Laboratory Data: Blazing New Pathways for Connection

Automating the exchange of laboratory data lets people get down to the real work of public health

Epidemiologists, laboratory scientists, and surveillance officers across our nation are doing the tough day-to-day work of monitoring diseases and investigating cases. They need to be able to do their jobs without having to spend time on manual and duplicative data entry, following up on missing or delayed data, or fixing computer issues because they don’t have what they need in their systems.

Since the start of the COVID-19 pandemic, laboratory reporting has skyrocketed, from ~30 million reports per year to up to ~50 million every month.

This is the reason Epidemiology and Laboratory Capacity (ELC) Cooperative Agreement investments have been made to specifically expand electronic laboratory reporting (ELR). Where traditional methods like fax or mail are slow and error-prone, ELR automation speeds the ability to respond to cases, outbreaks, and public health emergencies.

ELR makes more connections, faster

The structures, pathways, and close partnerships around ELR, which ELC strengthened over the past decade, helped public health quickly address the laboratory data challenges of the COVID-19 response. For example, in 2020, there was neither a process nor an expectation for public health departments to report laboratory results, including all COVID-19 test results (independently from case data), directly to CDC. This COVID-19 laboratory data was critical to help

people understand their personal risk,
communities know the level of local disease transmission to improve response efforts, and
healthcare systems be prepared.

To respond to COVID-19, we leveraged existing connections with the Association of Public Health Laboratories (APHL) Informatics Messaging Service (AIMS) — a platform used to send critical data between laboratories, testing centers, hospitals, state and local health departments, and CDC. A new workflow was created for over 55 state, territorial, and local jurisdictions, with laboratory data flowing to CDC within four weeks. Since March 2020, more than 3 billion COVID-19 electronic laboratory records have been processed via AIMS. These laboratory data are used for routine reporting across CDC, HHS, the White House, and Congress. They are also made publicly available and can be accessed at healthdata.gov and on the CDC COVID Data Tracker.

“Electronic Laboratory Reporting (ELR) is, in my opinion, an unsung hero of the COVID-19 response across the nation. But it could not have happened without the building of systems at laboratories and in health departments to send and receive the data, and many hours of hard work in states and local jurisdictions over the past 15 years. This shows why investments in data infrastructure and the workforce (the skilled people who build and maintain it) are so important!”

– Annie Fine, MD, Chief Science and Surveillance Officer and Senior Advisor to Data Modernization Initiative, Council of State and Territorial Epidemiologists

Free SimpleReport app adds capacity

During the pandemic response, there was a surge of non-traditional partners and organizations that performed COVID-19 testing and had never reported laboratory results to public health departments before. These partners and organizations needed a secure way to collect and report COVID-19 testing data.

The free SimpleReport application developed by CDC and the U.S. Digital Service allows any testing provider, such as a school, correctional facility, assisted living facility, or employer, to securely send high-quality, structured data to public health departments. SimpleReport makes the reporting process easier, saving time and effort by replacing multiple faxes, phone calls, and sharing of spreadsheets. The tool has now expanded to allow reporting of combination flu/COVID tests and is currently piloting a solution for reporting of sexually transmitted disease (STD) testing.

Electronic Test Orders and Results linking healthcare and public health laboratories

The faster public health laboratories receive and process test orders, the sooner they can provide results that are essential for early intervention, active surveillance, and response to outbreaks and public health emergencies. CDC and APHL have been working together to create new capabilities for Electronic Test Orders and Results (ETOR) between healthcare facilities and public health laboratories.

ETOR builds on and unifies existing electronic systems using agreed-upon standards to transmit laboratory test orders, specimen information, patient data, and results. It allows data to flow between the healthcare provider’s existing electronic medical record system and the laboratory’s existing information management system. This exchange decreases the use of paper-based test orders and reports, reducing the risk of errors from manual data entry and result reporting, while ensuring that accurate testing information is captured and transmitted to a patient’s medical record in a timely manner.

ReportStream expands to more conditions

CDC and the U.S. Digital Service developed ReportStream, a platform that allows public health departments to get faster, more accurate laboratory data directly from testing facilities, laboratories, and more — all through a single connection. While initially developed to meet the needs of the COVID-19 response, as part of DMI, the expansion of ReportStream is underway to handle any condition, as well as other laboratory data flows.

What’s next

While there is still work to do, many of the initial targets have been reached, and we have arrived in a place not imagined years ago. Through a combination of funding and technical assistance, we’ve seen dramatic adoption of technologies that make it easier to exchange laboratory data across the nation, and we continue to strengthen our readiness for any future threat.