Solution Description
Background
The nation depends on public health laboratories. They conduct tests that help detect and prevent outbreaks, mitigate the spread of disease, and screen newborns for disorders that can be deadly or devastating without swift intervention. Facilitating electronic test order and result data exchange 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.
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 Electronic Test Orders and Results initiative and has provided APHL the funding and guidance needed to launch a comprehensive public health laboratory-focused solution.
APHL has served public health as a trusted non-profit 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 Detor solution was developed to support its members and advance the public health laboratory testing process.
Solution
At a high level, there are three possible Electronic Test Orders and Results (ETOR) implementation paths available – web portal, system integrated (direct), and system integrated (indirect). The APHL Detor solution 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 for the manual entry of orders and retrieval of test results. This system can be integrated with a public health laboratory’s LIMS. | Integrated solution enabling two systems to communicate directly (e.g., a hospital’s EHR and a public health laboratory LIMS) via an interface. Direct integration is 1:1 and requires message translation by one or both systems. | Integrated solution enabling two systems to communicate directly (e.g., a hospital’s EHR and a public health laboratory LIMS) via an “intermediary” that allows each system to maintain their native format and manages the translation for them. |
Detor 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 CDC, has served public health and healthcare 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)
Use Cases
The initial focus for Detor was to support the Healthcare Organization (HCO) and Public Health Laboratory (PHL) use case. See the below table for a description of use cases that are possible and will be considered during the initial design and development to facilitate future use case needs.
Healthcare Organization Public Health Laboratory | Public Health Laboratory Public Health Laboratory |
|---|---|
Exchange of test orders and results between a healthcare organization and a public health laboratory. e.g., Hospital orders Newborn Screening Test from state public health laboratory. | Exchange of test orders and results between two public health laboratories. e.g., In case of disaster and/or need to balance testing load, samples are rerouted from one public health laboratory to another for testing and resulting. |
Clinical Laboratory (e.g., Quest) Public Health Laboratory | Public Health Laboratory CDC Laboratory |
Exchange of test orders and results between a clinical laboratory and a public health laboratory. e.g., Clinical laboratory identifies a need for unique or high-complexity testing that needs to be routed to a public health laboratory. | Exchange of test orders and results between a public health laboratory and the CDC Laboratory. e.g., Public health laboratory identifies a need for unique or high-complexity testing that needs to be routed to CDC Laboratory. |
The high-level process flow of test ordering and resulting via Detor is:
The primary goals of Detor are:
Minimize the burden on both public health laboratories and partner test ordering organizations to manage numerous connections and message translations, reducing the technical staff requirements.
Integrate the test orders and results within partner organizations' existing information systems (e.g., 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.