Submitting Electronic Laboratory Results Information to DSHS
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.
About Disease Surveillance
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.
Submitting ELR Data to Meet Public Health Reporting Requirements under Meaningful Use Programs
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 using Certified Electronic Health Record Technology (CEHRT) to help meet EHR Incentive Programs’ requirements for reporting data to public health.
In order to meet the EHR Incentive Programs’ requirements for ELR reporting, participating EHs and CAHs must be actively engaged with public health and use CEHRT that is capable of sending ELR messages consistent with identified specifications. Participants in Stage 2 must be compliant with the specifications in the HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1, available from HL7 at http://www.HL7.org.
There are three ways an EHR Incentive Program participant can be “actively engaged” in ELR reporting:
- Active Engagement Option 1 – Completed Registration to Submit Data. An EH or CAH has registered to submit data with DSHS; registration was completed within 60 days after the start of the EHR reporting period; and the EH or CAH is awaiting an invitation from DSHS to begin testing and validation. Participants in the queue waiting for an invitation are considered to be “actively engaged.” Participants that have registered in previous years do not need to submit an additional registration to meet this requirement for each EHR reporting period.
- Active Engagement Option 2 – Testing and Validation: The EH or CAH is in the process of testing and validation of the electronic submission of data. Providers must respond to requests from DSHS within 30 days; failure to respond twice within an EHR Incentive Program reporting period would result in that provider not meeting the measure.
- Active Engagement Option 3 – Production: The EH or CAH has completed testing and validation of the electronic submission and is electronically submitting production data to DSHS. Production data refers to data generated through clinical processes involving patient care, and it is used to distinguish between data and “test data” which may be submitted for the purposes of enrolling in and testing electronic data transfers.
The Texas ELR Onboarding Manual describes the ELR onboarding process and the DSHS requirements in detail.
- HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1, available from HL7 at http://www.HL7.org.
- Public Health Information (PHIN) Vocabulary and Distribution System (VADS) ( https://phinvads.cdc.gov/vads/SearchVocab.action)
- Reportable Condition Mapping Tables (RCMT) ( http://www.cdc.gov/ehrmeaningfuluse/rcmt.html)
- For HL7 Implementation Guide, see www.HL7.org
- For LOINC, refer to: http://loinc.org/usage
- For SNOMED, refer to: http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html
- For the layout of messages to DSHS, please email firstname.lastname@example.org.
Frequently Asked Questions Regarding Electronic Lab Result Submission in Texas:
Q: What type of lab tests results should eligible hospitals and providers submit? Can you provide us a list of the lab tests of which results we need to submit?
A: Notifiable conditions (any laboratory examination of a specimen derived from a human body which yields microscopical, cultural, serological, or other evidence of a reportable disease) should be reported according to the implementation guidelines provided above.
Q: When can I submit the lab results to the public health agency?
A: The Texas NEDSS ELR system at DSHS is currently operational.
Q: Where do I submit the lab results to?
A: The NEDSS ELR system at DSHS is the single point of contact for laboratory result reporting indicative of notifiable conditions. For assistance, please contact NEDSS@dshs.texas.gov. The NEDSS staff will provide eligible providers and hospitals (or hospital systems) with data format specifications and will schedule technical assistance as needed.
Q: What about my facility’s test results that are performed and reported by a commercial lab? Will those count toward my MU requirements?
A: Any electronic interface intended to satisfy a meaningful use requirement to submit data to a public health agency must be a certified EHR product (CEHRT). EHs and CAHs are required to send ELR result data from CEHRT to public health to meet the requirements of the EHR Incentive Programs.
- EHs and CAHs should submit positive test results for reportable conditions performed in their hospital lab from their certified EHR to DSHS. When a specimen is sent to a reference lab for testing (i.e. the hospital is not the performing facility but does have record of the test result in their EHR), EHs and CAHs must submit the data using CEHRT through ELR to meet EHR Incentive Programs’ requirements.
Q: What user agreements are required for notifiable condition reporting to DSHS?
A: Memorandums of Agreement or Memorandums of Understanding are not required for notifiable condition reporting to the Department of State Health Services.
This document is intended to serve as clarification that pursuant to Texas state Statute and Federal Regulation, Memorandums of Agreement or Memorandums of Understanding are not necessary for reporting of notifiable diseases by specified entities to the Department of State Health Services (“Department”).
Chapter 81, Subchapter C of the Texas Health and Safety Code requires reporting on certain identified diseases to health authorities or the Department. Persons required to report under the statute include, physicians, dentists, veterinarians, local school authorities and individuals in charge of clinical or hospital laboratories. Reporting procedures and notifiable conditions are outlined in Department rule, Texas Administrative Code, Title 25, Chapter 97. Memorandums are not required under this reporting structure.
The Health Insurance Portability and Accountability Act of 1996’s (HIPAA) Privacy Rule authorizes the disclosure of protected health information (PHI) by covered entities, without individual authorization from the patient, to public health authorities such as the Department for public health purposes including, but not limited to, public health surveillance and investigations. The Electronic Laboratory Reporting program is operated by the Department for public health purposes.
The Privacy Rule, at 45 CFR 164.512(a), allows covered entities to disclose PHI to public health authorities such as the Department, when required by state laws. Chapter 81 of the Texas Health and Safety Code is the applicable state statute for this type of reporting.
Covered entities operating in Texas are expected to comply with applicable mandatory reporting requirements in Texas state law and may rely on HIPPA for additional legal basis for disclosing the required information to the Department. This reporting does not require the Department to enter into any legal Memorandums.
Contact IDI@dshs.texas.gov for questions and more information.
For information on the new DSHS electronic case reporting (eCR) initiative, please visit the Electronic Case Reporting (eCR) page.