Public Health Informatics

Hi,

In our lab we have created a set of surveillance versions of the tests that we do both for. These do not report a result to the provider and are not billed. They have a different test code than the Dx version of the test which makes it easy to separate the data out.

Hope this helps,

-Josh-

Joshua Weiner, MS

Laboratory Information System Specialist

(Pronouns: He, him, his)

City of Milwaukee Health Department 

Zeidler Municipal Building | 841 N. Broadway, Room 205 | Milwaukee, WI 53202

Office: (414) 286-3526 | Direct: (414) 286-3532 | jweine@milwaukee.gov | www.milwaukee.gov/health | Facebook | Twitter | Instagram  

We have different order choices for diagnostic versus surveillance/confirmation testing (For example, "Enteric culture" vs "E coli confirmation", or "Influenza A/B PCR" vs "Influenza Surveillance").  The billing codes (CPT codes) we use in the LIMS indicate to our billing system whether the order choices are billable to the facility or to the surveillance program.  We use a suffix at the end of the CPT code in the LIMS, which gets converted in the billing system.  For surveillance testing, if the test method is FDA-cleared, we report the results back to the facility.  If the test method is not FDA-cleared (such as whole genome sequencing), the results are not reported back to the facility (we can designate a test or order choice as non-reportable in the LIMS).  Any time the testing is for a reportable condition, we report the results via HL7 to our state public health system. Our LIMS allows reporting to public health even if the test is not reportable to the facility; however, some non-FDA cleared results are not reported to the public health electronically to prevent the results from being accessed by local jurisdictions.  For those things, we create reports in our LIMS that can be scheduled and sent via email, placed in a network directory, or run ad-hoc).  If our state epidemiologists want us to perform diagnostic testing for outbreak/surveillance purposes, they coordinate with the facility and our lab to get the sample(s) to us.  They log the case(s) on a shared spreadsheet, which our billing department uses to bill the testing to the EPI program, rather than to the submitting facility. 

The accessioning process isn't any different for either type of testing.  We have a web portal where our facilities place their test orders.  We instruct them on which test to order ,depending on the purpose of the testing, in our lab manual which is published on our website and linked in our web portal.  There are "ask on order entry" questions they must answer, which give us information we need, depending on the type of testing. For example, when ordering influenza surveillance, the ordering facility must give their test result and method used, i.e., positive for influenza A by rapid antigen.  For order choices that often get ordered incorrectly, we build rules in the LIS to display a message when they are ordered, giving further guidance as to which test they should be ordering.  If a facility orders the wrong test, our staff can easily change it to the correct test when accessioning the sample.