"Starting From Scratch" - the Recipe for An Effective STD ELR Framework in Virginia

Background:  Electronic laboratory records (ELR) are paramount to the future of STD surveillance.  The advent of Meaningful Use (MU) incentives for healthcare providers also provides public health with enhanced data collection opportunities.  However, the lack of sufficient informatics infrastructure within STD programs presents formidable challenges, especially for programs lacking an electronic medical record system.

Objectives:  This abstract describes efforts from Virginia’s STD program to develop an effective ELR infrastructure. Existing integrated operations, new collaborations and validation activities are described that form the basis for ongoing STD ELR infrastructure development.

Project Description:  Virginia has an integrated division inclusive of STD/HIV programs, including a unit called Health Informatics & Integrated Surveillance Systems (HIISS) that provides cross-programmatic epidemiologic and data support.  Since 12/2008, HIISS has worked with Virginia’s NEDSS staff on incoming, parsed HL7 messages that are subsequently stored via SQL server.  Unlike NEDSS, STD/HIV surveillance systems lack built-in capacity for ELR review.   Hence, HIISS required an interface for manual ELR validation.  Non-STD federal funding has also been solicited to assist with ELR infrastructure and validation.  Participation in Informatics/MU/laboratory workgroups and engagement with the department’s IT office has been encouraged. 

Findings:  Since 9/2010, HIISS has received $565,186 in HIV ELR funds, hired one full-time informaticist and nine contractors using various program funding (6 validators, 1 HL7 and 2 SQL contractors), validated approximately  4,100 STD and 5,900 HIV ELRs, provided laboratory feedback, collaboratively purchased 19 licenses of commercial ELR software, assessed ELR parsing issues and received ELR training. 

Conclusions:  Informatics collaboration and integration can provide scarce resources that strengthen STD ELR infrastructure and improve cross-programmatic understanding.  ELR validation is a necessity for ensuring data quality.

Implications for Programs, Policy, and Research:  STD programs must establish validation procedures before ELR importation to ensure data quality.  Collaborating with other public health programs can create mutually beneficial funding streams and bi-directional understanding of infrastructure requirements and expertise.