PHLIP & RnR Hub HIMSS Latino Community | August 30, 2012

Collaborative project to assist public health laboratories (PHLs)

exchange laboratory data with the CDC and other partner

agencies via electronic HL7 messaging.

The Plan

• PHLIP

• PHINMS

• RnR Hub Foundation

• Influenza Surveillance

• Pandemic Influenza

• ETOR Salmonella RnR In Action

• A National Resource: Information and laboratory scientists at the state and federal level addressing highly complex technical issues critical to public health.

• A Collaboration: commitment to utilize NwHIN IT architecture options for the exchange of electronic laboratory data at all levels of public health laboratories.

• A Community: to support and expand LIMS user communities, creating a process that can be applied to other highly complex problems.

• Products and Publications: Documentation of decisions made, fiscal and human resources needed, and lessons learned. Development and dissemination of Vocabulary and Messaging guides to meet the needs of the Public Health Laboratory “harmonized” list of LOINC and SNOMED codes for nationally notifiable diseases (NND’s).

• A Success: The realization of common goals and national priorities in a production environment.

What is PHLIP?

Fax/Web Surveillance

Achieve bi-directional laboratory data exchange

• State public health labs (SPHL) with CDC labs

• SPHLs with local partners

Which will

• Improve data quality, accuracy and accessibility

• Improve and expand data sources for active surveillance

• Create a strengthened collaborative environment for public health

National Public Health Laboratory System

[ Integrated and Interoperable ]

PHLIP Vision

• National collaborative process

• Provide detailed vocabulary implementation guidelines

• Build PHL capability for electronic test ordering and result reporting

• Develop and pilot data exchange

architecture options

• Establish a process to help labs increase messaging capability

PHLIP Florida RnR Hub Team

PHLIP Building Blocks

Transport

• PHINMS

Messaging

• ELSM – HL7 v2.3.1 ORU^R01

• ETOR – HL7 v2.6 OML^O33 and

OUL^R22

Vocabulary

• LOINC for ordered and resulted tests

• SNOMED for results

• SNOMED and HL7 for specimen

terms

• HL7 elsewhere in the message

Standards Used

• Public Health Information Network – Messaging System

• Provides public health applications a common platform for message transport

• Secure and reliable over the Internet

• Standards-based -“De-facto” standard for secure message transport

• Available at no cost to users

• Applications using PHINMS include: BioSense, ELR, LRN, NBS,NND, NHSN, LabCorp, PerSe, Foodborne, BSIO, PHLIP

• Used by Public Health Information Network Certification (PHIN)

• 10-year old product deemed “mission critical” by CDC

• Over 700 PHIN-MS nodes used in U.S.

What is PHINMS?

What is PHINMS?

Multiple Senders to Multiple Receivers = exponential growth of

connections and maintenance

Direct Send Model

RnR Hub

Solution

• The RnR Hub focuses on reducing the overhead of the PHINMS Direct

Send model

• Additional firewall configuration is not typically required for each Trading

Partner – infrastructure needs are low

• Facilitates rapid implementation of electronic message exchange

• Low deployment costs for partners - Ability to send pre-configured install “package”

• Reduction of management burden

• Message routing

• Certificate management

• Hardware and bandwidth needs

• Once on the RnR Hub, you can exchange

Information with all others on the RnR Hub

• Centralized Support provided by the RnR

Hub Team

What is the RnR Hub?

1. ELSM – Surveillance Message

2. Pandemic Influenza

3. ETOR Salmonella

RnR Hub in Action

PHLIP Use Case 1 – ELSM Influenza – Electronic Laboratory Surveillance Message

• Goal: All states sending Influenza results via the PHLIP HL7 Message to CDC

• New states to complete readiness assessment and agree to PHLIP decisions

• All states to provide Influenza reporting metrics

• PHLIP Assistance Teams to deliver onsite and virtual support and PHLIP Program Management to provide oversight.

• Future: additional PHLIS agents as prioritized by CDC

State Public Health Lab

(SPHL)

PHLIP Route-Not-Read

Hub

CDC – Influenza Division

Message Format: HL7 2.3.1 ORU

Contents: Influenza Laboratory Results (WHO Global Influenza Surveillance Network)

HL7 Test Result HL7 Test Result

Influenza

1. ELSM– Surveillance Message

2. Pandemic Influenza

3. ETOR Salmonella

RnR Hub in Action

•Exchange of influenza lab data with:

•Local partners

•Other states

•Federal partners

•International partners

•Exchange of lab test orders and results

•Develop surge capacity model for Pan

Flu testing

Pan Flu Project: Goals

DISTANCE from

Tallahassee to

AUSTIN = 868 MILES

1. ELSM– Surveillance Message

2. Pandemic Influenza

3. ETOR Salmonella

RnR Hub in Action

Use Case 2 – ETOR Service Requests

State to CDC – Electronic Test Order and Result

• HL7 Test Order from State

Public Health Lab (PHL) to

CDC Lab(s)

• HL7 Test Result from CDC

Lab(s) to State PHL

• Limited Scope Production

phase includes Salmonella

and Bacillus anthracis

State

Public

Health Lab

(SPHL)

PHLIP

Route-Not-

Read Hub

CDC Labs

Salmonella

& BRRAT

Message Format:

• Order = HL7 2.6 ORM

• Result = HL7 2.6 OUL

Contents: Salmonella & Bacillus Anthracis Orders and Results

Status: In progress

HL7 Test Order HL7 Test Order

HL7 Test Result HL7 Test Result

• Register all state public health labs on the RnR Hub

• Continue to collaborate with Federal, State, and Local public health

departments in addition to private health care providers and labs

• Continue to work on additional use cases like Electronic Lab Reporting

(ELR) in support of Meaningful Use

• Expand to other diseases for state to CDC and state to state

• Continue developing interoperability between Direct, SFTP and PHINMS

• Continue development of the PHLIP architecture, with the expectation that

the RnR Hub will serve as a connection to both the NwHIN and the State

Health Information Networks

• Additional Hub Services

What’s Next?

Collaboration

Contact Information

Eduardo Gonzalez Loumiet, MBA, PMP, CPHIMS

Uber Operations, LLC

Contractors to the Association of Public Health Labs

eduardo@UberOps.com

(850) 766-5338

www.APHL.org | www.UberOps.com