Electronic laboratory reporting (ELR) - Issues

Jurisdictional requirements

For lab system vendors and labs: States have a variety of reporting formats they require
- Itemize variations within and among states including sending and receiving organization and system

For states: Labs send message in a variety of formats
- Itemize variations among submitting labs/vendors
For states: Labs submit messages in a variety of erroneous or questionable or suboptimal formats, although they may be syntactically correct
New York State (collect samples of all the conditions below)
- Some labs submit a multiple-observation message as multiple messages with one observation (OBX) per message
- some labs submit OBX segments containing information that should be in NTE (Note) segments
- Some labs submit NTE segments with observation information that should be in OBX segments
- Some labs use OBX-5 repetitions incorrectly, or at least questionably: simply to chop up a long Text result into short pieces
Microbiology linkage
- Most labs don’t do it
  - Some labs even send the drug sensitivity observations in separate messages/files from the organism results: no linkage is possible
- Of those who do it, none does it completely correctly
- The 2.5.1 IG is not clear enough about certain requirements
The HL7 manual is not crystal clear about when OBX-5 repetitions are appropriate and when they aren’t

different data exchanges may request different terminology including aggregated or rolled-up information; this may lead to different terminology requirements depending upon the receiving system's exchange requirements. How can or should this be handled?
many, if not most, of the current terminology practices place the onus for terminology mapping and transformation on the Senders; is this a best practice to be continued or should some of the onus be placed on the Receivers and/or other elements within the data exchange architecture such as RHIOs and/or HIEs?

Discussion between Jimmy Dee and Lily Tatham on PhConnect, ELR CoP forum, and further discussion on the CSI (Collaborative Software Initiative, authors of Utah’s TriSano) forum.
Not all labs have CLIA codes, e.g. Veterans Administration hospital labs.
Clem McDonald comments during WG webinar
- “Implementers don’t like to use Structured Numeric.”
- “No microbiology lab wants to flag abnormals.”

Different senders (labs) have different software systems, modules, and/or packages available, some of these have been provided by vendors and some are "home-grown". What candidate architectures are in use and what are the benefits of each architecture?