Introduction

Public health agencies collect information related to communicable diseases as part of their function to ensure the general health of the population. This information helps public health agencies prevent the spread of disease by both detecting occurrences of specific conditions and managing those occurrences when they happen. A fundamental building block of disease surveillance is accurate and timely diagnosis, which often takes the form of a positive lab test result for a predefined set of monitored conditions. This process is usually called Electronic Lab Reporting (ELR).

The National Electronic Disease Surveillance System (NEDSS) is an Internet-based infrastructure for public health surveillance data exchange. Rather than being a single, monolithic application, NEDSS is a system of interoperable subsystems, components and systems modules that include software applications developed and implemented by the CDC; those developed and implemented by State and Local health departments and those created by commercial services and vendors. Critical to the long-term success of NEDSS is the quick and efficient transmission of critical data from clinical systems to the appropriate local, state, and Federal public health agencies. The exact path of this data differs from state to state, as do the specific reporting requirements for individual conditions or suspected conditions. Consult with your state public health agency for specific requirements.

Meaningful Use

For both the Mod Period and Stage 3 Meaningful Use, there is now one public health reporting objective with multiple measures, including syndromic surveillance reporting. However, for Stage 3, only EPs who practice in urgent care settings are eligible to claim this measure. The Medicare and Medicaid Programs Electronic Health Record Incentive Program Final Rule for Stage 3 (October 2015), contains the following objective and measure relative to syndromic surveillance:

EH/CAH Objective: The eligible hospital or CAH is in active engagement with a public health agency to submit electronic public health data from CEHRT except where prohibited and in accordance with applicable law and practice.
EH/CAH Measure: The eligible hospital, or CAH is in active engagement with a public health agency to submit electronic reportable laboratory results.

Though the infrastructure to support HIEs is still developing, there is an expectation that as the program proceeds expectations for submission of disease surveillance information to public health agencies via HIE will increase.

Technical Standards

The ONC 2014 Edition Health Information Technology (Health IT) Certification Criteria (September, 2014) identified the following standards for ELR data results submission for Stage 2 which continue to apply for the Mod Period (2015-2017), as well as Stage 3:

(g):Electronic transmission of lab results to public health agencies. Standard. HL7 2.5.1 (incorporated by reference in § 170.299). Implementation specifications. HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 (US Realm) (incorporated by reference in § 170.299) with Errata and Clarifications, (incorporated by reference in § 170.299) and ELR 2.5.1 Clarification Document for EHR Technology Certification, (incorporated by reference in § 170.299)

For terminology, use of SNOMED-CT® and LOINC® coding is required.

Testing Procedures

The National Institute of Standards and Technology (NIST) has provided a guidance document and testing tools (see right panel) for ensuring that certified EHR systems can properly submit lab results data to a public health agency.