OJPHI: Vol. 5
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Journal ID (publisher-id): OJPHI
ISSN: 1947-2579
Publisher: University of Illinois at Chicago Library
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©2013 the author(s)
open-access: This is an Open Access article. Authors own copyright of their articles appearing in the Online Journal of Public Health Informatics. Readers may copy articles without permission of the copyright owner(s), as long as the author and OJPHI are acknowledged in the copy and the copy is used for educational, not-for-profit purposes.
Electronic publication date: Day: 4 Month: 4 Year: 2013
collection publication date: Year: 2013
Volume: 5E-location ID: e51
Publisher Id: ojphi-05-51

Towards Interoperability for Public Health Surveillance: Experiences from Two States
Brian E. Dixon*123
Jason A. Siegel5
Tanya V. Oemig5
Shaun J. Grannis42
1Indiana University, Indianapolis, IN, USA;
2Regenstrief Institute, Indianapolis, IN, USA;
3Center of Excellence on Implementing Evidence-Based Practice, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Indianapolis, IN, USA;
4Indiana University School of Medicine, Indianapolis, IN, USA;
5Atlas Development Corporation, Calabasas, CA, USA
*Brian E. Dixon, E-mail: bdixon@regenstrief.org


To characterize the use of standardized vocabularies in real-world electronic laboratory reporting (ELR) messages sent to public health agencies for surveillance.


The use of health information systems to electronically deliver clinical data necessary for notifiable disease surveillance is growing. For health information systems to be effective at improving population surveillance functions, semantic interoperability is necessary.

Semantic interoperability is “the ability to import utterances from another computer without prior negotiation” (1). Semantic interoperability is achieved through the use of standardized vocabularies which define orthogonal concepts to represent the utterances emitted by information systems. There are standard, mature, and internationally recognized vocabularies for describing tests and results for notifiable disease reporting through ELR (2). Logical Observation Identifiers Names and Codes (LOINC) identify the specific lab test performed. Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) identify the diseases and organisms tested for in a lab test.

Many commercial laboratory and hospital information systems claim to support LOINC and SNOMED CT on their company websites and in marketing materials, and systems certified for Meaningful Use are required to support LOINC and SNOMED CT. There is little empirical evidence on the use of semantic interoperability standards in practice.


To characterize the use of standardized vocabularies in electronic laboratory reporting (ELR) messages sent to public health agencies for notifiable disease surveillance, we analyzed ELR messages from two states: Indiana and Wisconsin. We examined the data in the ELR messages where tests and results are reported (3). For each field, the proportion of field values that used either LOINC or SNOMED CT codes were calculated by dividing the number of fields with coded values by the total number of non-null values in fields.


Results are summarized in Table-1. In Indiana, less than 17% of incoming ELR messages contained a standardized code for identifying the test performed by the laboratory, and none of the test result fields contained a standardized vocabulary concept. For Wisconsin, none of the incoming ELR messages contained a standardized code for identifying the test performed, and less than 13% of the test result fields contained a SNOMED CT concept.


Although Wisconsin and Indiana both have high adoption of advanced health information systems with many hospitals and laboratories using commercial systems which claim to support interoperability, very few ELR messages emanate from real-world systems with interoperable codes to identify tests and clinical results. To effectively use the arriving ELR messages, Indiana and Wisconsin health departments employ software and people workarounds to translate the incoming data into standardized concepts that can be utilized by the states’ surveillance systems. These workarounds present challenges for budget constrained public health departments seeking to leverage Meaningful Use Certified technologies to improve notifiable disease surveillance.

[TableWrap ID: t1-ojphi-05-51] Table 1 

Proportion of “Raw” ELR Data Samples with LOINC or SNOMED CT Concepts

Sample % OBX-3 Fields with LOINC % OBX-5 Fields with SNOMEDCT
INPC Messages 16.5% 0.0%
WDHS Messages 0.0% 12.3%


The authors further thank Shahid Khokhar of the Regenstrief Institute and Keith Michaelson of Atlas Public Health for their help with the extraction of the ELR message data.

This work was supported, in part, by the Indiana Center of Excellence in Public Health Informatics through a grant award (501HK000077) from the U.S. Centers for Disease Control and Prevention.

1.. Dolin RH, Alschuler L. Approaching semantic interoperability in Health Level SevenJ Am Med Inform Assoc 2011;18(1):99–103.
2.. Wurtz R, Cameron BJ. Electronic laboratory reporting for the infectious diseases physician and clinical microbiologistClin Infect Dis 2005;40(11):1638–43.
3.. Dixon BE, McGowan JJ, Grannis SJ. Electronic laboratory data quality and the value of a health information exchange to support public health reporting processesAMIA Annu Symp Proc 2011;2011:322–30.

Article Categories:
  • ISDS 2012 Conference Abstracts

Keywords: Standards, Interoperability, Electronic Laboratory Reporting, Public Health Surveillance, Computerized Medical Records Systems.

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org