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About Electronic Disease
Surveillance at the Department of State Health Services
monitoring the occurrence of disease through reporting of test results for notifiable
conditions is a cornerstone of public health
surveillance in Texas. The National
Electronic Disease Surveillance System (NEDSS) Electronic
Laboratory Reporting (ELR) system at the Texas Department of State Health
Services (DSHS) provides a method for hospital and clinical laboratories to electronically
submit test results to fulfill their statutory obligation to report test
results to the public health authority.
What is Electronic Laboratory Reporting (ELR)?
Reporting (ELR) is the electronic transmission of results from laboratories that
conduct tests for specific high-profile and/or contagious diseases to public
health authorities so that appropriate actions can take place to limit the
spread and manage impacts of the disease. ELR has many benefits, including improved
timeliness of results, reduction of manual data entry errors, and reports that
are more complete.
ELR Data to Meet Public Health Reporting Requirements for Meaningful Use
While all hospitals and
clinical laboratories may participate in ELR, Eligible Hospitals (EHs) or
Critical Access Hospitals (CAHs) participating in the Centers for Medicare and
Medicaid Services’ Electronic Health Record Incentive Programs may use their
successful participation in ELR reporting to help meet Incentive Programs’
requirements for reporting data to public health.
In order to meet the Incentive Programs’
requirements, participating EHs and CAHs must use Certified Electronic Health
Record Technology (CEHRT) that meets specific requirements including being capable
of sending ELR messages using the HL7
Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public
Health, Release 1(available on the HL7
website), and being
“actively engaged” in public health reporting. DSHS will provide appropriate
documentation to Incentive Program participants.
Lab Reporting On-Boarding Process
The resources below describe the ELR onboarding process and the DSHS
requirements in detail:
Step 1. Registration
Step 2. Pretesting
- Facility must proceed to do vocabulary mapping and validation
with DSHS. The facility will complete the ELR vocabulary mapping worksheet
provided by DSHS as much as possible.
- The link to the vocabulary mapping spreadsheet can be found
at Texas ELR Vocabulary Mapping Worksheet_Draft
Step 3. Testing
- Facility will develop and generate HL7 messages for specific
conditions that conform to the HL7 Version 2.5.1 Implementation Guide:
Electronic Laboratory Reporting to Public Health, Release 1 (US Realm) with Errata.
- The facility will pretest their message(s) using the National
Institute of Standards and Technology (NIST) validation tool.
- Examples of result types to be tested include;
- Coded result (CWE)
- Numeric result
- Titer result
- Structured numeric result.
the context-free validation reports indicate the test messages are free of
errors (Error count is 5-10), send copies of the validation reports to
- After the facility has met the message
applicable criteria, they will contact DSHS to set up a secure message
Step 4. Acceptance
facility will begin to send live production batch transmission of messages to
DSHS for structure and content validation.
Step 5. Production
- Once an eligible hospital has completed validation they will
receive an acknowledgement of their success and be placed into production
will continue to send batch messages to DSHS for
- DSHS will give permission to engage the
facility in parallel validation, a process whereby the Subject Matter
Experts (SMEs) at DSHS will perform gap analysis to compare the data submitted
into DSHS NEDSS with the content of the paper laboratory report to make sure
the content are similar and synonymous.
- Any issues with parallel
validation will be discussed with the DSHS NEDSS team and communicated to the
facility for appropriate action.
- Once parallel validation is
concluded, DSHS will inform the facility when to discontinue paper submission
of reportable disease events.
Message Header Segment
Specification for ELR in Texas State
|| Sending Facility
Facility Name^CLIA number^CLIA
|| Namespace ID
identifies the facility that is sending the data.
|| Universal ID
|| Must be a CLIA number
|| Universal ID Type
Literal value: NEDSS
Literal value: TX-ELR