About Electronic Disease Surveillance at the Department of State Health Services

Detecting and monitoring the occurrence of disease through reporting test results for notifiable conditions is a cornerstone of public health surveillance in Texas. The Texas National Electronic Disease Surveillance System (NEDSS) system, maintained and operated by the Texas Department of State Health Services (DSHS) Public Health Data and Informatics Exchange (PHID) Unit, provides a method for laboratories and providers to submit electronic laboratory report (ELR) results.
 

What is Electronic Laboratory Reporting?

ELR is the electronic transmission of results from laboratories that conduct tests for notifiable disease conditions. These reports are required to be reported to public health authorities so that appropriate actions can take place to limit the spread and manage the impacts of the organism or disease. ELRs serve as the primary trigger for public health investigations and provide a gauge for local health officials to assess the level of activity for various infections within their community. The timeliness, accuracy, and completeness of ELRs are extremely important to ensure rapid public health response.
 

Submitting ELR Data to Meet Public Health Reporting Requirements for Promoting Interoperability Program

While all hospitals and clinical laboratories may participate in ELR, Eligible Hospitals (EHs) or Critical Access Hospitals (CAHs) may fulfill their obligation to comply with the Centers for Medicare and Medicaid Services (CMS) Promoting Interoperability Program (PIP). EHs and CAHs may use their successful participation in ELR reporting to help meet PIP requirements for reporting data to public health.

To meet the CMS PIP requirements, participating EHs and CAHs must use Certified Electronic Health Record Technology (CEHRT) that meets specific requirements including being capable of sending ELR messages using the HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 (available on the  HL7 Standards Product Brief - HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 (US Realm) | HL7 International) and being “actively engaged” in public health reporting. DSHS will provide appropriate documentation to PIP participants. 

Electronic Lab Reporting Onboarding Process

The resources below describe the ELR onboarding process and the DSHS requirements in detail:

• To find out if you are eligible for ELR for Promoting Interoperability Program; (page 2 of the Texas ELR Onboarding Guide).
• The complete onboarding manual can be found in the Texas ELR Onboarding Guide.
• Electronic Laboratory Reporting (ELR) Onboarding Checklist; Texas ELR Issue Resolution Checklist.
• Examples of some conditions for which test messages are to be generated and pretested using the NIST HL7 V2 General Validation Tool.
• The Texas-specific ELR format can be found in the Texas HL7 2.5.1 ELR specification guide.

Step 1. Registration

• To register your intent for HL7 2.5.1 ELR Onboarding; go to the ELR Provider Registration Form (smartsheet.com) and complete the form.
• The DSHS’ Infectious Disease Informatics (IDI) team will email the registration confirmation to the facility and if there are questions, then please email idi@dshs.texas.gov. 

Step 2. Pretesting

• The facility will be provided the Vocabulary Mapping Worksheet to complete and email back to and Validation with the DSHS IDI team for validation.

Step 3. Testing

• Facility will develop and generate HL7 messages for specific conditions that conform to the HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 (US Realm) with Errata.
• The facility will pretest their message(s) using the ELR Validation Tool @ NIST. 
• Examples of result types to be tested include:
  • Coded result (CWE)
  • Numeric result
  • Titer result 
• Once the context-free validation reports indicate the test messages are free of errors (Error count is less than 10), send copies of the validation reports to IDI@dshs.texas.gov.
•  After the facility has met the message applicable criteria, the DSHS IDI team will contact facility to set up a secure message transport system. 

Step 4. Acceptance Testing/Preproduction

• The facility will send live production messages into our test system for analysis.
• DSHS will give permission to engage the facility in parallel validation, a process whereby the Subject Matter Experts (SMEs) at DSHS will perform gap analysis.
• Any issues with parallel validation will be discussed with the DSHS IDI team and communicated to the facility for appropriate action.

Step 5. Production

• Once an eligible hospital has completed validation they will receive an acknowledgement of their success and be placed into production status.