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About Electronic Disease Surveillance at the Department of State Health Services

Detecting and monitoring the occurrence of disease through reporting of 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 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) test results to fulfill their statutory obligation to report test results to the public health CAHs participating in the Centers for Medicare and Medicaid Services’ (CMS) Electronic Health Record Incentive Programs may use their successful participation in ELR reporting to help meet Incentive Programs’ requirements for reporting data to public health.

In order to meet the Incentive Programs’ 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 Incentive Program participants. 

Electronic Lab Reporting On-boarding 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 July 2021).
• The complete onboarding manual can be found at Texas ELR Onboarding Guide July 2021.
• 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 ELR Validation Tool @ NIST.
• The Texas specific ELR format can be found at Texas HL7 2.5.1 ELR 2021 Specification Draft 07/30/21.
  

Step 1. Registration

• To register your intent for HL7 2.5.1 ELR Onboarding; go to https://www.dshs.state.tx.us/nedss/forms/Public-Health-Gateway-Provider-Registration-Form.aspx and complete the form.
• The DSHS’ Infectious Disease Informatics (IDI) team will set up a meeting with the facility to participate in an initial planning meeting to discuss the on-boarding process with DSHS’ IDI team.
• Representative from the facility should include Information Technology, Infection prevention/infection control, integration, Electronic Health Records (EHR) vendor, HL7 subject matter expert (SME) and terminology SME. 
  

Step 2. Pretesting

• Facility must proceed to do Vocabulary Mapping and Validation with DSHS.
  • (The facility will complete the ELR vocabulary mapping worksheet provided by DSHS as much as possible).
• The link to the vocabulary mapping spreadsheet can be found at Texas ELR Vocabulary Mapping Worksheet Draft.
  • Reportable Conditions Mapping Tables (RCMT)
  • Specimen Type SNOMED Value Set
    

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 National Institute of Standards and Technology (NIST) ELR Validation Tool @ NIST. 
• Examples of result types to be tested include:
  • Coded result (CWE)
  • Numeric result
  • Titer result
  • Structured numeric result.
• Once the context-free validation reports indicate the test messages are free of errors (Error count is 5-10), 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 begin to send live production batch transmission of messages to DSHS for structure and content validation. 
  

Step 5. Production

• Once an eligible hospital has completed validation they will receive an acknowledgement of their success and be placed into production status. 
• The facility will continue to send batch messages to DSHS for validation.
• 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 to compare the data submitted into DSHS NEDSS with the content of the paper laboratory report to make sure the content is similar and synonymous.
• Any issues with parallel validation will be discussed with the DSHS IDI team and communicated to the facility for appropriate action.
• Once parallel validation is concluded, DSHS will inform the facility on when to discontinue paper submission of reportable disease events.
  

Message Header Segment Specification for ELR in Texas State