Preventing and treating disease outbreaks in Nebraska is faster and more efficient with a new Internet-based laboratory order and reporting system. The system, can aid public health officials in more quickly identifying and communicating the presence of disease so treatment can begin faster, thus reducing the number of people infected and severity of the disease.
The system is housed at the Nebraska Public Health Laboratory at the University of Nebraska Medical Center in Omaha.
The Electronic Laboratory Information and Retrieval Technology (ELIRT) system is a Internet-based communication tool that allows clinics, hospitals and physician offices to order laboratory tests, and get results back, through a computer system. Currently, about 100 users access the system across the state. Officials hope to ultimately provide the service to some 500 users.
ELIRT marks the NPHL’s first major revision of the laboratory information reporting system since it was first devised in 1999. The system, previously called the Public Health Laboratory Information Program (PHLIP), was the first web-based laboratory test ordering and reporting system for public health laboratories in the country.
It uses web-based portal technology called Guardian that was developed by the Information Management Services Division of the State of Nebraska.
Public health tests include those that test for disease such as West Nile virus, sexually transmitted diseases, hemorrhagic E-coli, lead-screening, salmonella, Bordetella, pertussis and tuberculosis. It also could provide early warning should a bioterrorism event occur.
“If someone contracts salmonella, the state will know much quicker, health officials can go to the restaurant where the food was eaten and figure out where the pathogen came from, then go in and do an investigation,” said John Glock, information technology manager, Nebraska Center for Rural Biosecurity and the Nebraska Public Health Laboratory.
“This system can potentially help prevent death. Time is critical. This will replace the arduous paperwork and speed up the process. From a bioterrorism perspective, it will let us know if there’s a problem earlier and will provide quicker response to public health needs,” said Glock, who led the development of the technology he and others have patented and hope to market to other states.
ELIRT will make information available statewide on infectious disease statistics, trends, and number of cases of certain infectious diseases reportable to the state, that affect public health, including those such as West Nile virus. Officials also are developing the system for epidemiological research – to study patterns, causes, and control of disease in groups of people.
In its first year, officials estimate it will save taxpayers more than $100,000 by reducing manual paperwork, duplication and human error. ELIRT was developed by UNMC in cooperation with the Nebraska Health and Human Services System Nebraska Public Health Laboratory.
At the Nebraska Public Health Laboratory where almost 52,000 laboratory tests for some 70 different public health-related diseases are sent each year, accuracy and efficiency is important. The lab processes and reports results to client requesting the tests, as well as to public heath officials.
ELIRT users across Nebraska can sort by test ordered, by county or patient name. Ten pages of information can be generated in five seconds where it used to take an hour, Glock said.
Without ELIRT, ordering and getting test results is done manually, such as by mail or fax. Test results then are faxed or communicated over the telephone.
ELIRT, which makes reporting results of public health tests more uniform, also captures a history of laboratory results that originate from users so the information can be accessed at any time. Test results, which also are reportable to the state, are sent automatically the state lab, and ultimately are forwarded to the Centers for Disease Control and Prevention (CDC) in Atlanta.
“Believe it or not, the majority of public health labs do this by paper in most states. When the test arrives, they print, mail, or fax results to clients. But with this, you can look it up on the Internet with the proper credentials,” said Glock. He said the project started as an experiment. “We asked would our idea work, how much better would it be and would our customers like it.”
“This is really going to help us,” said Jody Garrett, manager of microbiology and virology at The Nebraska Medical Center. “Right now, we document all these results by hand. This will automate all of that for us. It’s also more accurate.” She said the information also is provided in real-time so priority test results are made available immediately.
“It’s all about efficiency,” Glock said. “With all this live data, the dream is to be able to do the same for influenza tracking where we can see how many current cases there are. Our system is the interface system that sends information to Lincoln and ultimately to the CDC. We were the first state in the U.S. to interface with the CDC. It provides an efficient, more accurate way for states to feed reportable information to the CDC.”
Robin Williams, community health educator, Nebraska Department of Health and Human Services System, said ELIRT benefits the state by allowing communicable disease investigators to begin epidemiological investigations as soon as the lab test is done rather than waiting for the result to be sent via mail or from physicians.
“The system also allows for quick search of specific lab results, i.e. different diseases being investigated. The system is much faster than the previous system used so time effectiveness is a large factor,” Williams said. “I think the ELIRT system is a successful tool that helps us better investigate and survey disease throughout Nebraska.”
Steven Hinrichs, M.D., principle investigator for the project, said Nebraska is fortunate to have access to expertise in people and technology at UNMC and its hospital partner, The Nebraska Medical Center. “Nebraska is a leader in health information programs as evidenced by the ELIRT system,” said Dr. Hinrichs, Stokes-Shackleford Professor of Pathology in the UNMC Department of Pathology/Microbiology and director of the Nebraska Public Health Laboratory. “The infrastructure available to us is second to none in the nation.”
“If a physician in Broken Bow wants to order a test, he or she just types in the order, sends the specimen here, then they can get results without calling, they just check online. Getting to this was a big deal,” Dr. Hinrichs said.
The team plans to market the system to other states.
“When we started this project in 2001, we thought for sure something like this was being done already to computerize the system,” Garrett said. “Each lab has its own electronic system, so interfacing electronically with other systems is not an easy task.”
She explained each lab, including the CDC, has hundreds of codes for tracking information and the codes are different in each lab. The team created an interface to convert the codes, and provided training on the system.
Brian Lenz, client service coordinator, Nebraska Public Health Laboratory, said State Epidemiologist Tom Safranek, M.D., and his staff continuously monitor the state of health of Nebraskans for various disease.
“Our users really like the fact they can go online and look up test results without calling us,” Lenz said. “They can just go online and look patient results up, they can also see a cumulative history of test results.”