Although nearly all laboratory testing for the Zika virus is conducted at public health laboratories, most of these labs currently do not have the ability to electronically exchange information such as orders and test results.
However, a joint project between the Office of the National Coordinator for Health Information Technology and the Centers for Disease Control and Prevention is attempting to create a national system for order entry and test reporting so that public health labs can interface with providers’ electronic health records, replacing the current manual process between providers and labs.
The agencies are also partnering with the Association of Public Health Laboratories, according to Michael Baker, an analyst in ONC’s Office of Policy.
“There’s a wide distribution of Zika virus cases that have been laboratory confirmed. And, it’s shocking that we don’t have a way that this information can get around efficiently and completely, which could slow care,” said Baker, who noted that in 2016 there were more than 5,000 cases of the mosquito-borne illness in the contiguous United States and more than 36,000 cases in the U.S. Territories.
So far, in 2017, there are only 110 Zika cases in the U.S. But, the outbreak will ramp up as this year’s mosquito season progresses, and “the creation of this system is going to help us track those cases better,” he added.
“We want to make sure that any Zika data that is created gets into the right hands quickly and is seen by the right stakeholders at the right time,” said Michelle Meigs, senior informatics program manager at the Association of Public Health Laboratories. “The tools that are in place right now to manage that data and specimens throughout the testing lifecycle are really lacking.”
To facilitate electronic transmission and sharing of laboratory test data, Meigs offered that the project will leverage Health Level 7 International’s emerging Fast Healthcare Interoperability Resources (FHIR) standard and a web portal for providers. “We are going to be looking at not only instituting the HL7 test order and results standard between the portal and the laboratory, but also hopefully from the EHR itself through the portal and to the laboratory,” she added.
Among the goals of the project, which is funded by the Department of Health and Human Services, is to ensure that public health labs receive a standard pregnancy status with electronic lab orders. Because Zika can be passed to fetuses, potentially causing severe fetal birth defects, capturing pregnancy status and sharing the data with public health partners is critical to documenting Zika infection in pregnant women and informing interventions.
“We want to be able to track those cases and prioritize those testing regions so we know to inform the women, potentially, between providers and labs as fast as they can so they can work with their providers for monitoring,” said Baker.
Part of the HHS Ventures Fund, the CDC-ONC project was one of five entrepreneurial projects selected for growth-stage funding—$375,000 in total—to advance the department’s innovation agenda.
“This project would enable efficient data transmission and improve care for patients by transmitting orders and results in a faster and more efficient way,” states an HHS announcement. “Additionally, this would build the capacity of public health laboratories to respond and manage future changes in testing requirements guidance from public health authorities.”
Baker said Florida and Texas have committed to be pilot sites for the project, as most of the U.S. Zika cases are located in those two states. “Once we get these pilots up and running, other states and other state public health labs will hopefully agree to take part in this,” he concluded.
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