1Solution Description
- Shepherd, Rachel | APHL
Note that page is still in development. The preliminary sharing of this information is intended to benefit the ETOR initial implementers in preparation for their implementations, with the understanding that some information may change as our development evolves.
Background
Rapid and timely data exchange of laboratory test information is essential for patient care. State and local public health laboratories provide critical testing for healthcare organizations, such as hospitals, urgent care clinics, community centers, and physician offices. Facilitating ETOR with public health laboratories will result in the exchange of faster, more up-to-date, and complete laboratory test information for the benefit of all interested parties. Enabling ETOR is critical for enhancing patient care and supporting public health reporting.
CDC’s Data Modernization Initiative (DMI) team has prioritized laboratory data exchange as part of their multi-year data strategy to streamline data sharing between clinical and public health entities while reducing the burden on both parties. CDC’s Division of Laboratory Systems is leading this ETOR initiative and has provided APHL the funding and guidance needed to launch a comprehensive public health laboratory focused ETOR project.
APHL has served public health as a trusted nonprofit partner for over 60 years. As a member-driven organization, we are committed to our mission to promote the role of public health laboratories in shaping national and global health objectives, and to support policies, programs, and technologies that assure continuous improvement in the quality of laboratory practice and health outcomes. APHL’s ETOR intermediary was developed to support its members and advance the public health laboratory testing process.
Solution
At a high level, there are three possible ETOR implementation paths available – web portal, system integrated (direct), and system integrated (indirect). The AIMS ETOR Intermediary follows the system integrated (indirect) approach, which supports the modernization and innovation of IT capabilities and services.
Web Portal | System Integrated (Direct) | System Integrated (Indirect) |
Separate system accessed by clinical providers for manual entry of orders and retrieval of test results. This system can be integrated with public health laboratory’s LIMS. | Integrated solution that enables clinical partner’s EHR system to communicate directly with public health laboratory LIMS. Direct integration is 1:1 and requires message translation by one or both systems. | Integrated solution enabling clinical EHR system to communicate with public health laboratory LIMS via an “intermediary” that allows each system to maintain its native format and manages the translation for them. |
The APHL Intermediary was developed on the existing cloud-based infrastructure known as the APHL Informatics Messaging Services (AIMS) platform. This cloud-based platform, funded and supported through a cooperative agreement with the CDC, has served public health partners as a public health data exchange mechanism since 2008. AIMS securely receives, filters, routes, and delivers millions of individual messages per month to and from public health laboratories, agencies, CDC programs, and thousands of healthcare organizations. Details on the AIMS environment and Security Posture are available here: AIMS Trust Center - AIMS Resource Center - Confluence (atlassian.net)
The high-level process flow of test ordering and resulting via the intermediary is:
The primary goals of the intermediary solution are:
Minimize the burden on both the public health laboratory and healthcare organization to manage numerous connections and message translations, reducing the technical staff requirements.
Integrate the test orders and results within the organizations' existing systems (EHRs and LIMS), reducing the need for additional systems and manual entry.
Establish a long-term solution that can manage high-volume testing and scale for public health emergency use.