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| | | text = This is sublevel34 of my sandbox, where I play with features and test MediaWiki code. If you wish to leave a comment for me, please see [[User_talk:Shawndouglas|my discussion page]] instead.<p></p> |
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| ==3. Workflow and information management for COVID-19 (and other pandemics)== | | ==Sandbox begins below== |
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| ===3.1 Laboratory informatics and workflow management===
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| ===3.2 Laboratory informatics and reporting requirements===
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| Epidemiology can broadly be split into two categories: descriptive epidemiology and analytical epidemiology. Descriptive epidemiology involves studies and other activites that deal with geographical comparisons and temporal trend descriptions of disease. As such, the collection and use of quality incidence data is vital to developing hypotheses.<ref name="NaitoUtil14">{{cite journal |title=Utilization and application of public health data in descriptive epidemiology |journal=Journal of Epidemiology |author=Naito, M. |volume=24 |issue=6 |pages=435–6 |year=2014 |doi=10.2188/jea.je20140182 |pmid=25327184 |pmc=PMC4213216}}</ref> Analytical epidemiology allows for the testing of those hypotheses using both experimental and obsevational studies, as well as control groups. Similarly, the collection and use of quality experimental and observational data is vital for proving or disproving hypotheses.<ref name="CDCPrinc12">{{cite book |url=https://www.cdc.gov/csels/dsepd/ss1978/SS1978.pdf |format=PDF |title=Principles of Epidemiology in Public Health Practice |author=Centers for Disease Control and Prevention |edition=3rd |publisher=Centers for Disease Control and Prevention |year=2012 |accessdate=11 April 2020}}</ref> In both cases, proper reporting of public health data is critical to the success of epidemiologists' response to outbreaks and pandemics, as well as the credibility of their research.<ref name="HamiltonUsing19">{{cite book |chapter=Chapter 5: Using Technologies for Data Collection and Management |title=The CDC Field Epidemiology Manual |author=Hamilton, J.J.; Hopkins, R.S. |editor=Rasmussen, S.A.; Goodman, R.A. |publisher=Oxford University Press |edition=4th |pages=71–104 |year=2019 |isbn=9780190933692}}</ref><ref name="vonElmTheStren07">{{cite journal |title=The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies |journal=PLoS Medicine |author=von Elm, E.; Altman, D.G.; Egger, M. et al. |volume=4 |issue=10 |at=e296 |year=2007 |doi=10.1371/journal.pmed.0040296 |pmid=17941714 |pmc=PMC2020495}}</ref>
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| The proper reporting of COVID-19 case data is no exception. In the United States, the CDC has taken a standardized approach to collecting reports on "individuals with at least one respiratory specimen that tested positive for the virus that causes COVID-19."<ref name="CDCInformRepo20">{{cite web |url=https://www.cdc.gov/coronavirus/2019-ncov/php/reporting-pui.html |title=Information for Health Departments on Reporting Cases of COVID-19 |author=Centers for Disease Control and Prevention |work=Coronavirus Disease 2019 (COVID-19) |publisher=Centers for Disease Control and Prevention |date=21 March 2020 |accessdate=21 March 2020}}</ref> Their COVID-19 Case Report Form is designed to collect a wide variety of information about a COVID-19 case, including patient demographics, epidemiological characteristics, exposure and contact history, and clinical diagnosis and treatment procedures. Currently, the CDC is asking local and state health departments to submit case reports, and asking healthcare providers and laboratories to contact those health departments when "concerned that a patient may have COVID-19." The CDC has also slimmed its reporting requirements, limiting reporting of "persons under investigation" to areas where testing must be forwarded to the CDC due to insufficient capacity to test locally.<ref name="CDCInformRepo20" /> Electronic reporting using the CDC's system is preferred, but they have a protocol for those areas unable to submit electronically. Canada has similar reporting expectations, with their own case report form and electronic data submission process through the Public Health Agency of Canada.<ref name="CanadaInterim20">{{cite web |url=https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/interim-guidance-surveillance-human-infection.html |title=Interim national surveillance guidelines for human infection with Coronavirus disease (COVID-19) |author=Government of Canada |publisher=Government of Canada |date=10 February 2020 |accessdate=11 April 2020}}</ref> And in the European Union, member countries and the U.K. are asked to report through the Early Warning and Response System.<ref name="ECDCCaseDef20">{{cite web |url=https://www.ecdc.europa.eu/en/case-definition-and-european-surveillance-human-infection-novel-coronavirus-2019-ncov |title=Case definition and European surveillance for COVID-19, as of 2 March 2020 |author=European Centre for Disease Prevention and Control |publisher=European Centre for Disease Prevention and Control |work=COVID-19 Portal |date=02 March 2020 |accessdate=11 April 2020}}</ref>
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| ====3.2.1 ICD and CPT coding====
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| Related are any internal reporting requirements, particularly for test reporting in labs and medical facilities (and in some cases, reporting to local health departments requires internal reporting adjustments). The [[International Statistical Classification of Diseases and Related Health Problems]] (ICD) is a commnoly used system of diagnostic codes for classifying diseases, including nuanced classifications of a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Their ICD-10-CM code set has been modified to include lab testing codes for COVID-19, as has the [[Current Procedural Terminology]] (CPT) code set. This guide provides basic information about these codes (and should not be considered legally binding advice), but see the referenced material (and following citations) for more details concerning those codes<ref name="GreenCoding20">{{cite web |url=https://www.mgma.com/data/data-stories/coding-guidance-for-new-icd-10-cm-and-lab-testing |title=Coding guidance for new ICD-10-CM and lab testing codes for COVID-19 |work=MGMA Stat |author=Green, C.; Bradley, V. |date=01 April 2020 |accessdate=11 April 2020}}</ref><ref name="AAPHowTo20">{{cite web |url=https://www.aappublications.org/news/2020/03/12/coding031220 |title=How to use ICD-10-CM, new lab testing codes for COVID-19 |author=AAP Division of Health Care Finance |publisher=American Academy of Pediatrics |date=12 March 2020 |accessdate=11 April 2020}}</ref><ref name="RCA_CDCPub20">{{cite web |url=https://revenuecycleadvisor.com/news-analysis/cdc-publishes-icd-10-cm-official-guidelines-covid-19 |title=CDC publishes ICD-10-CM Official Guidelines for COVID-19 |work=Revenue Cycle Advisor |date=06 April 2020 |accessdate=25 April 2020}}</ref><ref name="RemerWeNow20">{{cite web |url=https://www.icd10monitor.com/we-now-have-a-code-for-covid-19-here-s-how-to-use-it-correctly |title=We now Have a Code for COVID-19; Here’s How to use it Correctly |author=Remer, E.E. |work=ICD-10 Monitor |date=15 April 2020 |accessdate=25 April 2020}}</ref>:
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| * The CPT code 87635 has the long descriptor of "Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique." The American Medical Association's ''CPT Assistant'' [https://www.ama-assn.org/system/files/2020-03/cpt-assistant-guide-coronavirus.pdf fact sheet] for SARS-CoV-2 reporting proves useful in supplying assistance on how and when to apply this CPT code in reporting.
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| * The U.S. government-adopted ICD-10-CM—an authorized version of WHO's ICD-10<ref name="CDCIntern20">{{cite web |url=https://www.cdc.gov/nchs/icd/icd10cm.htm |title=International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) |author=National Center for Health Statistics |publisher=Centers for Disease Control and Prevention |date=31 March 2020 |accessdate=25 April 2020}}</ref>—has been updated by the CDC and the National Center for Healthcare Statistics. It includes not only new codes for conditions associated with COVID-19 but also codes for exposure and screening. The principal diagnosis code "U07.1, COVID-19" is sequenced first, followed by any appropriate codes for associated manifestations (though there is an obstetrics exception). The CDC's [https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf official coding guidelines], as well as [https://www.icd10monitor.com/we-now-have-a-code-for-covid-19-here-s-how-to-use-it-correctly guidance] from Dr. Erica Remer may prove useful in choosing the correct codes.
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| Laboratories analyzing specimens for SARS-CoV-2 must be equipped to implement and handle analytical testing and test orders using the new test codes. However, they also must be able to quickly and accurately transfer vital case information to the appropriate health authority.
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| ====3.2.2 Reporting to local and regional health departments====
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| Given the valuable nature of case reports during an epidemic<ref name="HamiltonUsing19" /><ref name="vonElmTheStren07" />, health care providers, facilities, and laboratories are being held responsible for sending case date to their local and regional health departments. That information then feeds up to the state-level health department, which then makes its way to the national-level entity responsible for handling epidemiology (in the case of the U.S., the CDC). However, the general disease reporting requirements vary from state to state, with some states encouraging full electronic laboratory reporting (ELR), while others still encouraging faxed or mailed reports. Add in the urgency and confusion associated with a pandemic, and COVID-19 reporting requirements prove to vary just as much. Some states' health departments have taken a proactive approach to reporting. For example, Iowa's Department of Public Health has issued several mandatory COVID-19 reporting orders meant to supplement existing reporting rules, including an order requiring all Iowa health care providers and public, private, and hospital laboratories "to immediately report all positive and negative Coronavirus Disease 2019 (COVID-19) testing results to the department."<ref name="ClabaughRescind20">{{cite web |url=https://idph.iowa.gov/Portals/1/userfiles/7/Mandatory%20Reporting%20Order.pdf |format=PDF |title=Rescind the March 5, 2020 Temporary Novel Coronavirus Disease 2019 (COVID-19) Mandatory Reporting Requirement and Replace With the Following Order |author=Clabaugh, G. |publisher=Iowa Department of Public Health |date=19 March 2020 |accessdate=25 April 2020}}</ref> Other states have not been as clear on their reporting requirements, in some cases not having any guidance documents or clear information on their health department website for how providers, facilities, and labs should report COVID-19. In those cases, the presumption is that most labs have contacted the health department for advice or are reporting COVID-19 cases as immediately reportable, based upon the state's existing reporting requirements for immediately reportable diseases.
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| Table 1 addresses the reporting requirements for the United States' 50 states, while Table 2 covers U.S. territories. If clear reporting guidance specific to COVID-19 could be found, it was described. If no such guidance could be found, then the state's existing guidance and rules regarding disease reporting were referenced. In some cases, the state health departments don't clearly spell out whether a faxed or mailed report is required after immediately phoning in a report. In other cases, it's not clear if ELR—though it exists—is an acceptable form of reporting COVID-19 cases. This ambiguity is stated in the form of a "(?)" found next to the "Y" and "N" for electronic filing and faxing. In '''all''' cases, if there is any doubt about reporting requirements, call your local health department to confirm.
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| | style="background-color:white; padding-left:10px; padding-right:10px;" colspan="6"|'''Table 1.''' U.S. state-based COVID-19 reporting requirements
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| ! style="background-color:#e2e2e2; padding-left:10px; padding-right:10px;" |State
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| ! style="background-color:#e2e2e2; padding-left:10px; padding-right:10px;" |Electronic file (Y/N)
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| ! style="background-color:#e2e2e2; padding-left:10px; padding-right:10px;" |Fax? (Y/N)
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| ! style="background-color:#e2e2e2; padding-left:10px; padding-right:10px;" |Forms for reporting
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| ! style="background-color:#e2e2e2; padding-left:10px; padding-right:10px;" |Contact
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| ! style="background-color:#e2e2e2; padding-left:10px; padding-right:10px;" |Additional details
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.alabamapublichealth.gov/covid19/healthcare.html Alabama]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://redcap.link/u0i8heo3 Novel Coronavirus Report Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|ALNEDSSsupport@adph.state.al.us
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"Providers who are either reporting laboratory results for patients tested by a commercial or clinical laboratory (not tested by the BCL) or reporting deaths among patients with positive results must complete" the report form. "Laboratories are required to report all negative and positive COVID-19 virus test results electronically (faxes do not count). If not already enrolled, laboratories will need to manually enter test results directly into the surveillance system." Email the contact to enroll staff access to the system.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://dhss.alaska.gov/dph/Epi/id/Pages/COVID-19/healthcare.aspx Alaska]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://dhss.alaska.gov/dph/Epi/Documents/pubs/conditions/frmInfect.pdf Confidential Infectious Disease Report Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|COVID Reporting Hotline: 1-877-469-8067<br /> <br />Urgent situation: 907-269-8000 or 800-478-0084 (after-hours)<br /> <br />ELR: megan.tompkins@alaska.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"Providers must report laboratory-confirmed cases of COVID-19 to SOE by either leaving a message on the COVID Reporting Hotline (1-877-469-8067) or via fax using the standard Infectious Disease Report Form." "[A]ll results both positive and negative must be reported via either integration into existing electronic laboratory reporting (ELR) data feeds or fax (907-563-7868). Please email Megan Tompkins ... to inform us about how your facility will report."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/index.php#novel-coronavirus-lab-resources Arizona]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/novel-coronavirus/lab-resources/sample-aggregate-form.xlsx Sample Aggregate Weekly Submission Form]<br />[https://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/novel-coronavirus/lab-resources/sample-adhs-csv-file.csv Sample ADHS CSV File]<br />[https://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/novel-coronavirus/lab-resources/sample-adhs-excel-file.xlsx Sample ADHS Excel File]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Fax: (602) 364-3199<br /> <br />ELR: elr@azdhs.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"[A] laboratory as defined in A.R.S. § 36-451(4) shall report all COVID-19 test results (positive and negative) to the Arizona Department of Health Services in an electronic format as follows: a. For laboratories reporting to the Arizona Department of Health Services through electronic lab reporting ('ELR'), results of all COVID-19 tests; b. For laboratories not reporting to the Arizona Department of Health Services through ELR, a weekly aggregate number of total COVID-19 tests performed and their results." If reporting is accomplished through mail or fax, use the Sample Aggregate Weekly Submission Form. "Aggregate reporting does NOT replace mandatory laboratory reporting requirements per [https://www.coconino.az.gov/DocumentCenter/View/411/Communicable-Disease-Reporting-Rules- Arizona Administrative Code R9-6-204]."<br /> <br />"ADHS has created a new electronic option for reporting results of COVID-19 in-house testing as an alternative to Health Level Seven (HL7) electronic laboratory reporting or direct entry into MEDSIS. This can now be accomplished through a standardized spreadsheet or comma separated value (CSV) file format."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.healthy.arkansas.gov/programs-services/topics/epidemiology Arkansas]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.healthy.arkansas.gov/images/uploads/pdf/CommunicableDiseaseReportingForm.pdf Communicable Disease Reporting Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: (501) 537-8969 or 1-800-554-5738 after-hours
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Arkansas Department of Health doesn't appear to have published any information about specific COVID-19 reporting requirements. The DoH is [https://www.healthy.arkansas.gov/images/uploads/pdf/List_and_Instructions_Reportable_Diseases.pdf presumably] treating "suspected or confirmed" COVID-19 cases as an immediately reportable event that "are to be reported immediately to the ADH," via telephone. The language used on its reportable disease instructions suggests that a follow-up fax of the case report isn't required; however, call and confirm with the DoH. The DoH disease reporting web page makes no mention of ELR.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Reportable-Disease-and-Conditions.aspx California]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.cdph.ca.gov/CDPH%20Document%20Library/ControlledForms/cdph110a.pdf Confidential Morbidity Report]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://www.cdph.ca.gov/Programs/CCLHO/Pages/CCLHO-Health-Officer-Directory.aspx Local health officers]<br /> <br />CalREDIE: CalREDIEHelp@cdph.ca.gov or (866) 866-1428
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The DPH [https://www.cdph.ca.gov/Programs/OSPHLD/LFS/CDPH%20Document%20Library/LFSCOVID19ltr-1.pdf has added] COVID-19 to its Reportable Diseases and Conditions lists for [https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/ReportableDiseases.pdf health care providers] and [https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/LabReportableDiseases.pdf laboratories]. This health care provider document indicates that a "case or suspected case" of COVID-19 should be reported immediately by phone. The document makes no mention of requiring a follow-up fax or digital report by health care providers. The laboratory document indicates "[l]aboratories must report any initial findings as well as any subsequent findings. "Any laboratories approved to test for SARS-CoV-2 must report all positive and non-positive (negative, indeterminate, and specimen unsatisfactory) test results from both antigen/molecular and antibody/serology tests for SARS-CoV-2." Laboratory findings are "are reportable to the local health officer of the health jurisdiction where the patient resides by telephone within one (1) hour ... from the time that the laboratory notifies the health care provider or other person authorized to receive the report." Labs are asked to also subsequently report results electronically (ELR) to the California Reportable Disease Information Exchange (CalREDIE) "within one working day of identification."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.colorado.gov/pacific/cdphe/report-a-disease Colorado]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://drive.google.com/file/d/151OUa9o2vPG32tSx_eqlMVP86zkTv3Yw/view?usp=sharing General Communicable Disease Reporting Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Fax: (303) 782-0338<br /> <br />CEDRS: lavelle.fernandez@state.co.us<br /> <br />ELR: andrew.horvath@state.co.us
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The state doesn't appear to have specific rules or a reporting form for laboratory reporting of COVID-19. Presumably labs are reporting COVID-19 as is required for any communicable disease. The state lists multiple ways to report a case: calling, faxing a General Communicable Disease Reporting Form, through CEDRS, or by using ELR. The also offers guidance for healthcare providers. "Any suspected or confirmed case or outbreak of COVID-19 should immediately be reported to the local or state public health agency. To report, utilize the [Outbreak COVID-19 Outbreak Report Form]. Send this form to your local public health agency OR to CDPHE by securely emailing a completed form to: cdphe_haioutbreak@state.co.us."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://portal.ct.gov/DPH/Epidemiology-and-Emerging-Infections/Laboratory-Reporting Connecticut]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://portal.ct.gov/-/media/DPH/EEIP/Forms/nCoV_-PUI_Form.pdf?la=en 2019 Novel Coronavirus (COVID-19) Case Report Form]<br /> <br />[https://portal.ct.gov/-/media/Departments-and-Agencies/DPH/dph/infectious_diseases/pdf_forms_/OL15C_Form.pdf?la=en Reportable Laboratory Findings, Form OL-15C]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Fax: (860) 629-6962<br /> <br />ELR: dph.elr@ct.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Presumably labs are reporting COVID-19 as is required for any communicable disease. This has traditionally been done using Form OL-15C sent through [https://portal.ct.gov/DPH/Epidemiology-and-Emerging-Infections/Laboratory-Reporting mail or fax], as well as [https://portal.ct.gov/DPH/Epidemiology-and-Emerging-Infections/Electronic-Laboratory-Reporting ELR]. "Providers can now submit a COVID-19 case report [https://dphsubmissions.ct.gov/Covid/InitiateCovidReport online]. This is the preferred way to submit COVID-19 case reports."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.dhss.delaware.gov/dhss/dph/php/alerts/dhan421.html Delaware]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Call: 1-888-295-5156<br /> <br />Email: reportdisease@delaware.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"COVID-19 is a reportable condition to the DPH. Any positive test results from any laboratory must be reported to DPH via the Delaware Electronic Reporting Surveillance System (DERSS). If you have a strong clinical suspicion that a patient may be infected with COVID-19 based on clinical symptoms and epidemiological factors (e.g., close contact with a confirmed case, recent travel to an area with sustained transmission), contact the DPH Office of Infectious Disease Epidemiology at 1-888-295-5156, or report through reportdisease@delaware.gov within 24 hours leading to submission of test samples to a commercial lab to allow for surveillance and monitoring as appropriate." The state makes no mention of reporting negative COVID-19 test results.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://dchealth.dc.gov/service/infectious-diseases District of Columbia]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: (202) 442-8141 or 1-(844)-493-2652 after-hours<br /> <br />Fax: (202) 442-8060
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|DC Health doesn't appear to have published any information about specific COVID-19 reporting requirements. The DoH is [https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Notifiable%20Diseases%20and%20Conditions%20in%20DC%20v20180327.pdf presumably] treating COVID-19 tests with "provisional diagnosis or the appearance of suspicious symptoms" as an immediately reportable event that "must be reported immediately by telephone ... and confirmed by submission of a case report within 24 hours." ELR appears to be reserved for specific diseases other than COVID-19.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://www.floridahealth.gov/diseases-and-conditions/disease-reporting-and-management/disease-reporting-and-surveillance/surveillance-and-investigation-guidance/index.html Florida]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Fax: (850) 414-6894<br /> <br />ELR: MUElectronicLabReporting@flhealth.gov or ELR@flhealth.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"Commercial laboratory results for COVID-19 will either be reported through electronic laboratory reporting (ELR), faxing, or phone calls from laboratories. Results received at the Bureau of Epidemiology will be sent to counties via Merlin. Bureau of Public Health Laboratories test results are reported to [county health departments] through
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| Merlin and they are mailed to the ordering providers." In separate documentation, the state notes that both positive and negative COVID-19 laboratory results should be reported. As for health care providers and facilities, they must report a [[http://www.floridahealth.gov/diseases-and-conditions/disease-reporting-and-management/disease-reporting-and-surveillance/_documents/novel-coronavirus-reporting-hcp.pdf specific set of persons related to COVID-19] to the County Health Departments.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://dph.georgia.gov/epidemiology/disease-reporting Georgia]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://dph.georgia.gov/document/document/notifiable-disease-report-form-0/download Notifiable Disease Report Form]<br /> <br />[https://dph.georgia.gov/media/58276/download Notifiable Disease Reporting Requirements]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Fax: Based on [https://dph.georgia.gov/district-health-officers District Health Office]<br /> <br />Call: 1-866-782-4584
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Georgia lists COVID-19 as an immeadiately reportable disease condition. "All Georgia physicians, laboratories, and other health care providers" are encouraged to call their District Health Office or the main number. The state is also accepting COVID-19 reports through its [http://sendss.state.ga.us/sendss/login.screen SendSS] online application.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://health.hawaii.gov/coronavirusdisease2019/for-clinicians/evaluating-puis/ Hawaii]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://health.hawaii.gov/docd/files/2020/01/Hawaii-PUI-Form-nCoV-2019.pdf Person Under Investigation (PUI) and Case Report Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Fax: (808) 586-4595<br /> <br />ELR: helpdesk@hawaiihie.org
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"Per the Hawaii Administrative Rules, Chapter 11-156, the Person Under Investigation (PUI) and Case Report Form must be completed for any person who tests POSITIVE for COVID-19. Please fax the completed form to the Disease Outbreak Control Division at (808) 586-4595. COVID-19 is considered an URGENTLY REPORTABLE condition." It's not entirely clear if laboratories can use ELR through the [https://health.hawaii.gov/docd/for-healthcare-providers/meaningful-use/ Hawaii Health Information Exchange] for COVID-19 reporting. They [https://www.hawaiihie.org/ simply state]: "Results for patients who have been tested for COVID-19 are incorporated into their records in the HHIE Community Health Record."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://healthandwelfare.idaho.gov/Health/Epidemiology/tabid/111/Default.aspx Idaho]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: (208) 334-5939<br /> <br />Fax: (208) 332-7307<br /> <br />ELR: PublicHealthMU@dhw.idaho.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Idaho Department of Health and Welfare doesn't appear to have published any information about COVID-19 reporting requirements. They [https://coronavirus.idaho.gov/frequently-asked-questions/ simply state] that "Labs will report their results to the state, and those numbers will be posted on this website each day." Presumably this means that labs should be following the state's reportable diseases protocol for reporting "within one working day of identification or suspicion" using phone or fax. No standardized reporting form appears to exist. It's not clear if [https://healthandwelfare.idaho.gov/Providers/PublicHealthMeaningfulUseReporting/tabid/2486/Default.aspx ELR] is being used to report COVID-19 cases.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://www.dph.illinois.gov/topics-services/diseases-and-conditions/infectious-diseases/infectious-disease-reporting Illinois]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Fax: Based on [http://www.idph.state.il.us/LHDMap/HealthRegions.aspx Local Health Department]<br /> <br />ELR: DPH.Helpdesk@illinois.gov or DoIT.Helpdesk@Illinois.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Illinois Department of Public Health doesn't appear to have published an information about COVID-19 reporting requirements. However, given their [http://www.dph.illinois.gov/sites/default/files/publications/illinois-laboratory-reporting-requirements-poster.pdf laboratory reporting requirements] in general, COVID-19 is nearly certain to require "immediate" reporting, which to the state means within three hours. Its laboratory reporting requirements document recommends contacting the [http://www.idph.state.il.us/LHDMap/HealthRegions.aspx local health department] to send the report. However, ELR through Illinois’ National Electronic Disease Surveillance System (I-NEDSS) appears to be the preferred method.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.coronavirus.in.gov/files/COVID-19%20specimen%20submission%20and%20collection%20guidelines_04.13.20.pdf Indiana]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://forms.in.gov/Download.aspx?id=5082 Confidential Report of Communicable Diseases]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|ELR: (317) 233-7684 or ijameson@isdh.in.gov<br /> <br />Fax: (317) 233-7747
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"You should report both positives and negatives the same way you report all other reportable disease conditions to ISDH. This is primarily through electronic laboratory reporting (ELR) through the ISDH NBS system. If your facility currently reports labs through ELR to ISDH, contact Irene Jameson to set up COVID-19 reporting (317-233-7684 or ijameson@isdh.in.gov). If your facility does not currently report through ELR, please have your infection preventionist (IP) report through a morbidity report. Provide a pdf of the lab report to your IP as they will need to attach this file when submitting their report. ISDH is not onboarding new ELR/NBS customers currently. Alternatively, you can fax positive reports to 317-233-7747." Such reporting should be done [https://www.coronavirus.in.gov/files/IN_COVID-19%20Reporting_Order%204.8.20.pdf within 24 hours] of test completion.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://idph.iowa.gov/CADE Iowa]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://wiki.idph.iowa.gov/Portals/3/userfiles/6/Reportable%20Disease%20Information/1%20Disease%20Reporting%20Card.pdf Disease Reporting Card]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|ELR: [https://idph.iowa.gov/cade/idss Jill Newland]<br /> <br />Fax: (515) 281-5698
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"All Iowa health care providers and public, private, and hospital laboratories are [https://idph.iowa.gov/Portals/1/userfiles/7/Mandatory%20Reporting%20Order.pdf required] to immediately report all positive and negative Coronavirus Disease 2019 (COVID-19) testing results to the department. Reports must be made electronically through the Iowa Disease Surveillance System (IDSS) when a facility has electronic transmission capabilities, otherwise reports can be faxed to 515-281-5698."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.kdheks.gov/epi/disease_reporting.html Kansas]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.kdheks.gov/epi/download/Kansas_Reportable_Disease_Form.pdf Kansas Reportable Disease Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: (877) 427-7317<br /> <br />Fax: (877) 427-7318
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"COVID-19 is a [https://www.kdheks.gov/coronavirus/toolkit/Guidance_for_CLIA_Approval_To_Begin_COVID-19_Testing.pdf reportable disease], so you must have a mechanism for reporting both positives and negatives to KDHE." However, the KDHE doesn't appear to have any additional laboratory reporting instructions for COVID-19. It's not explicitly clear, but the state is presumably treating COVID-19 as a four-hour (within four hours of test completion) reportable disease. According to its [https://www.kdheks.gov/epi/download/KANSAS_NOTIFIABLE_DISEASE_LIST.pdf reportable diseases guidance]: "For 4-hour reportable diseases report to the KDHE Epidemiology Hotline: 877-427-7317. For all other reportable diseases fax a Kansas Reportable Disease Form and any lab results to your local health department or to KDHE: 877-427-7318 within 24 hours or by the next business day." The KDHE disease reporting web page makes no mention of ELR.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://apps.legislature.ky.gov/law/kar/902/002/020.pdf Kentucky]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://chfs.ky.gov/agencies/dph/covid19/casereportinginstructionsandform.pdf COVID-19 Person Under Investigation (PUI) Report Form]<br /> <br />[https://chfs.ky.gov/agencies/dph/dehp/idb/Documents/KentuckyReportableForm2003.pdf Kentucky Reportable Disease Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Fax: (502) 696-3803
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"If the test result for COVID-19 is positive, please fax the completed PUI form to the KDPH secure fax line at 502-696-3803 along with the EPID-200 Reportable Disease Report Form." It's not clear if any COVID-19 reporting is being performed [https://khie.ky.gov/tech/Pages/publichealthreporting.aspx using ELR].
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://ldh.la.gov/index.cfm/page/1013 Louisiana]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://ldh.la.gov/assets/oph/Center-PHCH/Center-CH/infectious-epi/Surveillance/DiseaseReportFormNO.pdf Confidential Disease Case Report]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: (504) 568-8295<br /> <br />Fax: (504) 568-8290
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Louisiana's [http://ldh.la.gov/assets/oph/Center-CP/HANs/HAN_20-13.pdf Emergency Rule - LAC 51:105 and 107] adds COVID-19 to Class A reportable diseases. "This Emergency Rule makes the reporting of COVID-19 cases mandatory for all healthcare providers. This Emergency Rule makes all laboratory tests for COVID-19, whether positive or negative, reportable to the State within 24 hours of test result." Class A diseases "of major public health concern" are [http://ldh.la.gov/assets/oph/Center-PHCH/Center-CH/infectious-epi/Surveillance/sanitarycode.pdf apparently] to be reported "by telephone immediately." The LDH disease reporting web page makes no mention of ELR.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/disease-reporting/index.shtml Maine]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: 800-821-5821<br /> <br />Fax: 800-293-7534
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Maine CDC doesn't appear to have published any information about specific COVID-19 reporting requirements. The Maine CDC is [https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/disease-reporting/documents/MeCDC_LabGuide_2018.pdf presumably] treating COVID-19 tests that are "positive by any method" as an immediately reportable event "by telephone to Maine CDC." According to its guidance, it doesn't appear ELR is employed for immediately reportable events.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://phpa.health.maryland.gov/Pages/what-to-report.aspx Maryland]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://phpa.health.maryland.gov/IDEHASharedDocuments/what-to-report/DHMH_1281.pdf Confidential Report: Laboratory Evidence of Certain Communicable Diseases]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://health.maryland.gov/Pages/departments.ASPX Local health department]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Maryland Department of Health doesn't appear to have published any information about specific COVID-19 reporting requirements. The DoH is [https://phpa.health.maryland.gov/IDEHASharedDocuments/ReportableDisease_Lab.pdf presumably] treating COVID-19 tests with "a positive laboratory finding" as an immediately reportable event that "should be submitted to the local health department in the jurisdiction where the lab is located." It's not clear what the best method for reporting (phone, fax, ELR) is for COVID-19 positive results. Presumably labs should contact their [https://health.maryland.gov/Pages/departments.ASPX local health department] to confirm this. The DoH disease reporting web page makes no mention of ELR.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.mass.gov/lists/infectious-disease-reporting-and-regulations-for-health-care-providers-and-laboratories Massachusetts]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://www.naccho.org/membership/lhd-directory?searchType=standard&lhd-state=MA#card-filter Local health departments]<br /> <br />MDPH phone: (617) 983-6800<br /> <br />MDPH fax: (617) 983-6813
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The State of Massachusetts doesn't appear to have published any information about specific COVID-19 reporting requirements. The state is [https://www.mass.gov/doc/list-of-diseases-reportable-by-healthcare-providers/download presumably] treating COVID-19 "suspected and confirmed cases" as an immediately reportable event that "should be reported to your local board of health" by phone, or if unavailable, to the Massachusetts Department of Public Health by phone or fax. The MDPH disease reporting web page makes no mention of ELR.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.michigan.gov/mdhhs/0,5885,7-339-71550_5104_53072---,00.html Michigan]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|MDSS: [https://www.michigan.gov/documents/MDSS_Support_Resources_87777_7.pdf Support contacts]<br /> <br />Contact: Local health department list in reporting guide
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Michigan Department of Health & Human Services has updated its ''[https://www.michigan.gov/documents/mdhhs/MDHHS_Brick_Book_609755_7.pdf Health Care Professional's Guide to Disease Reporting in Michigan]'' to include detections of SARS-CoV-2. They note that "if the agent is identified by clinical or laboratory diagnosis," the detection (by both healthcare providers and laboratories) "must be reported to the Michigan Disease Surveillance System (MDSS) or local health department within 24 hours." As for how: "Mandatory reporting of communicable diseases can (and, whenever possible, should) be accomplished via the MDSS. The MDSS is a web-based communicable disease reporting system developed for the state of Michigan." If unable to electronically report, contact the local health department using the directory in the disease reporting guide.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.health.state.mn.us/diseases/coronavirus/hcp/report.html Minnesota]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.health.state.mn.us/diseases/coronavirus/hcp/covidreportform.pdf COVID-19 Case Report Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Fax: (651) 201-5743<br /> <br />Phone: (651) 201-5414 or (877) 676-5414
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"The Minnesota Department of Health (MDH) is requiring all mandated reporters to report any cases and deaths due to SARS-CoV-2 to MDH within one working day." This includes health care facilitites, medical laboratories, and in special cases veterinary laboratories. Case report forms can be faxed or case reports submitted by phone. The MDoH disease reporting web page makes no mention of ELR.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://msdh.ms.gov/msdhsite/_static/14,0,194.html Mississippi]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://msdh.ms.gov/msdhsite/_static/resources/5072.pdf Reportable Diseases and Conditions form]
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: (601) 576-7725 or 1-800-556-0003; for weekends, holidays and after 5pm: (601) 576-7400
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Mississippi State Department of Health [https://msdh.ms.gov/msdhsite/_static/14,21911,420,874.html states]: "All COVID-19 results must be reported to the Mississippi State Department of Health at this time." However, it gives no further guidance specifically for commercial laboratories or health care providers testing for SARS-CoV-2. Presumably the MSDH is considering COVID-19 a Class 1A disease, [https://msdh.ms.gov/msdhsite/_static/resources/1719.pdf required] to be "reported directly to the Department of Health by telephone within 24 hours of first knowledge or suspicion." The MSDH also has an [https://msdh.ms.gov/msdhsite/_static/14,0,194.html online disease reporting tool] (account required); however, it's not clear if it is equipped to received COVID-19 reports.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/how-to-report-lab-results.php Missouri]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/xls/lab-result-reporting-template.xlsx sFTP Excel template]<br /> <br />[https://health.mo.gov/living/healthcondiseases/communicable/communicabledisease/cdmanual/pdf/CD-1.pdf Disease Case Report form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|sFTP: (573) 526-5271<br /> <br />Fax: (573) 751-6417
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Missouri Department of Health and Senior Services has officially added COVID-19 to its list of immeadiately reportable conditions, including a waiver "to require that all positive and negative results for COVID-19 are sent directly to DHSS. Now, all laboratories must report directly to DHSS." They add that "[l]aboratories are encouraged to report via electronic means ... by secure file transfer protocol (sFTP)." Alternatively, labs may also submit a report to the Bureau of Reportable Disease Informatics (BRDI) via fax. "[M]edical providers (non-laboratories) also have an obligation to submit disease case reports (form CD-1) to DHSS. However, under the current suspension, when the testing is conducted outside the hospital by a separate laboratory that must also report the result to the Department, only the laboratory must make the report."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://dphhs.mt.gov/publichealth/cdepi/reporting Montana]
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y (?)
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://dphhs.mt.gov/publichealth/FCSS/countytribalhealthdepts Local health department]<br /> <br />DPHHS phone: (406) 444-0273
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Montana Department of Public Health and Human Services doesn't appear to have published any information about specific COVID-19 reporting requirements. The state is [https://dphhs.mt.gov/Portals/85/publichealth/documents/CDEpi/DiseaseReporting/LHJ_ReportableDiseaseList_Dec2019DPHHS.pdf presumably] treating COVID-19 like its other reportable diseases: "whether suspected or confirmed" the case "must be reported immediately to your local health jurisdiction as required by the Administrative Rules of Montana." If the local public health jurisdiction is unavailable, a call can be placed to the MDPHHS. It is not clear if laboratories should report both positive and negative results, though [https://www.kpax.com/news/coronavirus/covid-19-cases-in-montana-rise-to-9 news reports] have shown that the DPHHS is reporting both positive and negatives. The disease reporting web page makes no mention of ELR.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://dhhs.ne.gov/Pages/Disease-Reporting.aspx Nebraska]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://dhhs.ne.gov/epi%20docs/ReportableDiseaseCaseReportForm.pdf Health Care Provider Confidential Communication form]<br /> <br />[http://dhhs.ne.gov/epi%20docs/ReportableDiseaseLabForm.pdf Laboratory Summary of Reportable Diseases, Poisonings and Organisms]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: [http://dhhs.ne.gov/Pages/Disease-Reporting.aspx Based on county]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Nebraska Department of Health and Human Services provides little in the way of specific guidance for reporting COVID-19. They simply [http://dhhs.ne.gov/han%20Documents/UPDATE03132020.pdf state]: "Any patient (+) for COVID-19 virus should be immediately reported to local/state public health office." They define "immediate notification" as "required to call by telephone to a live public health surveillance official within 24 hours of detection." This apparently includes providers currently on ELR. Labs and healthcare providers should verify if any additional reporting (fax, ELR) is required.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://dpbh.nv.gov/Programs/OPHIE/Public_Health_Informatics_and_Epidemiology_-_Home/ Nevada]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://dpbh.nv.gov/Programs/OPHIE/Docs/Updated_Morbidity_Form_-_BP_4_2016/ Confidential Disease Reporting Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: Local health department list in reporting form
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Nevada DHHS guidance [https://nvhealthresponse.nv.gov/wp-content/uploads/2020/04/COVID19_Testing_Technical-Bulletin_4.20.20_FINAL.pdf states] health care providers, medical facilities, and laboratories should immediately notify the head of infection control or laboratory director at their facility AND "their local/state health department in the event of a probable or confirmed case of COVID-19." Its guidance appears to suggest a phone call for such notification. According to the state's [http://dpbh.nv.gov/Programs/OPHIE/Docs/Updated_Morbidity_Form_-_BP_4_2016/ disease reporting form], this phone call should be done in addition to faxing a report. "All cases, suspect cases, and carriers
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| must be reported within 24 hours." It's not clear if ELR is being accepted for COVID-19 reporting.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.dhhs.nh.gov/dphs/cdcs/forms.htm New Hampshire]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.dhhs.nh.gov/dphs/cdcs/covid19/covid19-reporting-form.pdf COVID-19 Case Report Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: (603) 271-4496<br /> <br />Fax: (603) 271-0545
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Health care providers and laboratories should immediately report suspect and confirmed cases of COVID-19 to the New Hampshire Department of Health and Human Services. It seems likely the DPHHS prefers both a phone call and a faxed report, though it's not explicitly stated. The case should likely be "reported within 24 hours of
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| diagnosis or suspicion of diagnosis." The NHDHHS disease reporting web page makes no mention of ELR.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|New Jersey
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|ELR: [https://cdrs.doh.state.nj.us/cdrss/login/loginPage See quick-start guide]<br /> <br />[https://www.nj.gov/health/cd/reporting/index.shtml Local health departments]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"[T]he New Jersey Domestic Security Preparedness Task Force [https://nj.gov/governor/news/news/562020/approved/20200323c.shtml hereby directs] that commercial laboratories operating in New Jersey report all COVID-19 test results to the New Jersey Department of Health beginning March 23, 2020. The results of all COVID-19 tests performed before this date shall be included in the initial report. Subsequently, results shall be sent daily, and included results not previously reported. Information shall be transmitted no later than 8:00 p.m. each day through the Department of Health’s CDRSS platform. Specific data reported shall include positive, negative, and inconclusive test results. This directive shall supplement, not supplant, any other existing reporting requirements." From that statement, it's not clear if laboratories should also be immediately phoning their results to the health department in addition to ELR over CDRSS.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://nmhealth.org/about/erd/ideb/ids/ New Mexico]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://nmhealth.org/publication/view/form/3288/ Notifiable Condition Report Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: (505) 827-0006<br /> <br />Fax: (505) 827-0013
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The New Mexico Department of Health doesn't appear to have published any information about specific COVID-19 reporting requirements. The DoH is [https://nmhealth.org/publication/view/policy/372/ presumably] treating "confirmed or suspected" COVID-19 cases as an immediately reportable event that "require immediate reporting by telephone to Epidemiology and Response Division." It's not clear if a faxed report is also required. The DoH disease reporting web page makes no mention of ELR.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.health.ny.gov/professionals/diseases/reporting/communicable/ New York]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://www.health.ny.gov/forms/doh-389.pdf Confidential Case Report - DOH-389]<br /> <br />[https://www1.nyc.gov/assets/doh/downloads/pdf/hcp/urf-0803.pdf Universal Reporting Form - PD-16]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://www.nysacho.org/directory/ Local health departments]<br /> <br />ECLRS: eclrs@health.ny.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The New York Department of Health [https://coronavirus.health.ny.gov/system/files/documents/2020/04/doh_covid19_privatepracticesamplingsites_041920.pdf states]: "Positive results must be immediately reported to the local Department of Health by the laboratory performing the test, per established guidance, and all test results should be reported by the laboratories into New York State Department of Health’s Electronic Clinical Laboratory Reporting System (ECLRS) four times a day." The established guidance appears to be found in the state's [https://health.ny.gov/forms/instructions/doh-389_instructions.pdf updated reporting instructions], which now includes COVID-19 as a disease that "should be reported immediately to local health departments by phone followed by submission of the confidential case report form (DOH-389). In NYC use case report form PD-16." This means "within 24 hours of diagnosis." The instructions indicate case reports should be mailed. Both health care facilities and laboratories should report.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://epi.dph.ncdhhs.gov/cd/report.html North Carolina]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://epi.dph.ncdhhs.gov/cd/lhds/manuals/cd/reportforms/COVID19_part2.pdf COVID-19 Confidential Communicable Disease Report]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://www.ncalhd.org/directors/ Local health departments]<br /> <br />Fax: (919) 733-0490
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Per NCDHHS's clinical diagnostic [https://slph.ncpublichealth.com/bioterrorism/2019-ncov.asp laboratory guidance]: "Immediate notification of the detection of COVID-19 should be sent to the Communicable Disease Branch fax at (919) 733-0490. Statistics on total COVID-19 tests completed, total negative tests, and total positive tests on a cumulative and 24 hours basis should be sent daily to SERT Emergency Services (NCEM) SERTEmergencyServices@ncdps.gov and SERTPLANS (NCEM) sertplans@ncdps.gov for statistical reporting." This is similar to [https://slph.ncpublichealth.com/doc/COVID-19-ProviderGuidance-04202020.pdf April 20 guidance] which claims that "physicians and laboratories in North Carolina are required to immediately report suspected or confirmed cases of novel coronavirus infection to state or local health departments via telephone or facsimile of basic contact information of the case."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/infectious-diseases/infectious-diseases Ohio]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://odh.ohio.gov/wps/wcm/connect/gov/8a5539e9-f823-480d-a2c7-a30e80c33d62/form-confidential-reportable-disease.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9DDDDM3000-8a5539e9-f823-480d-a2c7-a30e80c33d62-mR0PC0i Ohio Confidential Reportable Disease form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://odh.ohio.gov/wps/portal/gov/odh/find-local-health-districts Local health districts]<br /> <br />ELR: ELR@odh.ohio.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|In March 2020, the Ohio Department of Health [https://coronavirus.ohio.gov/wps/wcm/connect/gov/b2581867-6e9d-433a-9eb6-1174eee07276/Director%27s+Journal+Entry+on+Updated+COVID-19+Reporting+Requirements.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9DDDDM3000-b2581867-6e9d-433a-9eb6-1174eee07276-n5829m- ordered] "confirmed cases of COVID-19 be reported immediately as a Class A disease pursuant to Ohio Adm. Code 3701-3-02(A) to the local health district in which the person resides (or the local health district wherein the person is being medicall evaluated if the person's residence is unknown or not in Ohio)." Physicians, medical care facilities, and laboratories are encouraged to report positive cases. Per the state's [https://odh.ohio.gov/wps/wcm/connect/gov/84ffece4-16f1-4602-9b93-7ce4eeb34680/section-1-reporting.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9DDDDM3000-84ffece4-16f1-4602-9b93-7ce4eeb34680-mI9Bggz communicable disease requirements], Class A diseases should be reported immediately by phone, with a follow-up HEA 3334 Ohio Confidential Reportable Disease form. That requirements doc also states " follow-up reports can also be made electronically through direct entry into the [https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/ohio-disease-reporting-system/ohio-disease-reporting-system Ohio Disease Reporting System] (ODRS) or through [https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/electronic-laboratory-reporting/electronic-laboratory-reporting Electronic Laboratory Reporting]."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.ok.gov/health/Prevention_and_Preparedness/Acute_Disease_Service/Disease_Reporting/index.html Oklahoma]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://www.ok.gov/health2/documents/Reportable%20Condition%20Poster%20Blue%20Card%202018.pdf Reportable Disease Card for Healthcare Providers (Blue Card)]<br /> <br />[http://www.ok.gov/health2/documents/Reportable%20Pathogen%20Poster%20Yellow%20Card%202018.pdf Reportable Disease Card for Laboratories (Yellow Card)]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|PHIDDO: adservice@health.ok.gov<br /> <br />Phone: (405) 271-4060<br />Fax: (405) 271-6680<br /> <br />ELR: AnthonyL@health.ok.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Oklahoma State Department of Health doesn't appear to have published any information about specific COVID-19 reporting requirements. The DoH is [https://www.ok.gov/health2/documents/Updated%20--%20Reportable%20Pathogen%20Poster%202019.pdf presumably] treating "laboratory results indicating" (i.e., "upon suspicion, diagnosis, or positive test") COVID-19 as an immediately reportable event "to the OSDH by PHIDDO or telephone (405-271-4060)." This also holds true for healthcare providers. The Public Health Investigation and Disease Detection of Oklahoma (PHIDDO) system is apparently the preferred method, though other methods are acceptable.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/COMMUNICABLEDISEASE/REPORTINGCOMMUNICABLEDISEASE/Pages/index.aspx Oregon]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/COMMUNICABLEDISEASE/REPORTINGCOMMUNICABLEDISEASE/Pages/counties.aspx COVID-19 Report Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://www.oregon.gov/OHA/PH/ProviderPartnerResources/LocalHealthDepartmentResources/Pages/lhd.aspx Local public health authority]<br /> <br />Fax: (971) 673-1100<br /> <br />Online morbidy reporting or ELR: (971) 673-1111
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"The Oregon Health Authority (OHA), Public Health Division, is [https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/COMMUNICABLEDISEASE/REPORTINGCOMMUNICABLEDISEASE/Pages/Emergency-Rule-COVID-19.aspx temporarily adopting] OAR 333-017-0800 and OAR 333-018-900, which adds a definition of COVID-19 and adds COVID-19 to the list of diseases reportable to public health authorities within 24 hours. Positive test results for COVID-19 must be reported within 24 hours and negative COVID-19 results within one working day." "Both medical laboratories and health care providers are [https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le2290.pdf required] to report COVID-19 test results to the state and local public health authorities." According to [https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1233 state law], reports should be initially submitted by phone call, with a follow-up report either through the [https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/COMMUNICABLEDISEASE/REPORTINGCOMMUNICABLEDISEASE/Pages/counties.aspx online morbidity report tool] or a fax. ELR may also be an option.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.health.pa.gov/topics/Reporting-Registries/Pages/Reporting-Registries.aspx Pennsylvania]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form (use PA-NEDDS)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|PA-NEDSS: 1-877-724-3258
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.health.pa.gov/topics/Documents/HAN/2020-PAHAN-482-03-05-ADV-Commercial.pdf From] the Pennsylvania Department of Health: "COVID-19 is a reportable condition to the DOH. Any positive test results from any laboratory must be reported to DOH via the Pennsylvania National Electronic Disease Surveillance System (PA-NEDSS)." COVID-19 is now on the [https://www.health.pa.gov/topics/Reporting-Registries/Pages/Reportable-Diseases.aspx list or reportable diseases], and it must be reported with 24 hours.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://health.ri.gov/diseases/about/reporting/ Rhode Island]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://health.ri.gov/forms/Provider-Reporting-Form-for-COVID-19.pdf PUI for COVID-19 - Reporting Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: (401) 222-2577 or (401) 276-8046 after hours<br /> <br />Fax: (401) 222-2488
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://health.ri.gov/diseases/ncov2019/for/providers/ Per] the Rhode Island Department of Health: "Any suspected cases of COVID-19 should be reported to RIDOH immediately. For any questions and to report cases, please call the Rhode Island Department of Health Center for Acute Infectious Disease Epidemiology at 401-222-2577 during business hours (Monday – Friday, 8:30 a.m. – 4:30 p.m.) or 401-276-8046 after hours." Presumably a follow-up fax using the COVID-19 reporting form is also required. The report "must be [https://health.ri.gov/diseases/infectious/resultsreportable.php reported] on the day of recognition or strong suspicion of disease." The RIDOH disease reporting web page makes no mention of ELR.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.scdhec.gov/health-professionals/south-carolina-list-reportable-conditions South Carolina]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N (?)
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://www.scdhec.gov/sites/default/files/Library/CR-009025.pdf Local public health office]<br /> <br />ELR: 1-800-917-2093
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.scdhec.gov/infectious-diseases/viruses/coronavirus-disease-2019-covid-19/physicians-frequently-asked-questions-covid-19 Per] the South Carolina Department of Health and Environmental Control: "If results were from a private lab, please notify DHEC of positive result. COVID-19 is an immediately reportable condition on the South Carolina List of Reportable Conditions." However, an [https://www.scdhec.gov/sites/default/files/Library/CR-009025.pdf April 22 update] now lists it as "urgently reportable," meaning within 24 hours by phone. The SCDHEC disease reporting web page does mention ELR, though it's not clear if it can be used to report COVID-19 cases.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://doh.sd.gov/diseases/infectious/Reporting.aspx South Dakota]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://apps.sd.gov/ph93morbidity/secure/index.aspx South Dakota Confidential Disease Report] (online/HTML)
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: (605) 773-3737 or 800-592-1861<br /> <br />Fax: (605) 773-5509
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"SD-DOH would like to [https://doh.sd.gov/news/Coronavirus.aspx#Providers remind] medical providers, hospitals, and laboratories that cases of COVID-19, caused by the SARS-CoV-2 virus, are considered immediately reportable in South Dakota (under Coronavirus Respiratory syndromes)." The SD-DOH and the state laws don't make clear what reporting method is best for Category I diseases, only that they should be reported immediately. Under "how to report," they list, in order, online reporting, phone, fax, and mail. The SD-DOH disease reporting web page makes no mention of ELR (other than completing the online/HTML form).
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.tn.gov/content/dam/tn/health/documents/cedep/novel-coronavirus/CaseReportingGuidance.pdf Tennessee]
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.tn.gov/content/dam/tn/health/documents/cedep/novel-coronavirus/3.-Updated-CDC-PUI-Form_2.29.20.pdf Person Under Investigation (PUI) and Case Report Form]
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Fax: (615) 741-3857<br /> <br />Phone: (615) 741-7247<br /> <br />ELR: ceds.informatics@tn.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"Healthcare providers who receive positive COVID-19 test results on their patients or patients in their facility [should report]." "Laboratories performing COVID-19 testing should be reporting these results electronically via ELR or our emergency spreadsheet template. If you are a laboratory that needs to report via one of these methods, please email ceds.informatics@tn.gov." These entities "should report within 24 hours of receiving a COVID-19 diagnosis, positive lab report on a patient, and/or becoming aware of a suspected or confirmed COVID-19 associated death." "Please submit a PUI Form on all positive COVID-19 test results from commercial labs only; you do not need to submit further information on a lab result from the TDH Public Health Laboratory. Please include a copy of the positive lab result." The Tennessee Department of Health lists three reporting options: faxing the PUI form and positive lab report, phoning, and electronically (via [https://hssi.tn.gov/auth/login Morbidity Reports] or ELR).
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.dshs.texas.gov/idcu/investigation/conditions/ Texas]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.dshs.texas.gov/IDCU/investigation/Reporting-forms/2017-EPI-2.pdf Infectious Disease Report] (Single case)<br /> <br />[https://www.dshs.texas.gov/IDCU/investigation/Reporting-forms/EPI-1-2017.pdf Infectious Disease Report] (Multiple cases)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://www.dshs.texas.gov/idcu/investigation/conditions/contacts/ Local health department]<br /> <br />ELR: COVID‑19ELR@dshs.texas.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"On March 24, 2020, Governor Greg Abbott [https://www.dshs.texas.gov/coronavirus/labs.aspx ordered] every public or private entity that is utilizing an FDA-approved test, including an emergency use authorization test, for human diagnostic purposes of COVID- 19, shall submit to DSHS, as well as to the local health department, daily reports of all test results, both positive and negative." The state lists novel coronaviruses as an immediately reportable event by phone. Although not explicitly stated, an Infectious Disease Report form may also be required after the phone call; verify with you local health department. ELR registration can be [https://www.dshs.texas.gov/nedss/forms/Public-Health-Gateway-Provider-Registration-Form.aspx performed online]. After online registration, "please send the name of your facility, email, and a good contact number to COVID‑19ELR@dshs.texas.gov to get your account created."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://health.utah.gov/epi/reporting/ Utah]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://health.utah.gov/epi/reporting/UDOH_CMR.pdf Utah Public Health Confidential Morbidity Report]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Fax: (801) 538-9923<br /> <br />Email: reporting@utah.gov<br /> <br />Phone: 1-888-EPI-UTAH<br /> <br />ELR: edx@utah.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Utah Department of Health doesn't appear to have published any information about specific COVID-19 reporting requirements. The DoH is [http://health.utah.gov/epi/reporting/Rpt_Disease_List.pdf presumably] treating COVID-19 cases as immediately reportable events ("within 24 hours of a suspect diagnosis") for healthcare facilities and laboratories. Reports may be faxed (note that the "disease reporting fax line is an email fax"), emailed, or phoned. Emailed reports must be through an encrypted and secure means. It also appears the DoH is performing some form of ELR through its Public Health Access system, though it's not clear if COVID-19 reports can be submitted that way.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.healthvermont.gov/disease-control/disease-reporting/infectious-disease-reporting Vermont]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: (802) 863-7240<br /> <br />Fax: (802) 951-4061<br /> <br />ELR: (802) 651-1619
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Vermont Department of Health offers little in regards to COVID-19 reporting requirements, except [https://www.healthvermont.gov/response/infectious-disease/novel-coronavirus-covid-19-health-care-professionals to say]: "Report all suspect cases immediately to the Vermont Department of Health Infectious Disease Epidemiology by calling 802-863-7240 (24/7)." It's not clear if a subsequent report must also be faxed or sent electronically; contact the health department to confirm. ELR is mentioned on the site's disease reporting page.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://www.vdh.virginia.gov/epidemiology/ Virginia]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|?
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|?
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[http://www.vdh.virginia.gov/content/uploads/sites/13/2016/03/Epi1.pdf Confidential Morbidity Report]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [http://www.vdh.virginia.gov/home/local-health-districts/ Local health department]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Other than [http://www.vdh.virginia.gov/coronavirus/health-professionals/vdh-updated-guidance-on-testing-for-covid-19/ to say] "[c]linical diagnosis of COVID-19 is a reportable condition, regardless of whether testing is pursued or not," the Virginia Department of Health offers little in the way of COVID-19-specific reporting requirements. The DoH indicates that if a patient isn't qualified to be tested by the state lab, clinicians should use the [https://redcap.vdh.virginia.gov/redcap/surveys/?s=NYKYR7W47M online reporting portal]. Additionally, the overall reporting requirements for the DoH are convoluted. The state simply [http://www.vdh.virginia.gov/surveillance-and-investigation/commonwealth-of-virginiastate-board-of-health/ indicates]: "Those required to report should report all conditions when suspected or confirmed to their local health department."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/NotifiableConditions Washington]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.doh.wa.gov/Portals/1/Documents/5100/420-110-ReportForm-COVID19.pdf COVID-19 Extended Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://www.doh.wa.gov/AboutUs/PublicHealthSystem/LocalHealthJurisdictions Local health jurisdiction]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Washington State Department of Health doesn't appear to have published any information about specific COVID-19 reporting requirements. The DoH is [https://www.doh.wa.gov/Portals/1/Documents/5100/210-002-Poster-Lab.pdf presumably] treating "preliminary or confirmed" COVID-19 cases as an immediately reportable event that "requires a phone call to reach a live person at the [local health jurisdiction], 24/7." It's not clear if a faxed report is also required. The DoH disease reporting web page makes no mention of ELR.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://oeps.wv.gov/reporting/Pages/default.aspx West Virginia]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://dhhr.wv.gov/COVID-19/documents/hcp/covid19_report_form.pdf 2019 Novel Coronavirus (COVID-19) Case Report Form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://dhhr.wv.gov/localhealth/pages/map.aspx Local health departments]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"Report suspect or confirmed cases WITHIN 24 HOURS to the local health department by phone and follow up with written report." It's not clear if ELR is an acceptable form of reporting COVID-19 cases.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.dhs.wisconsin.gov/disease/diseasereporting.htm Wisconsin]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://www.dhs.wisconsin.gov/forms/f4/f44151.docx Acute and Communicable Disease Case Report F-44151]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://www.dhs.wisconsin.gov/lh-depts/counties/index.htm Local health department]<br /> <br />WEDSS: DHSWEDSS@wisconsin.gov
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"The state epidemiologist has declared COVID-19 a Category I reportable disease per a memo issued on Feb. 4, 2020. Report immediately by telephone to the patient's local public health department upon identification of a confirmed or suspected case. The local health department shall then notify the state epidemiologist immediately of any confirmed or suspected cases. Within 24 hours, submit a case report electronically through the Wisconsin Electronic Disease Surveillance System (WEDSS), by mail or fax using an Acute and Communicable Disease case report, F44151 or by other means."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://health.wyo.gov/publichealth/infectious-disease-epidemiology-unit/reporting/ Wyoming]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://health.wyo.gov/wp-content/uploads/2016/04/22-12940_FillinDiseaseReportForm_2012.pdf Confidential Disease Report form]
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: 1-888-996-9104<br /> <br />Fax: (307) 777-5573
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|"Providers and laboratories must report positive [SARS-CoV-2] laboratory tests from commercial reference laboratories to WDH by faxing copies of the laboratory report form to 307-777-5573." According to Wyoming's [https://health.wyo.gov/wp-content/uploads/2020/04/2020ReportableListrevised-1.pdf Reportable Diseases and Conditions List], this faxed report would be in addition to immediate notification by phone. Additionally, "[h]ospital and reference labs with ELR capacity must report positive and negative results," as well as viral detection and serology results. According to that document, COVID-19 isn't a disease preferred for ELR.
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| |}
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| |}
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| {|
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| | STYLE="vertical-align:top;"|
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| {| class="wikitable" border="1" cellpadding="5" cellspacing="0" width="90%"
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| | style="background-color:white; padding-left:10px; padding-right:10px;" colspan="6"|'''Table 2.''' U.S. territory-based COVID-19 reporting requirements
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| ! style="background-color:#e2e2e2; padding-left:10px; padding-right:10px;" |Territory
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| ! style="background-color:#e2e2e2; padding-left:10px; padding-right:10px;" |Electronic file (Y/N)
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| ! style="background-color:#e2e2e2; padding-left:10px; padding-right:10px;" |Fax? (Y/N)
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| ! style="background-color:#e2e2e2; padding-left:10px; padding-right:10px;" |Forms for reporting
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| ! style="background-color:#e2e2e2; padding-left:10px; padding-right:10px;" |Contact
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| ! style="background-color:#e2e2e2; padding-left:10px; padding-right:10px;" |Additional details
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|American Samoa
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|N (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Can't locate the AMS COVID-19 Investigation Form
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://www.facebook.com/pg/asdoh.hotline/about Facebook page]<br /> <br />Phone: (684) 633-5871 or (684) 633-5872
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|According to [https://6fe16cc8-c42f-411f-9950-4abb1763c703.filesusr.com/ugd/4bfff9_8201b0412f8d4e9ea6f32116ee883b29.pdf American Samoa's report] ''Territory of American Samoa's Response and Action Plan to Combat the Cornoavirus Pandemic'', resources for testing are unforunately thin. It makes mention that the American Samoa Department of Health should be notified "immediately of probable or confirmed cases of COVID-19." It also mentions completing an "AMS COVID-19 Investigation Form." "If there is more than one case of novel coronavirus in a household, local area or facility, or an outbreak is suspects, notify Command Post immediately at (684) 633-5871 or (684) 633-5872."
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Guam
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y (?)
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: Office of Epidemiology and Research - Phone: (671) 735-7289, Fax: (671) 734-2066
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|It's clear that Guam is having laboratories [http://dphss.guam.gov/covid-19/ report cases] of COVID-19, but no reporting requirements for COVID-19 (or any other diseases) can be located on the Department of Public Health and Social Services website. Perhaps contact the Office of Epidemiology and Research for more information.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Northern Mariana Islands
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|No standardized COVID-19 reporting form
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Contact: [https://www.chcc.gov.mp/laboratory.php CHCC laboratory]
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|The CNMI Department of Public Health [https://drive.google.com/file/d/19Somy68fPQwTBIcBEiCYyZGo2tboeVgn/view has indicated] that laboratory testing has been primarily been performed by the Guam Public Health Laboratory, but due to them not being able to meet demand, the CNMI DPH will ship samples to Diagnostic Laboratory Services in Honolulu, Hawaii. Presumably those labs are responsible, in part, for reporting results back to the CNMI.
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|
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|Puerto Rico
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Unknown
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Unknown
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Unknown
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: (787) 765-2929<br /> <br />Email: contactus@salud.pr.gov
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|The Departamento de Salud de Puerto Rico [http://www.salud.gov.pr/OA%20COVID19/Forms/AllItems.aspx appears to have had] a relevant document ''OA 440 Sobre la distribución, manejo, administración y reporte de los resultados de las pruebas de COVID-19'' [http://salud.gov.pr/OA%20COVID19/OA%20440%20Sobre%20la%20distribuci%C3%B3n,%20manejo,%20administraci%C3%B3n%20y%20reporte%20de%20los%20resultados%20de%20las%20pruebas%20de%20COVID-19.pdf concerning] reporting results, but the website is down as of April 24, 2020.
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| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://doh.vi.gov/programs/epidemiology-disease-reporting U.S. Virgin Islands]
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|N
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Y
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|[https://doh.vi.gov/sites/default/files/January%202018_EPI-1_0.pdf Notification of Infectious Disease Form]
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|Phone: St. Croix - (340) 712-6299; St. Thomas and St. John - (340) 776-1519<br /> <br />Fax: [https://doh.vi.gov/programs/epidemiology-disease-reporting/contact-us Confirm these fax numbers]
| |
| | style="background-color:white; padding-left:10px; padding-right:10px;"|"To report a suspect COVID-19 case, call 3407126299 (STX) or 3407761519 (STT/STJ)." No other COVID-19-specific guidance can be found. The DoH is [https://docs.wixstatic.com/ugd/119519_9690ed799862457480a77985120a2b1e.pdf presumably] treating COVID-19 cases as immediately reportable events that should be phoned in. It's possible a follow-up infectious disease form should also be faxed within 24 hours. However, it's not clear if the fax number on the report form is accurate; confirm the fax number during the initial phone call.
| |
|
| |
| |}
| |
| |}
| |
| | |
| | |
| ===3.3 Additional benefits and challenges of laboratory informatics in disease testing and public health===
| |
| COVID-19 is at the forefront of the consciousness of humanity, by and large, and the informatics tools we implement for managing, treating, and surveilling the disease are of great import. From disease databases to [[electronic health record]]s, from bioinformatics tools for peptide and protein modelling to laboratory tools such as LIMS and LIS, we continue to fight back against the threat of the SARS-CoV-2 virus. Yet despite the gravity of the pandemic, this is neither the first nor the last time laboratory and scientific informatics will play a positive role in testing for disease and improving public health outcomes.
| |
| | |
| Health informatics technology, when used responsibly, has already proven to be useful in studying and treating diseases. In a 2013 research paper published in the journal ''BMJ Quality & Safety'', El-Kareh ''et al.'' analyzed and described the state of diagnostic health information technology (HIT). They noted that without the aid of HIT, clinicians are more error-prone, leaving them "vulnerable to fallible human memory, variable disease presentation, clinical processes plagued by communication lapses, and a series of well-documented ‘heuristics,’ biases, and disease-specific pitfalls."<ref name="El-KarehUseOf13">{{cite journal |title=Use of health information technology to reduce diagnostic errors |journal=BMJ Quality & Safety |author=El-Kareh, R.; Hasan, O.; Schiff, G.D. |volume=22 |issue=Suppl. 2 |pages=ii40–ii51 |year=2013 |doi=10.1136/bmjqs-2013-001884 |pmid=23852973 |pmc=PMC3786650}}</ref> Appropriate, well-designed HIT systems are capable of helping clinicians and laboratorians by providing more timely access to information, improved communication, better clinical reasoning and decision making, and improved workflows, as well as a reduction in diagnostic errors, and, as a result, improved patient safety and health outcomes.<ref name="NASEMImprov15">{{cite book |url=https://www.nap.edu/read/21794/chapter/7 |chapter=Chapter 5: Technology and Tools in the Diagnostic Process |title=Improving Diagnosis in Health Care |author=National Academies of Sciences, Engineering, and Medicine |publisher=The National Academies Press |pages=217–62 |year=2015 |doi=10.17226/21794 |isbn=9780309377720}}</ref>
| |
| | |
| From a public health perspective, the application of informatics to disease surveillance, reporting, and health habit promotion is also vital. Winters-Miner ''et al.'' note in particular the value of using informatics tools and methods to implement predictive analytics and data mining into public health. They use disease prevention and biosurveillance as major examples. We could, for example "analyze large populations of people to quantify risks related to public health, and help physicians to develop intervention programs for those patients at highest risk of some ailment or medical condition."<ref name="Winters-MinerBiomedical15">{{cite book |chapter=Chapter 3: Biomedical Informatics |title=Practical Predictive Analytics and Decisioning Systems for Medicine |author=Winters-Miner, L.A.; Bolding, P.S.; Hilbe, J.M. et al. |publisher=Academic Press |pages=42–59 |year=2015 |doi=10.1016/B978-0-12-411643-6.00003-X |isbn=9780124116436}}</ref> Additionally, through the use of syndromic surveillance systems (tools aiding in the detection of indicators leading up to disease diagnosis for individuals and populations<ref name="MandlImplement04">{{cite journal |title=Implementing syndromic surveillance: A practical guide informed by the early experience |journal=JAMIA |author=Mandl, K.D.; Overhage, J.M.; Wagner, M.M. et al. |volume=11 |issue=2 |pages=141–50 |year=2004 |doi=10.1197/jamia.M1356 |pmid=14633933 |pmc=PMC353021}}</ref>), they suggest that outbreaks can be better detected at local and national levels, and public health measures can be better implemented, increasing public awareness and hindering the spread of disease.<ref name="Winters-MinerBiomedical15" />
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| In the clinical laboratory, informatics systems have been influencing workflow improvements and improved sevice delivery in the lab for more than five decades.<ref name="JonesInform14">{{cite journal |title=Informatics and the Clinical Laboratory |journal=The Clinical Biochemist Reviews |author=Jones, R.G.; Johnson, O.A.; Baststone, G. |volume=35 |issue=3 |pages=177–192 |year=2014 |pmid=25336763 |pmc=PMC4204239}}</ref> And while improvements have been seen in the laboratory from not only the introduction of computerized systems<ref name="El-KarehUseOf13" /><ref name="NASEMImprov15" /><ref name="RaeenHowLab18">{{cite journal |title=How laboratory informatics has impacted healthcare overall |journal=Applied Research Projects |author=Raeen, M.R. |volume=54 |year=2018 |url=https://dc.uthsc.edu/hiimappliedresearch/54 |doi=10.21007/chp.hiim.0056}}</ref> but also the realization of quality control<ref name="ChawlaEval10">{{cite journal |title=Evaluating laboratory performance with quality indicators |journal=Laboratory Medicine |author=Chawla, R.; Goswami, B.; Singh, B. et al. |volume=41 |issue=5 |pages=297–300 |year=2010 |doi=10.1309/LMS2CBXBA6Y0OWMG}}</ref> and point-of-care testing<ref name="PricePoint01">{{cite journal |title=Poing of care testing |journal=BMJ |author=Price, C.P. |volume=322 |issue=7297 |pages=1285–8 |year=2001 |doi=10.1136/bmj.322.7297.1285 |pmid=11375233 |pmc=PMC1120384}}</ref>, more challenges remain. For example, quality management in the laboratory is still often a manual, time-consuming activity. While the LIS and LIMS have some tools to assist with this task, the inclusion of laboratory analytics and business intelligence tools into those systems may lead to even further quality and efficiencies in the lab.<ref name="ZiaguraUsing19">{{cite web |url=https://www.mlo-online.com/information-technology/lis/article/13017560/using-analytics-to-manage-qa-and-reduce-laboratory-errors |title=Using analytics to manage QA and reduce laboratory errors |author=Ziaugra, K.; Hawrylak, V.; Bickley, T. et al. |work=Medical Laboratory Observer |date=20 March 2019 |accessdate=25 April 2020}}</ref> In the realm of point-of-care testing, oversight and control of instruments can be lost when connectivity and training is lacking. Proper interfacing of these lab instruments could lead to improvements in those areas, says Siemens Healthineers' Daniel Gundler. "Maintaining POC instruments and overseeing the operators performing POC tests would be much easier if all the information and data from each instrument were accessible through one user interface in which coordinators could manage both the instruments and operators."<ref name="GundlerPOCT19">{{cite web |url=https://www.mlo-online.com/home/article/13017228/poct-made-easier-with-informatics |title=POCT made easier with informatics |author=Gundler, D. |work=Medical Laboratory Observer |date=23 January 2019 |accessdate=25 April 2020}}</ref>
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| ====3.3.1 System interoperability====
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| System interoperability also poses benefits and challenges to clinical disease testing and prevention. Interoperability is defined as ... Improving interoperability among clinical informatics systems is recognized as an important step towards improving health outcomes.<ref name="KunImprov08">{{cite journal |title=Improving outcomes with interoperable EHRs and secure global health information infrastructure |journal=Studies in Health Technology and Informatics |author=Kun, L.; Coatrieux, G.; Quantin, C. et al. |volume=137 |pages=68–79 |year=2008 |pmid=18560070}}</ref><ref name="GCHIImproving">{{cite web |title=Improving Patient Care through Interoperability |author=Global Center for Health Innovation |publisher=Global Center for Health Innovation |date=n.d. |accessdate=25 April 2020}}</ref> The National Academies of Sciences, Engineering, and Medicine had much to say on this topic in their 2015 publication ''Improving Diagnosis in Health Care''<ref name="NASEMImprov15" />:
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| <blockquote>Improved interoperability across different health care organizations—as well as across laboratory and [[radiology information system]]s—is critical to improving the diagnostic process. Challenges to interoperability include the inconsistent and slow adoption of standards, particularly among organizations that are not subject to EHR certification programs, as well as a lack of incentives, including a business model that generates revenue for health IT vendors via fees associated with transmitting and receiving data.</blockquote>
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| In particular, they discuss an additional concern, one that still causes issues today: interfaces between EHRs and the laboratory and other clinical information systems that feed medical diagnostic information into the EHRs<ref name="NASEMImprov15" />:
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| <blockquote>Additionally, the interface between EHRs and laboratory and radiology information systems typically has limited clinical information, and the lack of sufficiently detailed information makes it difficult for a pathologist or radiologist to determine the proper context for interpreting findings or to decide whether diagnostic testing is appropriate. For example, one study found that important non-oncological conditions (such as Crohn’s disease, human immunodeficiency virus, and diabetes) were not mentioned in 59 percent of radiology orders and the presence of cancer was not mentioned in 8 percent of orders, demonstrating that the complete patient context is not getting received. Insufficient clinical information can be problematic as radiologists and pathologists often use this information to inform their interpretations of diagnostic testing results and suggestions for next steps. In addition, the Centers for Disease Control and Prevention’s Clinical Laboratory Improvement Advisory Committee (CLIAC) expressed concern over the patient safety risks regarding the interoperability of laboratory data and display discrepancies in EHRs. They recommended that laboratory health care professionals collaborate with other stakeholders to “develop effective solutions to reduce identified patient safety risks in and improve the safety of EHR systems” regarding laboratory data.</blockquote>
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| In fact, interoperability issues have come up during the global laboratory response to the COVID-19 pandemic. In early April 2020, a report from ''Nature'' revealed that academic research laboratories wanting to assist with COVID-19 testing efforts have at times been stymied by the incompatability between academic informatics systems and hospital EHRs. Not only do hospitals use EHRs of differing types, but many of those EHRs were not designed to talk to other EHRs, let alone to academic and research laboratories' informatics systems. Combine this with strict account procedures and the costs of developing interfaces on-the-fly, more than a few medical systems have turned away the offer of help from academic and research labs.<ref name="MaxmenThousands20">{{cite journal |title=Thousands of coronavirus tests are going unused in US labs |journal=Nature |author=Maxmen, A. |volume=580 |issue=7803 |pages=312–13 |year=2020 |doi=10.1038/d41586-020-01068-3 |pmid=32273619}}</ref> As it turns out, HL7- other standard-based interfaces have long been expensive for many vendors to implement<ref name="John3504HL7_11">{{cite web |url=https://community.spiceworks.com/topic/175107-hl7-interface-cost-and-maintenance |title=HL7 Interface cost and maintenance |author=John3504 |work=Spiceworks |date=07 December 2011 |accessdate=25 April 2020}}</ref>, the cost justified typically when high volumes of samples are involved. Additionally, in more normal, non-pandemic circumstances, the requirement to interface with EHRs and [[hospital information system]]s (HIS) is almost exclusively found in the LIS and LIMS used in patient settings, i.e., in the hospitals, medical offices, and laboratories catering to dignosing disease in patients. Academic labs have not been equipped at any level (software, hardware, or personnel) to do high volume clinical testing, including ensuring their informatics systems can interface with clinical systems.
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| Interoperability benefits and challenges show up elsewhere too. Take for example the value of phenotypes, a representation of the genetic analysis of the collective observable traits of an organism, traits caused by the interaction of its genome with the environment. The value of patient phenotyping data is increasingly useful in the fight against known and novel viruses, as well as a broad variety of non-viral diseases. As Ausiello and Shaw note, in order for medicine to advance and produce improved patient outcomes, "traditional clinical information must be combined with genetic data and non-traditional phenotypes and analyzed in a manner that yields actionable insights into disease diagnosis, prevention, or treatment."<ref name="AusielloQuant14">{{cite journal |title=Quantitative Human Phenotyping: The Next Frontier in Medicine |journal=Transactions of the American Clinical and Climatological Association |author=Ausiello, D.; Shaw, S. |volume=125 |pages=219–26 |year=2014 |pmid=25125736 |pmc=PMC4112685}}</ref> Whether it's identifying "the measurable phenotypic characteristics of patients that are most predictive of individual variation" in treatment outcomes for chronic pain<ref name="EdwardsPatient16">{{cite journal |title=Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations |journal=Pain |author=Edwards, R.R.; Dworkin, R.H.; Turk, D.C. et al. |volume=157 |issue=9 |pages=1851–71 |year=2016 |doi=10.1097/j.pain.0000000000000602 |pmid=27152687 |pmc=PMC5965275}}</ref> or COVID-19<ref name="MousavizadehGenotype20">{{cite journal |title=Genotype and phenotype of COVID-19: Their roles in pathogenesis |journal=Journal of Microbiology, Immunology, and Infection |author=Mousavizadeh, L.; Ghasemi, S. |pages=30082-7 |year=2020 |doi=10.1016/j.jmii.2020.03.022 |pmid=32265180 |pmc=PMC7138183}}</ref><ref name="GattinoniCOVID20">{{cite journal |title=COVID-19 pneumonia: Different respiratory treatments for different phenotypes? |journal=Intensive Care Medicine |author=Gattinoni, L.; Chiumello, D.; Caironi, P. |year=2020 |doi=10.1007/s00134-020-06033-2 |pmid=32291463 |pmc=PMC7154064}}</ref>
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| Here again interoperability between EHRs and laboratory informatics systems comes into play. In a 2019 paper published by Zhang ''et al.'' in ''nph Digital Medicine'', the topic of extracting patient phenotypes from laboratory test results fed into EHRs is addressed.<ref name="ZhangSemantic19">{{cite journal |title=Semantic integration of clinical laboratory tests from electronic health records for deep phenotyping and biomarker discovery |journal=npj Digital Medicine |author=Zhang, X.A.; Yates, A.; Vasilevsky, N. et al. |volume=2 |at=32 |year=2019 |doi=10.1038/s41746-019-0110-4 |pmid=31119199 |pmc=PMC6527418}}</ref> They address one of the more difficult aspects of their research, in that while "[l]aboratory tests have broad applicability for translational research ... EHR-based research using laboratory data have been challenging because of their diversity and the lack of standardization of reporting laboratory test results." They add<ref name="ZhangSemantic19" />:
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| <blockquote>Despite the great potential of EHR data, patient phenotyping from EHRs is still challenging because the phenotype information is distributed in many EHR locations (laboratories, notes, problem lists, imaging data, etc.) and since EHRs have vastly different structures across sites. This lack of integration represents a substantial barrier to widespread use of EHR data in translational research.</blockquote>
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| The answer to the clinical and laboratory interoperability question is unclear. A 2019 article in the American Association for Clinical Chemistry's ''CLN Stat'' addressed remaining roadblocks, including lack of standards development, data quality issues, clinical data matching, lack of incentivizing health IT optimization, text-based reporting formats, differences in terminology, and HL7 messaging issues. They add that proposals from the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services include possible fixes such as standardized [[application programming interface]]s. They also note that middleware may pick up the slack in connecting more laboratory devices, rather than depending on the LIS to handle all the interfacing.<ref name="AACCStrength19">{{cite web |url=https://www.aacc.org/publications/cln/cln-stat/2019/february/21/strengthening-the-chain-of-interoperability |title=Strengthening the Chain of Interoperability |author=American Association for Clinical Chemistry |work=CLN Stat |date=21 February 2019 |accessdate=25 April 2020}}</ref> Even so, it remains obvious that more work needs to be done in the development and standard use of clinical and laboratory informatics applications if the promise of personalized medicine and the need for improved disease testing and response are to be fulfilled. In particular, how we responsibly protect personal health information while putting its anonymized variants to beneficial use for disease testing and prevention remains a critical question that must be solved in order to better prepare for the next COVID-19.
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| ==References==
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| {{Reflist|colwidth=30em}}
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