COVID‐19 Webinar for Case Investigation and Follow‐up

What is ELR?

June 9, 2020

Sita Smith Bureau of Infectious Disease and Laboratory Sciences MA Department of Public Health ELR Things to know

2 Scale of reporting

March 2020 • 90 MA clinical labs and reference labs • Around 2000 lab reports/day June 2020 • 200 clinical labs, reference labs, urgent care centers, point of care centers

• From 10000 – 18000 reports/day 3 Routine infectious disease reporting

Anna Jaques Lahey Clinic ARUP Addison Gilbert Hospital St. Luke's Hospital Baystate Medical Center Beverly Hospital Charlton Hospital Berkshire Health Systems Tobey Hospital Fairview Hospital Lawrence General Hospital Beth Israel Saint Vincents Hospital Beth Israel Plymouth Lowell General Saints Campus Steward Beth‐Israel Deaconess Medical Center Mayo Clinic Good Samaritan Medical Center Beth‐Israel Deaconess Needham Mercy Medical Center Holy Family Hospital Boston Children Hospital Metrowest Medical Center, Merrimack Valley Hospital Milford Regional Medical Center Morton Hospital Broad Institute Nashoba Hospital New England Baptist Hospital Brigham and Women's Hospital Saint Anne's Hospital Cambridge Health Alliance Laboratory Brigham And Women's Faulkner Hospital St. Elizabeth's Medical Center Whidden Hospital Dana‐Farber Cancer Institute Excell Clinical Labs Newton Wellesley Hospital New England Sinai Hospital Lawrence Memorial MGH Sturdy Memorial Hospital Melrose Wakefield North Shore Hospital Harrington Memorial Hospital Martha's Vineyard Hospital UMass Memorial Medical Center Heywood Hospital Cottage Hospital HealthAlliance Spaulding Rehabilitation Hospital State Laboratory Instititute 4 Imugen Cooley Dickinson Hospital Quest Laboratory Corporation of America Eye & Ear BioReference Additional COVID only reporting AccessDX CareOne ‐ Brookline Encompass NEDS

Aegis CareOne ‐ Concord etruenorth One Medical

AFC Methuen, Stoneham, Waltham, N Andover CareOne ‐ Lexington Exact Sciences BROAD

AFC Marlboro CareOne ‐ Lowell Excelsior ORDRS Houston/MD TOX

AFC Saugus CareOne ‐ Needham ExosomeDx_Biotechne‐eurofin Orig3n, Inc.

AFC Springfield CareOne ‐ Newton Fallon Pangea

AFC Swampscott CareOne ‐ Wilmington Fulgent Pediatric Associates of Greater Salem

AFC UC @Natick CareOne at Essex Park GeneSyS PerkinElmer

AFC Waltham, Patriots CareOne at Millbury Genetworx Pine Street (Boston Homeless)

Alliance at Devereux House CareOne at New Bedford Genomic Expression pmaonline Ammon CareOne at Peabody Greater Lawrence Family Health Center PrimaCare

Arcpoint CareOne at Weymouth Integrity PWN Health Assurance Carewell UC Jackson Labs QDX Pathology Services

Atrius Center for motivation & change John Dewey Academy Sparrow Healthcare

Bedford Research CHAlliance Nursing Homes kbmo diagnostics Tempus

Color Lab USA Haverhill Tewkesbury Hospital Biocerna

Biogen IDEC ConvenientMD Lafayette Rehabilitation The Horowitz Medical Group (THMG)

BioReference cQuentia Lemuel Shattuck Trident US Labs at Brockton

Boston Heart Diagnostics. Curative Leonard Florence Center for Living VA Bedford and Boston

Boston Home CVS Linden Ponds VA Central Western MA Brandon Woods of Dartmouth Davita Mako Medical Veritas Genetics 5

Brandon Woods of New Bedford Dispatch Meadow Green Nursing and Rehab Center Vikor

Cambridge Biomedical East Boston FHC Middleton Family Medicine Viracor Capstone East Side Clinical Lab (Sonicare) + Sunrise MIT Walden Behavioral Health How are we receiving labs?

• Faxes ‐ manual data entry (how many?) ~ 250 day • Team of 8 manually entering into Maven • Electronic laboratory reporting (ELR) • Vast majority of what we receive ~ 12000/day • Team of 4 monitoring and correcting • Simple Excel spreadsheets, received via sftp or secure mail ~ 2500/day • Team of 4 epidemiologists processing 6 Electronic Laboratory Reporting

MAVEN

7 Not real time

• We receive reports for everything resulted the day before • Usually one batch per day • Reports feed into Maven within half an hour of entering the portal • Having to correct errors will delay the process

8 HL7 message • FHS|^~\&|Lab Facility^2.16.840.1.114222.4.1.220759^ISO|Lab Facility^05D0000000^CLIA|MA‐MDPH^2.16.840.1.113883.19.3.2^ISO|MA‐ MDPH^0000000^CLIA|20200603130950‐0800||MA‐MDPH||MA‐MDPH:20200603130950‐0800 • BHS|^~\&|Lab Facility^2.16.840.1.114222.4.1.220759^ISO|Lab Facility^05D0000000^CLIA|MA‐MDPH^2.16.840.1.113883.19.3.2^ISO|MA‐ MDPH^0000000^CLIA|20200603130950‐0800||MA‐MDPH||MA‐MDPH:20200603130950‐0800 • MSH|^~\&|Lab Facility^2.16.840.1.114222.4.1.220759^ISO|2.16.840.1.114222.4.1.220759^Lab Facility^05D0000000^CLIA|MA‐ MDPH^2.16.840.1.113883.19.3.2^ISO|MA‐MDPH^0000000^CLIA|20200603131238‐0800||ORU^R01^ORU_R01|D‐ 4861207191202006032112953627|P|2.5.1|||NE|NE|USA||||PHLabReportNoAck^^2.16.840.1.113883.9.10^ISO • SFT|Lab Facility|1.0|Lab Facility|Binary Id Unknown • PID|1||110596808^^^Lab Facility&2.16.840.1.114222.4.1.220759&ISO^PI||Mouse^Mickey||19870501|M||2028‐9^Asian^CDCREC^^^^3.1.0|00 Fake street^^Disney^MA^02130^USA^H||^PRN^PH^^1^617^9834370|||||||||2186‐5^Not Hispanic or Latino^CDCREC^^^^3.1.0 • ORC|RE|3631467^Lab Facility^2.16.840.1.114222.4.1.220759^ISO|3631467^Lab Facility^2.16.840.1.114222.4.1.220759^ISO||CM|||||||1962476994^Mouse^Minnie^^^^^^NPI&2.16.840.1.113883.4.6&ISO^^^^NPI|||||||||Ordering Facility^D|00 Main St.^^Tunes^MA^02130^USA^O|^WPN^PH^^1^617^9834370|25 Fake Street^Building E23^Tunes^MA^02130^USA^O • OBR|1|3631467^Lab Facility^2.16.840.1.114222.4.1.220759^ISO|3631467^Lab Facility^2.16.840.1.114222.4.1.220759^ISO|94309‐ 2^^LN|||20200522075702‐0800|||||||||1962476994^Mouse^Minnie^^^^^^NPI&2.16.840.1.113883.4.6&ISO^^^^NPI||||||20200523065409‐0800|||F • OBX|1|CWE|94309‐2^SARS coronavirus 2 RNA:PrThr:Pt:XXX:Ord:Probe.amp.tar^LN|1|260415000^Not detected^SCT||Not detected|N^Normal^HL70078^^^^2.5.1|||F||||05D0000000^Performing Lab Facility^CLIA^2.16.840.1.114222.4.1.220759&ISO||||20200523022020‐ 0800||||Testing Institute^D^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^22D0000001|320 Fake St.^^Tunes^MA^02130^USA^B • SPM|1|D‐4861207191&Lab Facility&2.16.840.1.114222.4.1.220759&ISO^D‐4861207191&Lab Facility&2.16.840.1.114222.4.1.220759&ISO||697989009^Anterior nares swab (specimen)^SCT^^^^3.1.0||373067005^No (qualifier value)^SCT^^^^3.1.0|||||||||||20200522075702‐0800|20200522075703‐0800 • BTS|1 9 • FTS|1 Reports vs Maven Events

• Number of reports is not equal to the number of events • Reports are not deduplicated in the portal ‐ that happens in Maven, and is based on full name, date of birth and addresses. Reports that feed in without address can take longer to deduplicate • One person can have many tests • We do receive out‐of‐state reports from some MA facilities that we have to redirect 10 Spreadsheet processing

• 2000 – 2500 a day • Spreadsheets come in via secure email or sftp • Team cleans files • Runs location specific code to format the files • Imports them into Maven • Intense activity at beginning and end of each day

11 Spreadsheet variables Last_Name Specimen_Date First_Name Specimen_Source Middle_Name Specimen_number Sex Test Race Result Ethnicity (Hispanic/non‐Hispanic) Lab_Facility DOB Ordering_Facility ADDRESS1 Ordering_Provider CITY Ordering_Provider_Address ZIP Ordering_Provider_City

STATE Ordering_Provider_Zip 12 Patient_phone Ordering_Provider_State STAFF/RESIDENT Ordering_Provider_Phone Ongoing improvements

• Move away from manual data entry to spreadsheets • Move away from spreadsheets to true ELR • Consolidate the ELR portal, expand capability • Consolidate Maven, expand capability • Bring on more epidemiologist and analyst support • Environmental scan ‐ who exactly is processing tests for MA residents? • Work with new sites to ensure that we get the 13 demographic data we need Thank you

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