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标题：Government Leadership in Addressing Public Health Priorities: Strides and Delays in Electronic Laboratory Reporting in the United States
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作者：Rebecca Tave Gluskin ; Maushumi Mavinkurve ; Jay K. Varma 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：3
页码：e16-e21
DOI：10.2105/AJPH.2013.301753
语种：English
出版社：American Public Health Association
摘要：For nearly a decade, interest groups, from politicians to economists to physicians, have touted digitization of the nation’s health information. One frequently mentioned benefit is the transmission of information electronically from laboratories to public health personnel, allowing them to rapidly analyze and act on these data. Switching from paper to electronic laboratory reports (ELRs) was thought to solve many public health surveillance issues, including workload, accuracy, and timeliness. However, barriers remain for both laboratories and public health agencies to realize the full benefits of ELRs. The New York City experience highlights several successes and challenges of electronic reporting and is supported by peer-reviewed literature. Lessons learned from ELR systems will benefit efforts to standardize electronic medical records reporting to health departments. LABORATORY REPORTS SUPPORT passive public health surveillance, providing highly specific data about health conditions in a community. Efficient electronic exchange of laboratory information can facilitate time-sensitive decision-making. 1 This is particularly true for infectious diseases, which require timely, accurate data to confirm diagnoses, detect outbreaks, and prevent transmission of disease to additional people. As public health agencies expand their mission to address chronic diseases, such as diabetes, laboratory reporting will also have an important role. At present, electronic laboratory reports (ELRs) offer a more accurate, complete, and efficient data source for public health surveillance than do paper reports. 2 Significant progress has been made in using ELRs, but challenges still exist for this public health reporting system. Since early in the 21st century, clinical laboratories have been transitioning from a system of mailing or faxing test results to exclusively transmitting data electronically to health departments. After September 11, 2001, Congress set up the Terrorism Preparedness and Emergency Response funds to support the public health emergency preparedness activities of the Centers for Disease Control and Prevention (CDC). This revenue initiated many state and local ELR systems, but funds have declined from $970 million in FY 2003 to $657 million in FY 2012. 3 The National Electronic Disease Surveillance System coordinated by CDC provides standards and software and hardware resources to state and local health departments to implement standards-based ELR systems between clinics, health departments, and CDC. This national surveillance program has both accelerated ELR adoption, by providing standards, and delayed development, because of funding shortages and a lack of infrastructure support. 4 In New York City, local public health legislation also facilitated ELR adoption. 5 Improvements in technology, such as the incorporation of some messaging syntax standards into laboratory information management systems, have accelerated the shift to ELRs. 2 In 2010, 42 US states reported having general communicable disease surveillance systems that incorporate ELRs, 4 but how complete these systems are is unclear. Federal legislation such as the Health Information Technology for Economic and Clinical Health Act, part of the American Reinvestment and Recovery Act of 2009, further advanced the use of ELRs in health care facilities that employ electronic medical records (EMRs). This act created Meaningful Use (MU), a federal program with financial incentives to implement, upgrade, and demonstrate meaningful use of certified electronic health record technology. ELRs were included as part of the stage 1 MU incentives. 4,6 MU, however, does not provide financial incentives for commercial clinical laboratories to make technology upgrades. A broader goal of the health information technology legislation and MU is for health care providers to eventually communicate with public health agencies electronically, rather than by paper or phone. For several reasons, EMR adoption has been a challenge. 7 An efficient ELR surveillance system will be a valuable resource for public health, and the lessons learned from ELR implementation, such as the establishment of standards, will help inform the subsequent use of EMRs for public health surveillance. After reviewing the peer-reviewed literature addressing the topic of ELRs published between January 2000 and July 2012, we identified both substantial accomplishments and remaining challenges. The decision logic for the literature review and article inclusion is presented in Figure 1 . To outline the issues, we studied the New York City Department of Health and Mental Hygiene (DOHMH) experience and followed the flow of a report from the clinical laboratory to the public health department. Along this cascade of information we identified major strides, delays, and possible solutions. Open in a separate window FIGURE 1— Literature review inclusion decision tree for electronic laboratory reports in public health. Note . ELR = electronic laboratory report; LOINC = Logical Observation Identifiers Names and Codes. The term SNOMED was not included in the search criteria because it did not noticeably improve the results of the search over using the term LOINC alone.