Included in the strategies for demonstrating Meaningful Use of the EHR systems is the electronic submission of reportable laboratory results. This is often referred to as electronic laboratory reporting, or ELR. This objective applies to Eligible Hospitals.
Laboratory reporting is required for conditions which present a significant health risk to the community and for which there are measures available to control the spread or progression of disease. Electronic submission of findings meets Virginia’s reporting requirements. VDH provides a list of the conditions reportable by laboratory directors.
Please note: Submitters must continue traditional reporting practices (i.e. fax, phone, or mail) during implementation of electronic reporting until VDH determines that all on-boarding and quality assurance steps are complete.
Exclusions: Virginia is able to receive electronic laboratory reporting messages in HL7 2.5.1. There are no exclusions for the ELR message for Virginia hospitals.
For Meaningful Use (MU) Stage 1, providers must complete Steps 1-3 (Registration, Message Structure Validation, Connectivity). For MU Stage 2, providers must demonstrate ongoing progress towards Step 5 (Production). At the end of the reporting period, providers registered in the VDH Meaningful Use Registration System will receive acknowledgement, via email, of the VDH MU status achieved. VDH MU statuses are: Registered, Invited to Onboard, Testing and Validation, and In Production.
Click on each step below to learn more.
|1||Registration: Eligible Hospital (EH) registers intent to submit electronic lab report data for MU.|
|2||Message Structure Validation: EH generates electronic lab report messages with test data for structural validation by VDH.|
|3||Connectivity: EH sets up transport option with public health.|
|4||Message Content Validation: EH submits electronic lab report messages to public health for content validation using selected transport method.|
|5||Production: EH initiates ongoing submission of electronic lab report data and participates in periodic quality assurance activities.|
Is VDH accepting electronic laboratory reporting from eligible hospitals, including critical access hospitals?
Yes, VDH is accepting electronic laboratory messages from eligible hospitals and critical access hospitals for Stages 1 and 2 of Meaningful Use.
Are all health care providers and hospitals asked to submit reportable laboratory results?
In Virginia, hospital laboratories and other laboratories are being encouraged to replace paper-based reporting with electronic laboratory reporting, also called ELR. For hospitals, electronic lab reporting meets one of the Meaningful Use objectives.
Which conditions are laboratories required to report in Virginia?
Laboratory reporting is required for conditions which present a significant health risk to the community and for which there are measures available to control the spread or progression of disease. You can find the list of conditions reportable by laboratories in Virginia at http://www.vdh.virginia.gov/Epidemiology/documents/pdf/RepCond_TableforLabs.pdf.
What is the expected reporting timeframe for laboratory findings?
Virginia’s Regulations for Disease Reporting and Control specify the time frames in which reports must be submitted. For electronic lab reporting, batch transmissions should be scheduled at least daily. Even if rapidly reportable findings have been communicated to public health by telephone, they should be included in the transmission and sent within 24 hours of the finding. The reverse is also true. If a rapidly reportable finding is sent to VDH electronically, VDH still expects the hospital to call the local health department to communicate the finding.
How do I register my intent to submit reportable laboratory findings to VDH for Meaningful Use, Stage 1 or Stage 2?
Through VDH’s Meaningful Use Registration System.
Where can I find the specifications for the ELR “Meaningful Use” message?
Meaningful Use requires an HL7 2.5.1 message. See the following resources for information on these specifications:
Do we need to use LOINC and SNOMED codes in preparing our messages?
Yes, use LOINC (Logical Observation Identifiers Names and Codes) and SNOMED (Systematized Nomenclature of Medicine) to code tests, findings and other relevant information for electronic laboratory reports (ELRs). Use of LOINC is required to populate information related to tests and lab orders. Use of SNOMED codes for specimen information, organisms and other test findings, is required for Meaningful Use Stage 2. When LOINC or SNOMED codes do not exist, use of local or proprietary code is permitted. Compliance with all vocabulary standards specified in the HL7 v 2.5.1 Implementation Guide for ELR to Public Health is required for acceptance of the message by public health. A list of your lab’s unique LOINC and SNOMED combinations for reportable conditions should be submitted to VDH before structural validation of electronic laboratory messages so that VDH can set up the appropriate filters in our system.
Where do I find LOINC and SNOMED codes to start developing our messages?
LOINC (Logical Observation Identifiers Names and Codes) is used to represent tests and lab orders. You can search for LOINC codes and their descriptions by using key words or by entering a LOINC at http://search.loinc.org/.
SNOMED (Systematized Nomenclature of Medicine) is used to represent specimens and test findings. The official site for SNOMED vocabulary is the National Library of Medicine (NLM) site at https://uts.nlm.nih.gov/home.html. Click on the right hand corner “Sign up” and complete your information to request a UMLS (Unified Medical Language System) license. You will receive an email to authenticate your license request, then a second email when your request has been approved. To get to the SNOMED Browser, click on “SNOMEDT CT” on the green navigation bar, then “SNOMED CT Browser.” Another site where you can search for SNOMED codes by using key words or by entering a code is http://vtsl.vetmed.vt.edu/. To get to the SNOMED Browser, click the “Browser” button on the menu at the left.
Is there a typical logic or pattern for use of LOINC and SNOMED codes?
If a lab test is a more general test, like a culture, the LOINC code is also going to be general, e.g., bacteria identified or virus identified. In this instance, the SNOMED would transmit specific information about what bacteria or virus was identified, and will name an organism. If a lab test is more specific, like a pertussis DNA test, the LOINC code is also going to be specific. In this instance, the SNOMED code would be more general and indicate something like “positive” or “detected.”
How can I check developed messages to ensure they are valid and conform to HL7 standards?
Messages can be validated using the NIST (National Institutes of Standards and Technology) message validation tool, available at http://hl7v2-elr-testing.nist.gov/mu-elr/.
If our hospital uses a reference lab, do we need to include messages for findings from the reference lab?
Yes, the hospital must report findings from out-of-state reference labs. Please include these findings in your electronic lab report messages if your laboratory information system (LIS) is able to do so. If not, continue to submit these reports to public health by fax or mail.
Should ELR data transmissions be sent to the VDH central office or to the local health department?
You should submit ELR messages to the VDH central office. Because Virginia’s public health system uses centralized databases with role-based access for appropriate local public health staff, Meaningful Use data transmissions submitted through the VDH messaging portal make data available to local health department staff.
What are the options for transport of electronic laboratory messages?
Your options are identified on the Transport Options webpage.
What are the expected steps with regard to the Meaningful Use onboarding process for reportable laboratory findings?
The steps involved are outlined in the onboarding process above.
How long does it usually take for a hospital to progress through the onboarding steps, from development of message structure and content to the ongoing submission of messages to VDH’s production environment?
It depends on several factors, including the time and staff that the laboratory has available to work on the project, and how focused it remains in responding to and incorporating feedback from VDH on refining message structure or content. The process from beginning to end can take several months.
Once we begin sending ELR, can we stop mailing or faxing reportable lab findings to our local health department?
Not right away. While we want to transition from paper-based reporting to ELR, traditional mailed or faxed reports to your local health department will continue for a period after electronic reporting has begun to allow additional validation. You will be notified when you may discontinue the mailed or faxed reports.
Does ELR only replace reporting by the laboratory or does it also replace disease reports sent to public health by our Infection Preventionst (IP)?
ELR only replaces laboratory reporting. Clinicians, IPs and others are still required to report suspected or confirmed diagnoses of reportable conditions.
Where can I find additional information about Meaningful Use?
The following are links to web pages on Meaningful Use:
Electronic Lab Reporting: