Public Health Laboratories and Health System Change . Inter-Laboratory Communication


An important element of the public and private laboratory function is to communicate with other laboratories, health care practitioners, and public health officials. Electronic reporting of laboratory test results to the ordering physician has become routine in most large hospitals. But this function is also critical in PHLs, since much of the testing is referred from other laboratories, and a primary role is to support epidemiological surveillance.

The CDC has made efforts to help state and local public health laboratories comply with its own disease surveillance projects through the development of the Public Health Laboratory Information System (PHLIS).20  PHLIS is information transfer software that allows officials at SHAs, local health agencies, and PHLs to electronically report information to the CDC in support of CDC surveillance programs. Additionally, PHLIS allows the CDC to issue tables and summary reports to all sites. The modest requirements for operating PHLIS (a PC with 512 kilobytes of memory and a modem) increase its potential effectiveness as a tool for collecting and disseminating information on disease incidence and potential outbreaks for public health laboratories with dissimilar or non-existent laboratory information systems.

Currently, PHLIS is used primarily by local and state PHLs and the CDC to communicate test results electronically. Within SHAs, the CDC has developed the NETTS system, which state epidemiologists use to transmit information about reportable diseases originating from PHLs, private sector laboratories, or other sources.

PHLIS operates using a modular approach, with a separate module dedicated to the subject of each CDC disease surveillance program. Modules are designed uniquely, and users interfacing with a particular module receive prompts detailing what information to enter and where within the module to enter it. Decisions regarding what types of information would be required for a given program were made by the CDC in conjunction with ASTPHLD and other medical epidemiologists. After entering the information required in a given module, the user is able to select "SEND TO CDC," which prompts the PHLIS to call a central communications computer, log on by responding to identification prompts, and transfer data. PHLIS currently includes modules for CDC programs designed to track incidence of Salmonella, Shigella, Campylobacter, and Mycobacteria, and all state and territorial public health laboratories have agreed to participate in the program.

The Washington State PHL is also involved in the creation of an innovative system for electronic disease reporting between private laboratories and the state health agency. The goal of the system is to automate reporting in hopes of lessening the burden of reporting, improving accuracy, and expediting reporting. The Office of Epidemiology has received a grant from the National Center for Infectious Disease (NCID) at the CDC to pilot the system. The Office of Epidemiology is working closely with the PHL, Group Health Cooperative of Puget Sound, and Laboratory Pathology Associates on clinical and technical issues involved in automated reporting. Current issues being addressed by this project include establishing a mechanism for data transfer between private sector and public sector organizations, protocols for data recording, and encryption / confidentiality of records.