Layout 1


ISDS Annual Conference Proceedings 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and
reproduction in any medium, provided the original work is properly cited.

ISDS 2012 Conference Abstracts

Towards Interoperability for Public Health Surveillance:
Experiences from Two States
Brian E. Dixon*1, 2, 3, Jason A. Siegel5, Tanya V. Oemig5 and Shaun J. Grannis4, 2

1Indiana University, Indianapolis, IN, USA; 2Regenstrief Institute, Indianapolis, IN, USA; 3Center of Excellence on Implementing
Evidence-Based Practice, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and
Development Service, Indianapolis, IN, USA; 4Indiana University School of Medicine, Indianapolis, IN, USA; 5Atlas Development
Corporation, Calabasas, CA, USA

Objective
To characterize the use of standardized vocabularies in real-world

electronic laboratory reporting (ELR) messages sent to public health
agencies for surveillance.

Introduction
The use of health information systems to electronically deliver

clinical data necessary for notifiable disease surveillance is growing.
For health information systems to be effective at improving popula-
tion surveillance functions, semantic interoperability is necessary.

Semantic interoperability is “the ability to import utterances from
another computer without prior negotiation” (1). Semantic interop-
erability is achieved through the use of standardized vocabularies
which define orthogonal concepts to represent the utterances emitted
by information systems. There are standard, mature, and internation-
ally recognized vocabularies for describing tests and results for noti-
fiable disease reporting through ELR (2). Logical Observation
Identifiers Names and Codes (LOINC) identify the specific lab test
performed. Systematized Nomenclature of Medicine-Clinical Terms
(SNOMED CT) identify the diseases and organisms tested for in a
lab test.

Many commercial laboratory and hospital information systems
claim to support LOINC and SNOMED CT on their company web-
sites and in marketing materials, and systems certified for Meaning-
ful Use are required to support LOINC and SNOMED CT. There is
little empirical evidence on the use of semantic interoperability stan-
dards in practice.

Methods
To characterize the use of standardized vocabularies in electronic

laboratory reporting (ELR) messages sent to public health agencies
for notifiable disease surveillance, we analyzed ELR messages from
two states: Indiana and Wisconsin. We examined the data in the ELR
messages where tests and results are reported (3). For each field, the
proportion of field values that used either LOINC or SNOMED CT
codes were calculated by dividing the number of fields with coded
values by the total number of non-null values in fields.

Results
Results are summarized in Table-1. In Indiana, less than 17% of in-

coming ELR messages contained a standardized code for identifying
the test performed by the laboratory, and none of the test result fields
contained a standardized vocabulary concept. For Wisconsin, none
of the incoming ELR messages contained a standardized code for
identifying the test performed, and less than 13% of the test result
fields contained a SNOMED CT concept.

Conclusions
Although Wisconsin and Indiana both have high adoption of ad-

vanced health information systems with many hospitals and labora-
tories using commercial systems which claim to support
interoperability, very few ELR messages emanate from real-world
systems with interoperable codes to identify tests and clinical results.
To effectively use the arriving ELR messages, Indiana and Wiscon-
sin health departments employ software and people workarounds to
translate the incoming data into standardized concepts that can be uti-
lized by the states’ surveillance systems. These workarounds present
challenges for budget constrained public health departments seeking
to leverage Meaningful Use Certified technologies to improve noti-
fiable disease surveillance.

Table 1 – Proportion of “Raw” ELR Data Samples with LOINC or SNOMED
CT Concepts

Keywords
Standards; Interoperability; Electronic Laboratory Reporting; Public
Health Surveillance; Computerized Medical Records Systems

Acknowledgments

The authors further thank Shahid Khokhar of the Regenstrief Institute and
Keith Michaelson of Atlas Public Health for their help with the extraction
of the ELR message data.
This work was supported, in part, by the Indiana Center of Excellence in
Public Health Informatics through a grant award (501HK000077) from
the U.S. Centers for Disease Control and Prevention.

References

1. Dolin RH, Alschuler L. Approaching semantic interoperability in
Health Level Seven. J Am Med Inform Assoc. 2011;18(1):99-103.

2. Wurtz R, Cameron BJ. Electronic laboratory reporting for the infec-
tious diseases physician and clinical microbiologist. Clin Infect Dis.
2005;40(11):1638-43.

3. Dixon BE, McGowan JJ, Grannis SJ. Electronic laboratory data qual-
ity and the value of a health information exchange to support public
health reporting processes. AMIA Annu Symp Proc. 2011;2011:322-
30.

*Brian E. Dixon
E-mail: bdixon@regenstrief.org

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e51, 2013