Electronic Laboratory Reporting

From Clinfowiki
Jump to: navigation, search

Electronic Laboratory Reporting (ELR), is the electronic transmission from laboratories to public health of laboratory reports which identify reportable conditions and infectious diseases through an automated and secure process. ELR will replace paper-based reporting for most reportable infectious diseases and has the potential to be used for reporting of other laboratory findings, such as cancer pathology reports and blood lead level results.


  • Timeliness.
  • Reduction of manual data entry errors.
  • Reports that are more complete.


In 1997, the Centers for Disease Control and Prevention (CDC) and other public health partners got together to determine standards for electronically submitting surveillance data to public health laboratories across the country. These standards include:

  • An electronic message format of standard Health Level Seven (HL7)
  • Tests coded with the Logical Observation Identifiers Names and Codes (LOINC)
  • Results coded with the Systemized Nomenclature for Medicine terminology (SNOMED)

Meaningful use

Electronic Laboratory Reporting has been promoted as a public health priority for the past several years and its inclusion as a meaningful use objective for public health serves as a catalyst to accelerate its adoption. The Centers for Medicare & Medicaid Services (CMS) have launched the “Medicare and Medicaid Programs: Electronic Health Records Incentive Program” to provide incentive payments to Eligible Professionals (EPs), Eligible Hospitals [EHs) and Critical Access Hospitals (CAHs) participating in the Medicare and Medicaid programs, that adopt and successfully demonstrate meaningful use of certified Electronic Health Records (EHR) technology.

Stage 1 meaningful use:

  • Objective: Capability to submit electronic data on reportable (as required by state or local law) lab results to PH agencies and actual submission in accordance with applicable law and practice.
  • Measure: Performed at least one test of EHR’s technology’s capacity to provide results electronic submission of reportable lab results to public health agencies and follow–up submission if the test is successful.

While the reportable lab results meaningful use objective promotes adoption by hospitals and laboratories, it does not address state challenges in receiving the data nor does it provide vendors and laboratories practical implementation guidelines for providing electronic laboratory reports to public health.

Proposed criteria for Stage 2 Meaningful Use add surveillance reporting for eligible providers, giving them the option to either send the data from their EHR or to have it sent directly from their lab.

ELR for public health

With respect to public health disease surveillance activities, ELR is most useful for conditions where the diagnosis can be based solely on positive (or negative) results from laboratory testing, such as Chlamydia and Salmonella infection, among others. For other diseases that require more clinical input for diagnosis, such as Lyme disease, ELR can be a valuable adjunct but cannot replace clinical examination. ELR has the potential to be used for other public health surveillance purposes, including tracking the volume of test ordering (e.g., the number of influenza cultures ordered) to detect outbreaks at the earliest possible moment, and tracking the reporting of other laboratory-diagnosed non-communicable public health problems, such as lead or mercury toxicity.

ELR and Patient Privacy

The increased use of electronic medical records has been accompanied by an increased concern in the security of the information and the privacy of the individuals involved. Many electronic health record (EHR) and health information exchange (HIE) endeavors are struggling with how best to allow patients to opt-in or opt-out of information sharing arrangements. In the public health realm this issue is simplified somewhat by a provision of the Health Insurance Portability and Accountability Act (HIPAA). The act permits a provider to report a patient’s medical information pertaining to a communicable disease to the appropriate public health jurisdiction without the patient’s authorization. This HIPAA exemption is applicable regardless of the means used to transfer such information, whether it is by paper or electronic transmission, and whether the process is completely automated or is manually executed. ELR is covered by this rule and therefore, there are no requirements for anonymized laboratory results or otherwise stripped results of potentially identifying information.


Large national and regional laboratories have developed advanced information technology (IT) capabilities and use standardized test codes, making ELR possible, but not all lab systems have this capability, and many smaller laboratories that are not using a laboratory information system do not have the technology necessary for ELR. Additionally, many states have reporting regulations that are not structured for electronic reporting.

ELR Web Resources

Centers for Disease Control and Prevention Website; Electronic Laboratory Reporting (ELR) http://www.cdc.gov/ehrmeaningfuluse/elr.html

Orchardsoft Blog; Electronic Laboratory Reporting (ELR) – What is it anyway? http://www.orchardsoft.com/blog/?p=354

STC Website; The Value Of Electronic Laboratory Reporting For Public Health http://www.stchome.com/media/white_papers/value_of_electronic_laboratory_reporting_for_public_health.pdf

Submitted by (Yazan Jabr)