RnR Presentation to ELR National Working Group

PHLIP Route-Not-Read HubNational ELR Working Group | October 4, 2011

The Plan

• PHLIP• PHINMS• RnR HubsFoundation

• ELSM• Pandemic Influenza• ETOR Salmonella• Electronic Lab Reporting

RnR In Action

Florida RnR Hub Team• Frans de Wet• John Butler• Eddie Gonzalez

Loumiet

Nebraska RnR Hub Team• Jim Svoboda• John Glock

• Bob Williams

• PHLIP Assistance Teams

The Team

Public Health Laboratory Interoperability Project

(PHLIP)

PHIN-MS Route-Not-Read Hub (RnR Hub)

• A National Resource: Information and laboratory scientists at the state and federal level addressing highly complex technical issues critical to public health.

• A Collaboration: commitment to utilize NwHIN IT architecture options for the exchange of electronic laboratory data at all levels of public health laboratories.

• A Community: to support and expand LIMS user communities, creating a process that can be applied to other highly complex problems

• Products and Publications: Documentation of decisions made, fiscal and human resources needed, and lessons learned. Development and dissemination of Vocabulary and Messaging guides to meet the needs of the Public Health Laboratory “harmonized” list of LOINC and SNOMED codes for nationally notifiable diseases (NND’s).

• A Success: The realization of common goals and national priorities in a production environment.

What is PHLIP?

Achieve bi-directional laboratory data exchange • State public health labs (SPHL) with CDC labs • SPHLs with local partners

Which will• Improve data quality and accessibility• Improve data sources for active surveillance• Develop and test future system approaches• Create a Strengthened collaborative environment for public health

National Interoperable Laboratory System

PHLIP Vision

• National collaborative process

• Provide detailed vocabulary implementation guidelines

• Build PHL capability for electronic test ordering and result reporting

• Develop data exchange architecture options using the PHINMS

• Establish a process to help labs increase messaging capability

PHLIP Florida RnR Hub Team

PHLIP Building Blocks

• Public Health Information Network – Messaging System• Provides public health applications a common platform for message

transport • Secure and reliable over the Internet • Standards-based -“De-facto” standard for secure message transport• Available at no cost to users• Applications using PHINMS include: BioSense, ELR, LRN,

NBS,NND, NHSN, LabCorp, PerSe, Foodborne, BSIO, PHLIP• Used by Public Health Information Network Certification (PHIN)• 8-year old product deemed “mission critical” by CDC• Over 700 PHIN-MS nodes used in U.S.

What is PHINMS?

Multiple Senders to Multiple Receivers = exponential growth of connections and maintenance

Direct Send Model

RnR Hub

Solution

• The RnR Hub focuses on reducing the overhead of the PHINMS Direct Send model

• A PHINMS receiver is not required for bi-directional messaging• Additional firewall configuration is not typically required for each Trading Partner – infrastructure needs are low

• Facilitates rapid implementation of electronic message exchange• Low deployment costs for partners - Ability to send pre-configured install “package”

• Reduction of management burden• Message routing• Certificate management• Hardware and bandwidth needs

• Once on the RnR Hub, you can exchangeInformation with all others on the RnR Hub• Centralized Support provided by the RnRHub Team

What is the RnR Hub?

PHLIP Use Case 1 – ELSMInfluenza – Electronic Laboratory Surveillance Message

• Goal: All states sending Influenza results via the PHLIP HL7 Message to CDC

• New states to complete readiness assessment and agree to PHLIP decisions

• All states to provide Influenza reporting metrics

• PHLIP Assistance Teams to deliver onsite and virtual support and PHLIP Program Management to provide oversight.

• Future: additional PHLIS agents as prioritized by CDC

State Public Health Lab

(SPHL)

PHLIP Route-Not-Read

Hub

CDC – Influenza Division

Message Format: HL7 2.3.1 ORU

Contents: Influenza Laboratory Results (WHO Global Influenza Surveillance Network)

HL7 Test Result HL7 Test Result

2. Pandemic Influenza

3. ETOR Salmonella

4. Electronic Lab Reporting in Florida

RnR in Action

• Exchange of influenza lab data with:• Local partners• Other states• Federal partners• International partners

• Exchange of lab test orders and results

• Develop surge capacity model for Pan Flu testing

Pan Flu Project: Goals

DISTANCE from Tallahassee to AUSTIN = 868 MILES

Use Case 2 – ETOR Service Requests

State to CDC – Electronic Test Order and Result

• HL7 Test Order from State Public Health Lab (PHL) to CDC Lab(s)

• HL7 Test Result from CDC Lab(s) to State PHL

• Limited Scope Production phase includes Salmonella and Bacillus anthracis

State Public

Health Lab (SPHL)

PHLIP Route-Not-Read Hub

CDC LabsSalmonella & BRRAT

Message Format:• Order = HL7 2.6 ORM

• Result = HL7 2.6 OUL

Contents: Salmonella & Bacillus Anthracis Orders and Results

Status: In progress

HL7 Test Order HL7 Test Order

HL7 Test Result HL7 Test Result

SPHL to CDC· Bi-directional Test Orders and Results· Designed to replace “DASH” form and

faxed results· Test orders directly from State LIMS

· Reduces Steps for Laboratorians· Increases quality of data,

immediate validation of order· Automatic confirmation of receipt

of order

· Test results directly from CDC LIMS· Automatic Update of State LIMS· Preliminary, Final and Amended

results· Increases quality of data· Faster turn-around

State Public Health

Lab (SPHL)

PHLIP Route-

Not-Read Hub

CDCSalmonell

aLab

HL7 Test Order

HL7 Test Order

HL7 Test Result

HL7 Test Result

• Chapter 64D-3 of the Florida Administrative Code

• Notifiable diseases and conditions

• Disease surveillance

• HL7

Electronic Lab Reporting

Data Transmission:

• sFTP

• PHIN-MS

• VPN

• Dedicated Circuit

Electronic Lab Reporting

• Register all state public health labs on the RnR Hub

• Continue to collaborate with Federal, State, and Local public health departments in addition to private health care providers and labs

• Continue to work on additional use cases like Salmonella

• Coordinate with the Public Health Laboratory Solutions and Solution Architecture (PHLISSA) project

• Continue developing interoperability between Direct and PHINMS

• Continue development of the PHLIP architecture, with the expectation that the RnR Hub will serve as a connection to both the NwHIN and the State Health Information Networks.

What’s Next?

Teamwork

http://bit.ly/PHLIP-Info http://bit.ly/PHLIP-FLASH

http://bit.ly/RNR-1 http://bit.ly/RNR-2

http://bit.ly/PHINMS

Additional Resources

Eduardo “Eddie” Gonzalez LoumietTeam Leader – Florida RnR Hub

eddie@uberops.com(850) 766 – 5338

Contact Information