THE PHLIP ADVANTAGE ~Moving our Labs forward in data exchange~

Size: px

Start display at page:

Download "THE PHLIP ADVANTAGE ~Moving our Labs forward in data exchange~"

Reginald Phillips
5 years ago
Views:

1 THE PHLIP ADVANTAGE ~Moving our Labs forward in data exchange~

2 The PHLIP BIG Picture Patina Zarcone, MPH Director of Informatics & KM PHLIP Steering Committee Member

3 What We Know Laboratory Data is Vital to Patient and Population Health

4 What We Want 1. Surveillance Detection Response 2. Continuity of Operations (COOP) 3. Surge Capacity Early Warning, Early Detection, Rapid Response, At Ready Capacity, & Monitoring Response

5 So where do we start? Pick a spot on the Map and Agree on the Route to: Achieve interoperability Improve laboratory expertise and buy-in Build infrastructure Prepare for the next generation

6 100 labs working separately could all correctly code their local tests using LOINC and SNOMED, and yet the process could generate 100 different electronic messages for the same tests.

7 So..What is PHLIP doing about it? PHLIP enables Public Health Laboratories to speak the same language. PHLIP is doing for Public Health Labs what the banking industry did last century in order to let you use your ATM card everywhere.

8 The Three Pieces To PHLIP Harmonization of Vocabulary and Messaging Guides Implementation of Production Level Messages Building Collaboration and Cross Project Fertilization

9 PHLIP Vision All state public health laboratories will have capability for electronic bi-directional laboratory data exchange by SPHL to SPHL SPHL to CDC CDC to SPHL PHL s will lead national effort to harmonize test orders and test results

10 Foster a national collaborative process Provide detailed vocabulary implementation guidelines Build PHL capability for electronic test ordering and result reporting Develop and pilot data exchange architecture Establish processes to help additional state PHL s acquire electronic lab reporting capability Funding for ALL PHL s PHLIP Building Blocks

11 Projected Outcomes Strengthen a collaborative environment for public health informatics Improve data accessibility Improve data accuracy Improve patient care by providing better data Improve public health outcomes by providing better information for response management Expand data sources for active surveillance National integrated laboratory system

13 PHLIP Governance and Workgroups Gary Jones IS Manager PHLIP Steering Committee Member

14 Moving in the Right Direction: PHLIP governance Executive Committee Steering Committee Both groups have high level decision makers from stakeholders (States, CCID, NCPHI, and APHL)

15 Executive Committee Sets PHLIP Vision and Mission

16 Steering Committee Translates vision into Operational Plans for Workgroups

17 Getting into the Weeds! Our PHLIP workgroups

18 Influenza Message Implementation Lab Surveillance Messaging IT SMEs from the SPHLs, CDC and NCPHI as well as Standards SMEs Implementing the HL7 Test Result message for unsolicited Influenza results to CDC-EPI.

19 Vocabulary & Messaging WG Laboratory and IT SMEs from the SPHLs and CCID as well as Standards SMEs Coordinates the PHLIP community s development of the laboratory test method and result vocabulary (LOINC/SNOMED) and associated HL7 messaging

20 Primer WG All PHLIP participants contribute Focuses primarily on documenting the PHLIP story. (decisions, lessons learned etc..)

21 PHINMS Route Not Read Hub IT and interoperability SME s Piloting centralized technical architectures for message transmission between partners

22 Electronic Test Order and Result (ETOR) Laboratory and IT SMEs from the SPHLs and CCID as well as Standards SMEs Designs laboratory test order and linked result messages

23 Influenza ETOR Message Pilot Comprised of 5 pilot sites (IT and Lab SME s) Focused on implementing the 2.6 HL7 Test Order and Test Result message to support SPHL to SPHL surge capacity and mutual assistance.

24 7 weekly conference calls/webinars! Over 70 participants A LOT of time on the phone

25 To Participate in any PHLIP workgroup contact Michelle Meigs

26 PHLIP Tools and Deliverables and a detailed look at Electronic Test Order and Result Work John Carroll, MBA Riki Merrick, MPH PHLIP Cat herders aka PHLIP facilitators

27 PHLIP Complexity - Today # of NNDs 1 # of Value Use Cases 1 # of HL7 Messages 1 # of HL7 Versions 1 # of Versions of Vocabulary 1 # of SPHLs 7 # of CCID Labs 1 # of Networks Interoperable with PHLIP 0 # of Diseases & Conditions Beyond NNDs 0 # of Other Labs and Clinical Partners 0 PHLIP Complexometer 7 Note The numbers used in the PHLIP Complexometer are for illustration purposes only

28 PHLIP Complexity 10/1/2009 # of NNDs Influenza, LRN Agent, Salmonella 3 # of Value Use Cases surveillance, surge, routine 3 # of HL7 Messages ELSM, ETOR 2 # of HL7 Versions v2.3.1, v2.6 2 # of Versions of Vocabulary present, past, test 3 # of SPHLs assume 3 state trading partners per state 17 # of CCID Labs Influenza, LRN Agent, Salmonella 4 # of Networks Interoperable with PHLIP 0 # of Diseases & Conditions Beyond NNDs 0 # of Other Labs and Clinical Partners 0 PHLIP Complexometer 1,296 Note The numbers used in the PHLIP Complexometer are for illustration purposes only

29 PHLIP - Fully Implemented # of NNDs ~60 # of Value Use Cases 3+ # of HL7 Messages 3+ # of HL7 Versions 5 # of Versions of Vocabulary 3 # of SPHLs 50 # of CCID Labs ~80 # of Networks Interoperable with PHLIP? # of Diseases & Conditions Beyond NNDs? # of Other Labs and Clinical Partners? PHLIP Complexometer insert really BIG number here! Note The numbers used in the PHLIP Complexometer are for illustration purposes only

30 Reusable Resources The PHLIP Toolkit PHLIP Collaboration Portal (SharePoint) The PHLIP primer Readiness Assessment HL7 constrainable profiles Test Data Collection Sheet Test Category Sheet Encoding Guidelines Mapping Workbook

31 SharePoint

32 PHLIP Primer

33 PHLIP Primer Quotes

34 Readiness Assessment

35 Test Metadata Collection Sheet

36 Information Collected Agent (supra-family, family, genus, species) Specimen type (XXX, ISLT) Test class: Nucleic acid detection Test type: Probe, PCR (Conventional, Real-time) Specific target: Whole sequence, partial sequence Product: Manufacturer, specific product Is test stand-alone, panel Is result reported? What is reported? Raw result, interpretation, conclusion, summary conclusion?

37 Influenza Category sheet

38 Influenza Category sheet

39 Influenza Category sheet

40 Influenza Category Sheet

41 Influenza Category Sheet

42 Influenza Category Sheet

43 Influenza Encoding Guidelines

44 Influenza Mapping Workbook

46 First Value Use Case Laboratory Surveillance CDC CCHIS NCPHI SPHL & LIMS CCID Influenza Epi Result Data DMB PHIN MS Surveillance Result HL7 v PHLIP SPHLs 4 States in Production (VA, IA, CO, NE) 13 more States Testing Move to 50 PHLs

47 ETOR

48 PHLIP Focus HL7 Test Order and Linked Results Messages (ETOR) 2 use cases Test Result Harmonization Test Order Vocabulary Harmonization Route-not-Read Hubs (RnR) Test Message Validation Service Vocabulary Management Change Control Board

49 Slow Wasteful of Top Talent

50 Second Value Use Case State to CDC CDC CCHIS NCPHI SPHL & LIMS CCID LIMS Influenza Epi Result Data ELB PHIN MS Surveillance Result HL7 v PHLIP SPHLs CCID Lab (Salmonella) Order Data Specimen STAT Lab Hold until specimen received Order Data Routine Order - HL7 v2.6 RnR SPHL & LIMS FL IA NE VA Result Data Result Data Result - HL7 v2.6 Ship physical specimen B. anthracis has own flow Test Orders & Linked Results

51 To Be Process Flow States To CDC Initial Scope Local submitter sends a PHLIP HL7 Test Order and specimen RnR SPHL receives HL7 Test Order from submitter SPHL receives specimen and compares to order in LIMS SPHL conducts test(s) SPHL sends HL7 Test Result to submitter RnR Electronic report to submitter Yes Need referral? Yes Surveillance? SPHL prepares specimen for shipping to CDC SPHL LIMS prints edash* form to send with specimen SPHL LIMS transfers data for Lab Surveillance Reporting*** SPHL sends the specimen & edash form to CCID STAT Lab SPHL LIMS sends a PHLIP HL7 Test Order RnR CCHIS NCPHI DMB receives HL7 Message & Sends Data to CDC Epi RnR CCID STAT Lab receives shipments CCHIS NCPHI DMB receives HL7 Test Order & sends data to STAT Lab CDC Epi receives Laboratory Surveillance Report STAT Lab confirms specimen** and releases order STAT Lab investigates late shipments as needed STAT Lab transports specimen to CCID Lab CCID Lab assigns tests in STARLiMS CCID Lab CCID Lab**** CCID Lab CCID Lab**** enters CCID test Lab performs enters test performs results enters into test tests Day 1 results into tests Day 1 STARLiMS results into as possible STARLiMS as possible STARLiMS CCID Lab CCID Lab supervisor CCID Lab supervisor approves supervisor approves reports approves reports reports Report Report released Reportby released by CCID released Lab by CCID Lab to CCID STAT Lab to STAT Lab to STAT Lab CCID STAT Lab releases test results to DMB * For Influenza, the WHO form is used instead of the DASH form **For Influenza and some other NNDs, and frozen packages, STAT does not open ***Reporting may be through the SPHD depending on the Agent and/or State ****Tests performed in multiple CCID labs will be grouped as a study for reporting CCHIS NCPHI DMB sends a PHLIP HL7 Test Result to SPHL RnR Electronic report to SPHL

52 To Be Process Flow States To CDC - Generalized Local submitter sends a PHLIP HL7 Test Order and specimen RnR SPHL receives HL7 Test Order from submitter SPHL receives specimen and compares to order in LIMS SPHL conducts test(s) SPHL sends HL7 Test Result to submitter RnR Electronic report to submitter Yes Need Referral? Yes Surveillance? SPHL prepares specimen for shipping to CDC SPHL LIMS prints edash* form to send with specimen SPHL LIMS transfers data for Lab Surveillance Reporting*** RnR SPHL sends the specimen & edash form to CCID STAT Lab SPHL LIMS sends a PHLIP HL7 Test Order CCHIS NCPHI DMB receives HL7 Message & Sends Data to CDC Epi RnR CCID STAT Lab receives shipments CCHIS NCPHI DMB receives HL7 Test Order & sends data to STAT Lab CDC Epi receives Laboratory Surveillance Report STAT Lab confirms specimen** and releases order STAT Lab investigates late shipments as needed STAT Lab transports specimen to CCID Lab CCID Lab assigns tests in STARLiMS CCID Lab CCID Lab**** CCID Lab CCID Lab**** enters CCID test Lab performs enters test performs results enters into test tests Day 1 results into tests Day 1 STARLiMS results into as possible STARLiMS as possible STARLiMS CCID Lab CCID Lab supervisor CCID Lab supervisor approves supervisor approves reports approves reports reports Report Report released Report by released by CCID released Lab by CCID Lab to CCID STAT Lab to STAT Lab to STAT Lab CCID STAT Lab releases test results to DMB * For Influenza, the WHO form is used instead of the DASH form **For Influenza and some other NNDs, and frozen packages, STAT does not open ***Reporting may be through the SPHD depending on the Agent and/or State ****Tests performed in multiple CCID labs will be grouped as a study for reporting CCHIS NCPHI DMB sends a PHLIP HL7 Test Result to SPHL RnR Electronic report to SPHL

53 ROI Day-to-Day Operations SPHL doesn t have to double enter data on a DASH form and into their LIMS. STAT Lab doesn t have to re-enter data into STARLIMS. STAT Lab can accelerate release of Test Orders. CCID Lab can accelerate availability of Test Results. Increased confidence in the system. Reduction in possible errors and time of top talent to eliminate possible errors. Reduction of printing and mailing expenses.

57 Third Value Use Case State to State CDC CCHIS NCPHI SPHL & LIMS CCID LIMS CCID Lab (Salmonella, B. anthracis has own flow) Influenza Epi Order Data Specimen Result Data STAT Lab Hold until specimen received Result Data DMB Order Data Result Data PHIN MS Surveillance Result HL7 v Routine Order - HL7 v2.6 RnR Result - HL7 v2.6 HL7 Result RnR HL7 Order Specimen SPHL & LIMS Surge PHLIP SPHLs PanFlu IA MN - NE Physical Specimen PanFlu FL - TX Surge Capacity

59 And then there was Influenza A H1N1 (swine-like) Michelle Meigs Sr. Manager of Informatics PHLIP Steering Committee Member

60 What s in a name? A pig by any other name.

61 Influenza A unsubtypeable Novel Influenza A H1N1 Swine Influenza Virus Influenza A H1N1 swine-like Novel Influenza A H1N1 swine-like Influenza A H1, porcine swine-origin influenza virus Swine-origin Influenza A (H1N1) SO-IV Flu A/SW H1

62 PHLIP In Action PHLIP Outbreak Response States utilizing PHLIP Impact on daily operations PHLIP Role Lead in determining LOINC and SNOMED codes for new Influenza assays Collaborating with ELR, LIMSi, and other partners to harmonize

7th National Conference

7th National Conference on Laboratory Aspects of TB Atlanta, Georgia Advances in Laboratory Data Exchange Public Health Interoperability Project Update Jon Lipsky, The St. John Group June 14, 2011 1 Syllabus