Public Health Laboratories and Health System Change . Computerization of Laboratory Functions


Automation of key functions promises to dramatically improve the way that laboratories operate in the future. Internal operations, epidemiologic surveillance, communication with private laboratories, and use of test results could all be enhanced through the implementation of consistent laboratory information systems (LISs). In the private sector, many laboratories are investing in the infrastructure necessary to communicate with MCOs and other important constituencies. A critical question from the perspective of this study is the degree to which PHLs are involved in automation of information systems.

The vision for the future of automated LIS in the context of PHLs is that of one element in a seamless web of public health data. Communication of test results and other information between the PHL and both public and private sector organizations will be accomplished through automated electronic transactions. An automated system would also be linked into sophisticated epidemiology information that would assist in tracking the geographic patterns associated with outbreaks. This vision was articulated by Washington State in their Draft Information Services Plan, as reproduced in Figure 14.

Figure 14: Future Electronic Laboratory Data Network, Five Year Vision


The CDC has recognized the public health need to improve information infrastructure, and has articulated the need for involvement from laboratories. The CDC's vision for integrated disease information reporting is discussed in MMWR (February 16, 1996), and grants to improve information infrastructure have been established through the National Center for Infectious Disease (NCID) and Information Network for Public Health Officials (INPHO) program.

Some leadership in this area has also emerged from a coalition between CDC, CSTE, and ASTPHLD focusing on electronic reporting of clinical laboratory data. In March 1997, this group convened to develop draft recommendations for standardization of electronic reporting of laboratory results, which articulated problems and solutions in the areas of data flow, message format, and message content. These draft recommendations have been formally approved by CSTE and ASTPHLD, and have also been reviewed and accepted by the Health Information Systems and Surveillance Board (HISSB) within the CDC.

Our interviews suggest that there may be a growing gap between the development of needed infrastructure in the public and private sectors. Despite the CDC's current programs, development activity in PHLs is not robust. While some PHLs operate LISs to automate information transfer within the laboratory, few reported the ability to efficiently report test results to providers, other public health agencies and the CDC. Many PHLs indicated they still used paper for reporting laboratory results, and some PHLs were only recently beginning to computerize the process of billing customers for testing services associated with a fee.

The following section reviews the status of PHL information systems development relative to that of the private sector. We begin by describing the status of a common laboratory reporting nomenclature B a prerequisite to automation. We then describe current activity along three dimensions: (1) internal laboratory information systems; (2) inter-laboratory communication; and (3) creation of integrated knowledge bases.