can be used to lessen the burden of mandated disease reporting for health care and improve timeliness, completeness, and accuracy of surveillance for public health. The Digital Bridge project is also introduced, as a national single and scalable solution emphasizing the importance of the public-private partnership. Challenges facing the Digital Bridge approach include ensuring ongoing investments in all sectors for automation and data exchange, especially information technology infrastructure maintenance and a prepared workforce of engineers, epidemiologists, and data scientists.

Evaluation of Data Exchange Process for Interoperability and Impact on Electronic Laboratory Reporting Quality to a State Public Health Agency

Background: Past and present national initiatives advocate for electronic exchange of health data and emphasize interoperability. The critical role of public health in the context of disease surveillance was recognized with recommendations for electronic laboratory reporting (ELR). Many public health agencies have seen a trend towards centralization of information technology services which adds another layer of complexity to interoperability efforts.Objectives: To understand the process of data exchange and its impact on the quality of data being transmitted in the context of electronic laboratory reporting to public health. The study was conducted in context of Minnesota Electronic Disease Surveillance System (MEDSS), the public health information system for supporting infectious disease surveillance in Minnesota. Data Quality (DQ) dimensions by Strong et al., was chosen as the guiding framework for evaluation.Methods: The process of assessing data exchange for electronic lab reporting and its impact was a mixed methods approach with qualitative data obtained through expert discussions and quantitative data obtained from queries of the MEDSS system. Interviews were conducted in an open-ended format from November 2017 through February 2018. Based on these discussions, two high level categories of data exchange process which could impact data quality were identified: onboarding for electronic lab reporting and internal data exchange routing. This in turn comprised of eight critical steps and its impact on quality of data was identified through expert input. This was followed by analysis of data in MEDSS by various criteria identified by the informatics team.Results: All DQ metrics (Intrinsic DQ, Contextual DQ, Representational DQ, and Accessibility DQ) were impacted in the data exchange process with varying influence on DQ dimensions. Some errors such as improper mapping in electronic health records (EHRs) and laboratory information systems had a cascading effect and can pass through technical filters and go undetected till use of data by epidemiologists. Some DQ dimensions such as accuracy, relevancy, value-added data and interpretability are more dependent on users at either end of the data exchange spectrum, the relevant clinical groups and the public health program professionals. The study revealed that data quality is dynamic and on-going oversight is a combined effort by MEDSS Operations Team and Review by Technical and Public Health Program Professionals.Conclusion: With increasing electronic reporting to public health, there is a need to understand the current processes for electronic exchange and their impact on quality of data. This study focused on electronic laboratory reporting to public health and analyzed both on-boarding and internal data exchange processes. Insights gathered from this research can be applied to other public health reporting currently (e.g. immunizations) and will be valuable in planning for electronic case reporting in near future.

CREATING AN INFORMATIONAL WEBSITE FOR PHYSICS ACADEMIC COURSE: WEB DESIGN SPECIFICS

The article is devoted to the analysis of means and methods of creating an educational informational website for the Physics academic course. The stages of technical task creation, design of the main and typical pages of the website, layout, programming, content filling and publication are considered. The analysis of libraries, frameworks and popular WordPress and Joomla CMSes has been carried out as well as usability testing. Features of ready-made tools suitable for efficient creation of such web applications are considered. The contents of the front end and back end components of the given specification, as well as their connection with AJAX, are determined. The features of the WordPress architecture and the location of JSON files for the transmission of structured information are revealed. An original Student Score plugin for WordPress, that allows managing the contents of the e-register and displaying them for a teacher and students, as well as plugins for managing electronic laboratory reporting and user administration have been created.

Meaningful Use and Electronic Laboratory Reporting: Challenges Health Information Technology Vendors Face in Kentucky

Objectives: To explore the challenges Health Information Technology (HIT) vendors face to satisfy the requirements for Meaningful Use (MU) and Electronic Laboratory Reporting (ELR) of reportable diseases to the public health departments in Kentucky.Methodology: A survey was conducted of Health Information Exchange (HIE) vendors in Kentucky through the Kentucky Health Information Exchange (KHIE). The survey was cross-sectional. Data were collected between February and March 2014. Participants were recruited from KHIE vendors. Participants received online survey link and by email and asked to submit their responses. Vendors’ feedback were summarized and analyzed to identify their challenges. Out of the 55 vendors who received the survey, 35(63.64%) responded.Results: Of the seven transport protocol options for ELR, vendors selected virtual private network (VPN) as the most difficult to implement (31.7%). Secure File Transfer Protocol (SFTP) was selected as preferred ELR transport protocol (31.4%). Most of the respondents, 80% responded that they do not have any challenge with the Health Level 7 (HL7) standard implementation guide required by MU for 2014 ELR certification.Conclusion: The study found that the most difficult transport protocol to implement for ELR is VPN and if vendors have preference, they would use SFTP for ELR over KHIE choice of VPN and Simple Object Access Protocol (SOAP). KHIE vendors do not see any variability in what is reportable by different jurisdiction and also it is not difficult for them to detect what is reportable from one jurisdiction verse the other

Mapping Laboratory Reports to Illinois’ Extensively Drug-Resistant Organism Registry

ObjectiveTo streamline carbapenem-resistant enterobacteriaceae (CRE)surveillance by integrating electronic laboratory reporting (ELR)data and electronic case reports (eCR) automatically into Illinois’extensively drug-resistant organism (XDRO) registry.IntroductionCRE are drug-resistant bacteria that have a mortality rate of up to50% in those infected1. Several clusters of CRE have been detected inIllinois, often in long-term acute care hospitals2. In response Illinoiscreated the XDRO registry, a mandatory reporting system designedto aid inter-facility communication concerning CRE.Despite being a high priority for control in the US, the casedefinition for CRE has been the subject of debate3. There are over70 Enterobacteriaceae which can have different mechanisms ofcarbapenem resistance3. Criteria for carbapenem resistance includesusceptibility results, and phenotypic or genotypic detection. Thecase definition for the XDRO registry is intentionally more exclusive(specific) than that used by CSTE (Table 1). CSTE utilizes adefinition designed to maximize sensitivity. Illinois’ XDRO registry’sdefinition is more specific, meant to reduce unnecessary adoption ofcontact precautions and the negative consequences some patients mayexperience.Currently, case reporting to the XDRO registry is a manual dataentry process, which has important advantages. However, transitioningto automatic ELR integration will streamline the reporting processand minimize data entry effort. Unfortunately, the clinical informationneeded to investigate XDROs is often not captured by ELR. The eCRis a new message type being piloted in Illinois that contains manyclinical data elements. We examined the feasibility of combining ELRand eCR into reports for the XDRO registry. In the construction ofthese reports we examined the impact of using CRE definitions fromCSTE and the XDRO registry.MethodsWe obtained sample HL7 CRE messages from Illinois’ ELRdatabase. Using these messages and the HL7 Implementation Guidefor Electronic Laboratory Reporting, we mapped ELR fields to thosein the XDRO registry. Specific codes corresponding to the registryfields were found though a systematic keyword search of LOINC,SNOMED, and sample messages. When there was no match for anXDRO field in ELR, we referred to the HL7 CDA ImplementationGuide for the Electronic Initial Case Report and sample eCRmessages. A collection of fields and codes was created to correspondto both the CSTE and Illinois CRE case definition.ResultsThe XDRO registry has 37 unique fields. Twenty-six can bepopulated from ELR, four can be found in the eCR, and seven aregenerated within the system. In sample ELR and eCR messages all ofthe necessary fields were populated with appropriate text and codes.The mapping process was straightforward for demographic andfacility information, but more complicated for culture and organisminformation. Some XDRO tests do not have corresponding LOINCor SNOMED codes, so we will develop a logic statement to fill thesebased on free-text. Addition of the eCR adds important informationto the registry report, notably encounter type and encounter/admissiondate. We were able to create separate mapping schemas for theCSTE and XDRO registry definitions for CRE. Using each of thesedefinitions, we will quantify how many ELR messages would becommitted to the XDRO registry.ConclusionsBy combining the data captured in ELR and eCR, it is possible topopulate the fields of the Illinois XDRO registry. When this merge iscompleted it should result in more complete and better quality dataon CRE in Illinois. As intended, the definition of CRE used by theregistry is less inclusive than that used by CSTE. Future work willshow the number of CRE lab results captured by each definition.Table 1: CRE Definition

Australia's National Notifiable Diseases Surveillance System 1991–2011: expanding, adapting and improving

SUMMARYWe reviewed key attributes (flexibility, data quality and timeliness) of Australia's National Notifiable Diseases Surveillance System (NNDSS) over its first 21 years. Cases notified to NNDSS from 1991 to 2011 were examined by jurisdiction (six states and two territories) and sub-period to describe changes in the number of notifiable diseases, proportion of cases diagnosed using PCR tests, data quality (focusing on data completeness), and notification delays. The number of notifiable diseases increased from 37 to 65. The proportion of cases diagnosed by PCR increased from 1% (1991–1997) to 49% (2005–2011). Indigenous status was complete for only 44% notifications (jurisdictional range 19–87%). Vaccination status was complete for 62% (jurisdictional range 32–100%) and country of acquisition for 24% of relevant cases. Data completeness improved over the study period with the exception of onset date. Median time to notification was 8 days (interquartile range 4–17 days, jurisdictional range 5–15 days); this decreased from 11 days (1991–1997) to 5 days (2005–2011). NNDSS expanded during the study period. Data completeness and timeliness improved, likely related to mandatory laboratory reporting and electronic data transfer. A nationally integrated electronic surveillance system, including electronic laboratory reporting, would further improve infectious disease surveillance in Australia.

A Statewide Evaluation of the California Medical Supervision Program Using Cholinesterase Electronic Laboratory Reporting Data

The California Medical Supervision program is designed to protect workers who regularly mix, load, or apply the highly toxic Category I and II organophosphates and carbamates from overexposure by monitoring cholinesterase (ChE) inhibition in plasma and red blood cells. Since January 2011, testing laboratories are required to report test results electronically to the California Department of Pesticide Regulation who shares it with the Office of Environmental Health Hazard Assessment for evaluation. The purpose of this study is to assess the utility of this reporting in evaluating the effectiveness of the Program for illness surveillance and prevention. From 2011 to 2013, we received more than 90 000 test results. Despite data gaps and data quality issues, we were able to perform spatial and temporal analyses and developed a screening tool to identify individuals potentially at risk of overexposure. The data analysis provided some evidence that the Program is effective in protecting agricultural workers handling the most toxic ChE-inhibiting pesticides even though it also identified some areas of potential concerns with individuals that appeared lacking corrective actions in the workplace in response to excessive ChE depressions and parts of the state with disproportionately at-risk individuals. However, changes to the electronic reporting are needed to more accurately identify tests related to the Program and therefore improve the utility of the data received. Moreover, data analysis also revealed that electronic reporting has its limitation in evaluating the Program.