Electronic Laboratory Reporting (ELR) Frequently Asked Questions
Q: What constitutes Electronic Laboratory Reporting (ELR) in Texas?
A: ELR is the electronic transmission of laboratory test results of notifiable conditions from laboratories to public health authorities so that appropriate actions can be taken to limit the spread and manage impacts of the disease.
Q: Is the Texas Department of State Health Services (DSHS) accepting ELR data to fulfill CMS Promoting Interoperability Program (PIP) requirements?
A: Yes, Texas (DSHS) accepts ELR messages from organizations seeking to fulfill their CMS PIP public health requirement. For more information, please visit the http://mu/elr.aspx webpage.
Q: Which entities in Texas should submit ELR messages during Promoting Interoperability Stage 1 and Stage 2?
A: ELR data is accepted from eligible hospitals and critical access facilities. If you are interested in reporting data to DSHS, please complete and submit this ELR Provider Registration Form.
Q: How do I register my facility?
A: To register your facility, go to ELR Provider Registration Form, and if you need to register multiple facilities, then please complete the facility bulk registration template and submit through the registration.
Q: What type of lab test results should be submitted?
A: Texas Notifiable conditions should be reported according to the Texas ELR Onboarding Guide. implementation guidelines provided above. A list of reportable conditions is available at https://www.dshs.state.tx.us/IDCU/investigation/Notifiable-Conditions.pdf.
Q: Where do I submit the lab results to?
A: The National Electronic Disease Surveillance System (NEDSS) ELR system at DSHS is the single point of contact for laboratory and case result reporting indicative of notifiable conditions. For assistance, please contact IDI@dshs.texas.gov. The DSHS IDI staff will provide eligible providers and hospitals (or hospital systems/healthcare organizations) 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?
A: Communicable disease reporting is mandated in Texas Health and Safety Code which can be found via https://statutes.capitol.texas.gov/Docs/HS/htm/HS.81.htm#81.042. By statute, any laboratory that conducts reportable laboratory test(s) and the facility that orders such tests are responsible for reporting diseases and conditions to the DSHS by Texas Health and Safety Code Sec. 81.042.
Q: What HL7 versions can DSHS NEDSS ELR currently receive for ELR?
A: For Promoting Interoperability Program (PIP), the acceptable format for DSHS NEDSS ELR is HL7 2.5.1 following the respective standards and implementation guides.
Q: Do you require the use of standard vocabulary?
A: Yes, we require the use of standard clinical vocabulary and value sets, including but not limited to Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine (SNOMED), International Classification of Diseases (ICD)-10 and Unified Code for Unified Measures (UCUM). LOINC codes and associated descriptions are required for all observation identifiers (OBX-3). DSHS NEDSS expects all coded observations values (OBX-5) to use SNOMED codes and associated descriptions. This applies to all ordinal results such as positive and reactive as well as nominal results for organism names. This does not apply to numeric or structured numeric observation values.
Q: Why is the vocabulary worksheet required to be submitted to DSHS NEDSS?
A: DSHS NEDSS has found that vocabulary is one of the most time-intensive aspects of ELR validation. To expedite that process, DSHS IDI team has worked vocabulary validation into the ELR on-boarding process. During this validation, we will work with your facility to ensure only reportable lab results are being sent, verify the tests that are performed in-house and those performed by reference laboratories, confirm that the LOINC and SNOMED codes being sent are valid and descriptions are accurate, check for internal consistency between LOINC code, result type, and specimen source, and work out potential content issues on the front-end.
Q: What web-based tools are available to assist me in validating my message structure?
A: DSHS IDI team uses on-line ELR message tools to assist in validation. Examples include the ELR Validation Tool @ NIST for initial validation and error count.
Q: What transport mechanisms are available to send ELR to DSHS NEDSS?
A: Secure file transport protocol (sFTP), or FTP, S3 and Public Health Information Network Messaging System (PHIN-MS). DSHS IDI team does not establish secure transport with facilities until the initial pretesting with the NIST Tool is completed and most structural message errors have been resolved.
Q: Will new vendor(s) need Data Sharing Agreements?
- There is no Data Usage Agreement (DUA) required for notifiable condition reporting to the Department of State Health Services, as this information is required through regulation.
- Pursuant to Texas state Statute and Federal Regulation, Memorandums of Agreement (MOA) or Memorandums of Understanding (MOU) 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.
- If onboarding via Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) platform, an appropriate chain of trust must be established with the APHL using the eHealth Exchange, Care quality, or the APHL participation agreement. The APHL AIMS platform operate through Business Associate or equivalent authorities from the clinical care covered entity.