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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 National Electronic Disease Surveillance System (NEDSS) Electronic Laboratory Reporting (ELR) system at the Texas Department of State Health Services (DSHS) provides a method for hospital and clinical laboratories to electronically submit test results to fulfill their statutory obligation to report test results to the public health authority.

What is Electronic Laboratory Reporting (ELR)?
Electronic Laboratory Reporting (ELR) is the electronic transmission of results from laboratories that conduct tests for specific high-profile and/or contagious diseases to public health authorities so that appropriate actions can take place to limit the spread and manage impacts of the disease.  ELR has many benefits, including improved timeliness of results, reduction of manual data entry errors, and reports that are more complete.

Submitting ELR Data to Meet Public Health Reporting Requirements for Meaningful Use
While all hospitals and clinical laboratories may participate in ELR, Eligible Hospitals (EHs) or Critical Access Hospitals (CAHs) participating in the Centers for Medicare and Medicaid Services’ 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 website), 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 Meaningful use; (page 2 of the Texas Onboarding Guide_Texas_2016)
• The complete onboarding manual can be found at  Texas ELR Onboarding Guide_Texas_2016
• 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 tool.
• The Texas specific ELR format can be found at Texas HL7 2_5_1 ELR_Specification_ 2016_Final Draft 4-29-16 

Step 1. Registration

• To register your intent for HL7 2.5.1 ELR Onboarding; https://www.dshs.state.tx.us/nedss/forms/Public-Health-Gateway-Provider-Registration-Form.aspx
• The DSHS’ NEDSS team will set up Facility will participate in an initial planning meeting to discuss the on-boarding process with DSHS’ NEDSS team
• Representative from the facility should include IT, Infection prevention, integration, vendor, 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) validation tool. 
• 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 
•  After the facility has met the message applicable criteria, they will contact DSHS to set up a secure message transport system. 

Step 4. Acceptance Testing/Onboarding

• 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. 
• 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 are similar and synonymous.
• Any issues with parallel validation will be discussed with the DSHS NEDSS team and communicated to the facility for appropriate action.
•  Once parallel validation is concluded, DSHS will inform the facility when to discontinue paper submission of reportable disease events.

Message Header Segment Specification for ELR in Texas State