The Validator: A “Must See” Prequel to Electronic Laboratory Reporting

Background:  Electronic Laboratory Reporting (ELR) is the future for efficient and standardized receipt of communicable disease laboratory data. But, numerous challenges must be met, including staffing expertise and information technology infrastructure.  Receipt and importation of ELR is typically the primary focus for STD/HIV programs; however, structural and content validation are critical, interdependent components that must be addressed to ensure adequate ELR data quality management.

Methods:  The Division of Disease Prevention (DDP) collaborated with laboratories to establish mechanisms for HL7 ELR transport.   Once established, test message structural validation and issue resolution occurred using two validators contracted via HIV surveillance funding.  Messages were subsequently validated for content, comparing ELR to corresponding paper reports.  A customized application, with minor provider-specific modifications, was used to assign values to each ELR field for deterministic data matching.  Content validation results were summarized via Facility ELR Assessment Reports (FEAR) for programmatic review/approval.

Results:  Structural and content validation has been completed for >9,000 ELRs from five laboratories.   DDP has also performed HL7 structure validation for >120 different messages from 14 private laboratories, and identified and resolved >500 unique message errors.  Staff worked with laboratories to reduce data inaccuracies and incompleteness to <4%.  To date, the average ELR record is received 48 hours faster than traditional mail or facsimile.

Conclusions:  Validation of STD/HIV ELRs provides meaningful data for programmatic data quality acceptance standards.  Virginia’s STD/HIV validation framework has been incorporated as a core component for on-boarding all future ELR providers, including use by the general communicable disease program.  Results illustrate that receipt of ELR data compared to traditional paper reporting is more accurate, complete and faster, and that validation is critical for any new provider ELR messaging.  The use of FEAR reports allows STD/HIV programs to quantify and fix data quality issues prior to incorporation into surveillance systems.