Practical Informatics Lessons Using the Language of Laboratorians

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2 Practical Informatics Lessons Using the Language of Laboratorians

3 Learning Objectives Define Informatics and explain its relevance to Public Health and describe the function and importance of public health laboratory informatics programs Understand the importance of communication between laboratory and informatics staff Explain technical assistance (TA) and how labs may be able to utilize it Describe the AIMS platform and its utility to meet laboratory or agency needs

4 How are different states working with lessons learned and implementing them for more success in the future? Keith Higginbotham AL Department of Public Health

5 Practical Informatics Lessons Using the Language of Laboratorians A State s Perspective Keith Higginbotham, IT Manager Alabama Dept of Public Health 6/8/2016 1:46:21 PM 5864_ER_HEALTH 5

6 Alabama s State PHL Clinical and Environmental testing Serology, Clinical Chemistries, Mycology, Micro, Virology, NBS Milk/Water, Beach Waters, Shellfish, Environmental Lead and Rabies 2 Geographically separated labs Montgomery/Mobile ~1.9 million tests per year Customers 90 County Health Depts in 67 Counties Hospitals National labs (Labcorp and Quest) Private providers Law enforcement 2 LIMS Horizon (Chemware) Clinical and Environmental Neometrics (Natus) Newborn Screening 6/8/2016 1:46:21 PM 5864_ER_HEALTH 6

7 Definition of Laboratory Informatics The specialized application of information through a platform of instruments, software, and data management tools that allow scientific data to be captured, migrated, processed, and interpreted for immediate use, as well as stored, managed, and shared to support future research, development, and lab testing efforts while maximizing the efficiency of laboratory operations. - The Complete Guide to LIMS & Laboratory Informatics, 2015 Edition 6/8/2016 1:46:21 PM 5864_ER_HEALTH 7

8 Informatics at work in Alabama 1 st Qtr 2009 Implementation of Horizon LIMS 1 st Qtr 2009 Integration of LIMS and Billing System CPT, ICD9/ICD10, NPI (Oct 2014), Insurance details 2 nd Qtr 2009 Web Portal for Test Ordering/Reporting Decrease in paper result reporting More accurate, complete order info Distributed data entry to ordering facility Integration with CHD Encounter system (70% Orders) 3 rd Qtr 2009 HL ELR to NEDSS LOINC/SNOMED encoding Orion Rhapsody Integration Engine 6/8/2016 1:46:21 PM 5864_ER_HEALTH 8

9 Informatics at work in Alabama 2010 PHLIP ELSM (HL ) APHL PHLIP TA Leverage NEDSS ELR work Orion Rhapsody Integration Engine PHINMS/AIMS (FL RNR Hub) 2011 ETOR (HL7 2.6) Bi-directional Interface SuccessEHS 2 counties, 20 clinics Maintenance / Vendor Customizations TCP/IP Message Transport Orion Rhapsody Integration Engine 6/8/2016 1:46:21 PM 5864_ER_HEALTH 9

10 Informatics at work in Alabama 2012 LRN-B (HL ) CDC LRNB TA PHINMS/AIMS Hub Orion Rhapsody Integration Engine 2013 SDWIS to ADEM XML Manually uploaded to EPA web site 2013 Laboratory-base Enteric Disease Surveillance (LEDS) CSV file CDC LRNB TA PHINMS/AIMS Hub Orion Rhapsody Integration Engine 2015 PHLIP ELSM upgrade to HL APHL TA Orion Rhapsody Integration Engine 6/8/2016 1:46:21 PM 5864_ER_HEALTH 10

11 HOWEVER, IN THE BEGINNING A conversation between a laboratorian and IT 6/8/2016 1:46:22 PM 5864_ER_HEALTH 11

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13 Learning each others lingo Information Technologist + Laboratorian = Informatician LOINC codes SNOMED CT codes Interface Engine Messaging HL7 implementation guides Interoperability Server Virtualization Bandwidth SDLC Cloud Accessioning Aliquots CLIA CPT codes ICD9/ICD10 Codes WGS PFGE, PCR, ELISA Reference Ranges 6/8/2016 1:46:22 PM 5864_ER_HEALTH 13

14 Genesis of Informatics in AL No classification within state personnel for Informatics/Informatician Blend existing resources into a laboratory informatics team IT Manager (BCD, BCL, CEP) 1 FTE Programmer Analyst 1 FTE Senior Microbiologist 1 FTE Microbiologist Dedicated IT staff (Embedded Reporters) Teach/learn each other s business processes Utilize TA assistance from APHL and CDC Leverage previous informatics solutions 6/8/2016 1:46:22 PM 5864_ER_HEALTH 14

15 WITHOUT AN INFORMATICS TEAM The danger of not understanding the problem before developing a solution 6/8/2016 1:46:22 PM 5864_ER_HEALTH 15

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17 Develop an Informatics Roadmap Where are you now? APHL Informatics SA Tool Assess your current informatics capabilities Where do you want to go? Determine where you have informatics gaps Focus on areas to improve over the next year How do you get there? Informatician or Informatics Team Acquire new resources or redistribute existing resources Assess funding (personnel, hardware, software, etc.) Follow Best Practices Leverage work performed by others Workforce development APHL TA Consider participating in the APHL Informatics Committee 6/8/2016 1:46:22 PM 5864_ER_HEALTH 17

18 A GOOD INFORMATICIAN IS KIND OF LIKE 6/8/2016 1:46:23 PM 5864_ER_HEALTH 18

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20 As it is impossible to have all of the resources or people needed in one lab, you need to be able to pull from larger TA resources. Jason Hall CDC, Division of Preparedness and Emerging Infections

21 National Center for Emerging and Zoonotic Infectious Diseases Building Public Health Laboratory Informatics Capacity Jason Hall Division of Preparedness and Emerging Infections 2016 APHL Annual Meeting June 7, 2016

22 Self Assessment Tool Document existing capacities Understand current needs Identify gaps Assessment-Tool.aspx

23 Funding

24 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Health Information Systems program (project C) Flexible IT/Informatics personnel Electronic data exchange Electronic Laboratory Reporting (ELR) Case Notifications (NMI) Electronic Case Reporting (ecr) - prepare Integrated surveillance information systems Sustain/maintain Enhance Acquire/rebuild Hosting

25 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Health Information Systems program (project C) Activities for 2D: For Public Health Labs: Implement ELR with or within the public health department Create and send standards-based ELR for all reportable conditions to or within health department by upgrading or enhancing LIMS system Map local test, results, and specimen source codes to LOINC and SNOMED Add capacity at PHL to fully implement ELR with/within health department Build upon current ELR infrastructure to explore ETOR with another public health lab or hospital

26 Public Health Emergency Preparedness (PHEP) Capability Area 6 Updated to complement ELC HIS guidance Explicit support for public health labs Staff/contracts/training Electronic test ordering ELR LIMS

27 Funding Opportunity Announcement (FOA) Workgroup of the CDC Surveillance Leadership Board Evaluate language related to health IT of CDC cooperative agreement FOAs and generate guidance to make the language more comparable across the FOAs Identify ways in which CDC cooperative agreement programs can coordinate before, during and after awards Identify ways to connect technical assistance (TA) resources across CDC to support grantees funded under CDC cooperative agreements Deliverable Make recommendations to SLB on possible strategies to enhance efficiencies in IT investments funded under CDC FOAs

28 Technical Assistance

29 APHL Technical Assistance Services Reusable/adaptable solutions Technical consultations Development and implementation assistance

30 An example ELR Technical Assistance Transforming/filtering/routing ELR 21 6 ELR with PHL 18 4 Evaluation of ELR Infrastructure ELR with Large Labs ELR from Hospital/Health System Complete (63) Active (17) Creating Protocol policy or process docs Validating or Cleaning Data in ELR ELR with Regional Labs ELR with HIE

31 APHL Informatics Messaging Services (AIMS) A secure, cloud-based environment that accelerates the implementation of health messaging by providing shared services to aid in the transport, validation, translation, routing, parsing, storage, and use of electronic data.

32 A National Resource for Interoperability

33 Activities Supported by AIMS For Public Health Agencies (epi) Electronic Laboratory Reporting (ELR) Quest Diagnostics PAML Cerner Hospitals and other labs State to State Data Exchange ELR transferring Immunization messaging Syndromic messaging Electronic Case Reporting Host RCKMS Routing and transport (planned)

34 Activities Supported by AIMS For Public Health Labs Electronic Test Ordering and Reporting (ETOR) Standards-based messaging (planned) Surge capacity for pandemic flu Web Portal for test ordering and results reporting (planned)

35 Activities Supported by AIMS For CDC Influenza ELR (PHLIP) Message Transport Vaccine Preventable Diseases ELR (VPD) Message transport NNDSS Modernization Initiative (NMI) Message transport for some jurisdictions Laboratory Response Network Message transport for bioterrorism threats Animal Rabies ELR Transport, parsing and storage Remote access to data using virtual desktop

36 Influenza Sequence First Initiative

37 APHL AMD Bioinformatics Hub 6 Chart Title Category 1 Category 2 Category 3 Category 4 Series 1 Series 2 Series 3

38 For more information, contact CDC CDC-INFO ( ) TTY: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.