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CSTE National ELR Workgroup

Welcome to the CSTE National ELR Workgroup Basecamp! We hope you will utilize the space to share resources with colleagues, start discussion threads, and identify topics for the workgroup to tackle on future calls. All workgroup members will have the opportunity to join. Please note that you may edit your notification preferences to suit your needs (and your email inbox). If you are not already on the ELR distribution list and would like to receive call communications, please enroll using this subscription form (copy and paste in browser): https://app.smartsheet.com/b/form/5a91a4579952496682084796b82112e6
Becky Lampkins, Manager, Surveillance/Informatics Program at CSTEMegan Toe, CSTEScott Troppy, Surveillance Epidemiologist at MA DPHMeredith Lichtenstein, CSTEAmy Drake, NMJohn RobertsNancy Barrett, Epi 4/PH Informatics SpecialistErin Holt, TDHRita Altamore, EpidemiologistDavid DiCesareJason HallWalter Kemper, ELR Coordinator, NC DHHS Div of Public HealthJulie LuepkeCarmen Pugh, Labcorp Manager State Reporting at LabCorpTom Safranek +399 others
Posted by Annie Fine ·

Another MPV ELR question - need a "sense of the room"

Hi everyone,

How do folks feel about the possibility of federal regulation, similar to the CARES act, but for MPV. So the question would be if it would be helpful or not to have something which would require reporting of ELR for MPV, along with associated fields. Specific questions:

1) Helpful or not in general? (think about knowing who is getting tested, testing volume etc - not sure percent pos would be helpful  - my own feeling is probably not but curious what others think)

2) Would you want negative results? Plusses and minuses of that with reasons would be helpful

3) Are there any variables in particular that you would want to have as "required" in that type of rule or regulation? e.g., race, ethnicity, specimen source, based on conversations in this space. Doubt there is any way we could get reliable SOGI data via ELR but that is another question.

THANK YOU!

Also would you want to discuss this on an upcoming CSTE or APHL ELR call? thx

Annie

Comments & Events

John Satre, Informatician at Iowa Department of Public Health John Satre, Informatician
I don't think this would be helpful.

Iowa does not want negatives for MPV.

John Satre

Informatician

Division of Public Health Information Technology

Iowa Department of Health and Human Services



m. 515-229-0417

john.satre@idph.iowa.gov (mailto:john.satre@idph.iowa.gov)

STATE OF IOWA DEPARTMENT OF

Health and Human

Services
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Jennifer Stewart Jennifer Stewart
I would have said NC doesn't want negatives but I got overruled.  I don't know if it would be helpful, we have no problem getting them now (positives and negatives) from labs.  I would prefer not to go to rule making right now for MPX and continue to handle as a special case.  
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Benjamin Schram, Surveillance and Electronic Reporting System Coordinator – Epidemiologist III Benjamin Schram, Surveillance and Electronic Reporting System Coordinator – Epidemiologist III
North Dakota does not think this would be helpful.  We also do not want negatives for MPV, and state code covers all our requirements without the need for federal intervention.
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Bill Storm Bill Storm
OHIO requires labs to filter negatives for MPV/OPV.

We learned from CARES Act reporting, we rarely received meaningful data on those extra required and optional fields, so it's unlikely anything has changed.

Thanks,
Bill
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Nancy Barrett, Epi 4/PH Informatics Specialist Nancy Barrett, Epi 4/PH Informatics Specialist
Hi Annie,
Labs are already supposed to provide us with patient demographics, race/ethnicity, reported gender aka sex at birth, dob. Specimen source should be a given. I'd be happy with labs giving us complete HL7 2.5.1/2.3.1 messages including specimen source. And a faster TAT as we are getting lab results from providers before ELR, which is strange (strange for us as these are not coming in eICR reports).

Negative orthopox or monkeypox lab results are not reportable in CT - we do not want them (we will filter them out).

I hesitate to rely on labs to give us SOGI info- I think that is better from providers or case interviews. Also that is still all over the map between states and systems in states.

And to stand on my soapbox a bit - I don't think having something similar to CARES would be helpful. I think our lab partners are doing what they can and IMHO would rather have this be a cordial vs. adversarial arrangement. I think all of us have seen what people are saying in the news and opinion pieces. If labs can get us what we need based on HL7, and providers will report - I don't think extra legislation will help. I think messaging out that public health is doing the best they can at the local level to try to get providers as well as labs to report as complete information as possible would be a great message. And remember, most of us are still not fully staffed so now we have to do covid AND monkeypox. The overall public health infrastructure is still lacking - you can't build that to what it needs to be in 2+ years - and people are a major part of that (as a whole, I know each state is at a different point and we are working as hard as possible).   :-)
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Ann Kayser Ann Kayser
Minnesota does not wish to receive negative results for monkeypox/orthopox.

While reminding that other data elements, such as race and ethnicity, should be included and able to be messaged, it might be better to focus on quality messages through ELR, including the CDC labs, with enough demographic information to deduplicate into surveillance systems.

Agreeing with Nancy that much of the data elements that would be good investigation information may come from provider reporting or case interviewing.
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Corinne Davis, HL7 Implementation SME Corinne Davis, HL7 Implementation SME
NH is requiring negatives currently. 

I agree with Nancy and Ann. The current national labs that are sending ELR should focus on improving data elements like race/ethnicity and specimen source. The overall quality of ELR from the labs that have been sending for many years is just lacking.
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Carmela Smith, Informatics Team Lead at NMDOH Carmela Smith, Informatics Team Lead
New Mexico would like to receive negative results.
I don’t think it’s necessary for any additional federal regulations, like the CARES Act, at this time. 
-Carmela Smith
NM Dept of Health
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Sita Smith Sita Smith
MA is collecting all MPX results at this time. I concur with what people have said above -  better quality demographics and specimen source information from the lab (which is already required) would negate the need for additional federal regulations. Implementing AOE questions for CARES was very challenging, and we get very little useful information from them.
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Annie Fine, CSTE Annie Fine
Very helpful feedback - thank you all! Anyone who has not responded, please do so before end of day tomorrow. 
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Abhilasha Saxena, ELR Coordinator/Epidemiologist Abhilasha Saxena, ELR Coordinator/Epidemiologist
1) I am new to ELR so I can't speak on federal regulation due to my inexperience in the subject matter.

2) When asked by labs, TN has indicated preference for positive and equivocal results only. We have implemented workflow decision support algorithms to create investigations for positive labs in NBS. 

3) I will second Corinne, Ann and Nancy's suggestion that labs should focus on improving the data quality for the minimum required elements for ELR. So far majority of our time is spent in troubleshooting/rerouting labs with missing LOINCs.

- Abhilasha Saxena
ELR Coordinator, Tennessee
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Michelle Miller, Informatics Michelle Miller, Informatics
  1. Probably not necessary, per experience with similar for COVID
  2. No negatives for MPV via ELR for Washington state, reasons include:
     
    1. Generally, negatives are NOT reportable for any reportable condition in the state of WA (COVID is exception) 
    2. Negative reporting is not useful for public health action and can clog the system
  3. Race, ethnicity and specimen type are valued - but again per similar experience with COVID we found that making fields required often only resulted in an increase of “unknown” values
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Robin Williams Robin Williams
For NE, we did not utilize the AOE's. We request negatives but agree the focus should be on better standard data quality. No need for federal regulations.
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Millie Malai Millie Malai
From working with some federal ELR senders for COVID ELR, it may be that they do not report unless federally mandated. I'm speculating based on 2 examples during COVID where I heard: "We are only reporting what's in the CARES Act and nothing else". I don't represent a state or local PHA, but I wanted to share this as a data point for consideration. I apologize for the vagueness but do not want to name the senders directly. 
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Nancy Barrett, Epi 4/PH Informatics Specialist Nancy Barrett, Epi 4/PH Informatics Specialist
Hi Millie,
I don't know what other states will be doing but we will be reaching out to all of the labs reporting covid-19 results to see if they test for other CT reportable diseases. From our state perspective/laws/regulations, if they test a CT resident and determine a lab reportable finding, they must report. I'm not sure how this fits into CLIA or other requirements that a lab operates under. But you make an interesting point. I don't think it enough, in my opinion, to warrant a federal mandate unless the mandate was broad and included a responsibility for all labs to report to states based on state reporting requirements. Or we knew we got the information via another path. 
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