Page 49 - Driving Public Health in the Fast Lane

Laboratory Information Systems and Electronic Laboratory Reporting

Public health laboratories play a key role in public health surveillance, and are uniquely positioned to
provide laboratory testing and training to support population-wide health. Functioning at the federal,
state, territorial, local, and tribal level, governmental public health laboratories provide highly technical
and specialized testing for diseases and conditions of public health consequence, and have a core function
to support disease prevention, control, and surveillance. Additionally, through the structure of the
Laboratory Response Network (LRN), public health laboratories provide coordinated and rapid responses
to epidemics, biothreats, and environmental hazards including radiologic and chemical hazards. Key to
the LRN and the broader public health surveillance system is accurate and timely laboratory testing to
measure, track, and prevent the spread of public health threats.

Public health laboratories primarily provide test results to epidemiologists to support outbreak detection
and public health investigations. Secondarily, diagnostic information can be shared back to health
care providers to inform clinical care which requires bidirectional data exchange, and can create a
burden when reporting mechanisms and requirements differ between the public health and health care
communities. Advances in laboratory informatics—the specialized application of information technology
to laboratories—have streamlined data management in public health laboratories and enabled quicker
data exchange. Laboratory Information Management Systems (LIMS), the computer applications that
form the backbone of laboratory data collection, management, storage, and sharing, can eliminate the
need for manual and paper-based specimen accessioning, data management, and result recording. This
allows public health laboratories to electronically track specimens and workflows, and store laboratory
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data in a central, secure location. However, not all public health laboratories have implemented all these
features within their LIMS.

Electronic management systems such as LIMS enable electronic laboratory reporting (ELR) to public
health partners from both clinical and public health laboratories. Jurisdictional laws require laboratories
to report test results of reportable diseases to public health authorities and state health departments
in order to initiate case investigations. Laboratories generate secure laboratory reports and submit
reportable data either manually or electronically with ELR. While manual laboratory data reporting
methods are paper-based and impose significant administrative burdens, ELR can:

• Identify and extract reportable condition data from laboratory reports;

• Reduce data inaccuracies and improve data quality;
• Electronically transmit reportable condition data from laboratories to public health agencies. 6

Initially, as laboratories moved from manual-based systems to ELR, there were challenges surrounding
the lack of standardization of messaging formats, technical expertise in implementation, and appropriate
policies. In 2010, CDC partnered with the Council of State and Territorial Epidemiologists (CSTE) and the
Association of Public Health Laboratories to: create an ELR task force to develop, evaluate, and endorse
standards for ELR requirements; coordinate federal and state ELR implementation efforts; and conduct
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needs assessments to identify state-specific ELR strategies.

5 McPhillips-Tangum C, Saarlas K, Renahan-White A. The LIMS Project: Summary of Evaluation Findings. Public Health Informatics Institute. https://www.phii.org/sites/default/files/resource/pdfs/
LIMS%20Evaluation%20-%20website-FINAL-2.pdf. Published June 2007. Accessed May 3, 2019.
6 Electronic Laboratory Reporting (ELR). cdc.gov. https://www.cdc.gov/EHRmeaningfuluse/ELR.html. Updated May 19, 2016.
7 Electronic Laboratory Reporting (ELR) Task Force Overview. cdc.gov. https://www.cdc.gov/EHRmeaningfuluse/ELRtf.html. Updated August 23, 2016.

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