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Introduction

The purpose of this page is to capture the goals and requirements to enhance ELR reporting in the context of the COVID pandemic, and in that context provide clear guidance to all parties in the communication flow to enhance their contributions to enhance the ELR transaction to a Public Health Authority. 

This is meant to be a working document that we rapidly evolve based on latest understanding. Once it is believed to be sufficiently complete and accurate it will be published elsewhere as a guidance document.

Contacts

Hans Buitendijk - Cerner, HL7 Orders & Observations Co-Chair, EHRA Standards & Interoperability Chair

David Burgess - LabCorp, HL7 Orders & Observations Co-Chair

Freida Hall - Quest Diagnostics

Jason Hall - CDC

Janet Hamilton - CSTE

Riki Merrick - APHL, HL7 Orders & Observations Co-Chair, IHE Pathology and Laboratory Medicine Co-Chair

Craig Newman - Altarum, HL7 Public Health Co-Chair

Andrea Pitkus

Dan Rutz - Epic, IHE ???

Kathy Walsh - LabCorp

Michael Waters - FDA

Current Challenges

  • Is the following accurate interpretation of intent as we know it so far:
    • Enhance electronic order flow as much as possible that:
      • Ordering systems are capable of asking for and including all applicable AOEs with the order to the lab, particularly where that lab runs on a different system and even more so if that lab is external to the provider’s organization.
      • Users are strongly encouraged to include all known information at the time of ordering, recognizing that in a number of situations that information would not be available at time of order.
    • The ask is NOT to send an order for test related to a reportable condition to a PHA directly.
    • Enhanced ELR content to include all relevant demographic data received from the ordering provider AND all AOEs in the ELR transmission, whether done by the performing lab or perhaps the ordering provider as well based on local requirements.
  • If accurate, then the ways to achieve this are:
    • AOE Encoding
      • The AOE should be encoded according to the latest eDOS IG plus any additional LOINC coding for questions that are not yet in that IG.
    • Order Flow
      • Ideally we would like adoption of the latest LOI IG and ensure that where a test goes through multiple hops effectively all data is included for the performing lab (e.g., ordering provider to internal lab that may not need all that information with the order as they can get to it other ways, and then on to a reference lab that does not have that ability to find out otherwise since they are not integrated with the ordering system – the internal lab needs to ensure everything is included)
      • That is not likely to happen in this time window, so best is to provide reference to the specific AOE sections in the LOI IG that one is to include that for the AOEs into whatever the current order message is when using HL7 v2.  We have provided that approach effectively in a similar situation.
      • It is unclear how to get the data from the ordering provider to the performing lab (excluding paper) so the Lab can include it in the ELR.  There does not seem to be a viable alternative using .csv files to properly sync.
    • ELR Flow
      • Ideally we would like adoption of the latest LRI IG that includes ELR capabilities
      • That is not likely to happen, so similar as above, pre-adoption of the relevant sections in the LRI IG that is then included in the existing ELR transactions
      • Since ELR is subject to certification and the provider is supposed to use the certified version, there must be clarity that pre-adoption of the AOEs according to the latest LRI IG sections is permissible.
      • If neither of the above can be put in place, then the submitter is to send a .csv file according to a defined template preferable to a Direct Address (most stakeholders support that and has higher opportunity of automation in batches) or a portal for manual submission.


What is missing?  What would not work?


The current guidance documentation could lead somebody to the above, but also could lead them to a different conclusion.  We suggest it be kept as simple as possible with the least amount of options, lest the PHAs are willing to deal with a very large variety of formats.


A question was raised whether all data requested is already available in the eCR template.  This would be particularly important when data is not known at time of ordering, thus not known to performing labs that are not integrated with the ordering system when the lab sends the ELR some time later (even if days later).  That would require sending of updated orders, which may get challenging, rather should be covered by the eCR as it is provided multiple times.  Where the performing lab is integrated, there is high probability at the time of generating the ELR that the data that has become available could still be included.


We like to keep this group very small to align on understanding and best guidance within whatever guidance HHS provides overall to make this practical and implantable quickly.


If it helps, I can establish a Google Doc where we can all edit/suggest directly as we learn more and distill it down to very specific guidance on who is to do what.


If the above does not make sense, or there is already a clear effort in progress with the right SMEs involved, please let us know.  If the second, we would want to know who.


Requirements


Data Flow and Guidance


Open Issues


Resources for Background

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