Know your LIS vendors - implementing Electronic Laboratory Reporting at the front line

Authors: Susan May, Sue Lee, Heather Capel, John Piraino, Ray Aller Title: Know your LIS vendors – implementing Electronic Laboratory Reporting at the front line. Electronic Laboratory Reporting (ELR) is a critical component of public health preparedness; therefore many state and county public health jurisdictions are implementing electronic reporting solutions. Los Angeles County is currently interfacing over 120 clinical labs to the Public Health Disease Reporting System. This task requires familiarity with the capabilities of numerous Laboratory Information System (LIS) vendors. Achieving a viable interface solution with these vendors has presented a number of challenges and lessons learned. Since there are a limited number of widely used LIS vendors, knowledge of these experiences can be beneficial to others tasked with the same goal. One of the challenges with implementing an ELR interface is the variation in how HL7 standards are developed by each LIS vendor. Even within the same HL7 format, how data is mapped into HL7 fields can drastically differ between vendors, causing challenges when processing incoming public health results from multiple labs into a single system. To achieve a consistent representation of these diverse results, middleware solutions must perform careful transformations and filtering of messages. Another common challenge is the limited availability of data, such as patient address and phone number, which are critical components to enable public health staff to investigate reportable cases. However, frequently this data is not captured by the LIS or provided by the Hospital Information System (HIS) through the interface. Consequently, additional efforts and costs are necessary to acquire this information. Performing detailed analysis, on the HL7 messages, will ensure future compliance to an agreed upon HL7 standard. Finally, implementation of a solid middleware solution with the flexibility to handle the "surprises" that come with diverse LIS system messages is crucial.