Building Blocks: Newborn Screening Health IT Implementation Guide and Toolkit

Section 6: Abbreviations and Terms

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The table below identifies the most common abbreviations used in the Guide. In addition, this table provides definitions and explanations for many of the informatics concepts discussed in the Building Blocks chapters. Please refer to the Tools Reference Guide for definitions and descriptions of tools that are referenced in the Guide.

ABBREVIATIONS AND TERMS

AIMS

The APHL Informatics Messaging Services Platform is a secure, cloud-based environment that provides shared services to aid in the transport, validation, translation and routing of electronic data. For more information, visit https://aimsplatform.com/.

APHL

The Association of Public Health Laboratories represents state and local governmental health laboratories in the United States and works to strengthen laboratory systems serving the public’s health in the United States and globally. For more information, visit www.aphl.org.

Change Control

Change Control or Change Management is the process to manage changes that will affect the systems, processes and people supporting Newborn Screening data exchange.  A change control process will define how changes will be proposed, accepted, monitored and controlled.

Conformance

HL7 defines a conformance statement as “a claim that the behavior of an application or application module agrees with the constraints stated in one or more message profiles.”·  For our purposes, it is an agreed upon set of rules for how NBS will be exchanged that specifies what data is provided in the message, the format of that data and the associated standard codes.

Constrain

HL7 defines standards to different types of data exchange that can be used across a variety of use cases and stakeholders. The HL7 standard must be further constrained to define the specific set of data exchange rules for a given use case and set of stakeholders – NBS for example. The rules in a constrained profile will provide a more granular definition for data exchange that will stay true to the original HL7 definition. Examples include a refinement of required/optional fields, specific value sets for given data elements, additional fields and related business rules. One example is the definition of a specific set of LOINC codes applicable to the test/assays conducted for newborn screening. The HL7 standard simply requires the use of a LOINC code. The NBS profile constrains the data exchange to specific LOINC codes.

CSV

A comma-separated values file stores tabular data in plain text. Data partners may need to use a data broker to transform HL7 2.5.1 messages into another file format, such as CSV, before the file can be consumed by the EHR or LIMS.

Data Broker

In its simplest form, a data broker is a system or application that provides the capability to transform data from one format to another. For example, a broker can take data in a CSV format and transform it to HL7. Some example data brokers include Orion’s Rhapsody, Mirth Connect and Cloverleaf. Please note that the term is used with different definitions in other industries. For our purposes, the data broker is a tool utilized by data senders/receivers to transform data from one format another. Note that the Guide uses the term “Data Broker” interchangeably with “Integration engine.”

Data Exchange

Data exchange is the process whereby one stakeholder provides data from its source system in a format that is readable by a receiving system.

Direct

Direct is a national encryption standard for securely exchanging clinical healthcare data via the Internet. For more information, visit https://www.healthit.gov/policy-researchers-implementers/direct-project.

DURSA

Data Use and Retention Agreement. See the entry in the Tools Appendix for more information.

EHR

Hospitals use Electronic Health Record systems to manage patient records. The hospital’s EHR is a key system in NBS data exchange.

Electronic Messaging

For our purposes, Electronic Messaging refers to the exchange of standard HL7 messages between a hospital / clinic and a public health laboratory.

ELR

Electronic Laboratory Reporting is generally understood to mean laboratory reports to public health.

ETOR

Electronic Test Order and Result. For the purpose of this Guide, hospitals send the “electronic” HL7 message test order for the NBS panel to the laboratory, and the laboratory returns the “electronic” HL7 message result to the hospital.

FTP

File Transfer Protocol. See SFTP.

HIE

In practice, the term Health Information Exchange typically refers to the organization or system within a region that facilitates the exchange of healthcare data across healthcare providers and public health professionals. The Office of the National Coordinator for Health Information and Technology (ONC) is working with states to establish state HIEs and thereby build the states’ capacity to exchange health information quickly and securely. The maturity and scope of these HIEs varies considerably from state to state.

HL7

Health Level Seven is a standards-development organization that provides a comprehensive framework and related standards for the exchange of electronic health information. HL7 Messaging Standard Version 2.5.1 is the most common HL7 standard; it is the standard named in Meaningful Use guidelines.

Integration Engine

See “Data Broker.” For our context, the Guide uses these terms interchangeably.

IT

Information Technology

JMC

J Michael Consulting, LLC

LIMS

A Laboratory Information Management System is software that supports laboratory operations and tracks a variety of laboratory data and workflows.

LOI

Laboratory Orders Interface. See the entry in the Tools Appendix for more information.

LOINC

The Logical Observation Identifier Names and Codes is a standard for identifying medical laboratory observations. LOINC codes are a critical part of the NBS ETOR message. For more information, visit https://loinc.org.

LRI

Laboratory Results Interface. See the entry in the Tools Appendix for more information.

Map, Mapper, Mapping

The process of data mapping establishes the relationship between data elements in a source system to a destination system. The mapping definition also includes any rules on transformations required. Patient gender provides a simple example. The source system captures the data in a field called “Newborn Gender.” This field must be mapped to the HL7 field “PID-8 Administrative Sex” during message generation. The destination system then maps the data to a field called “Person Gender.”

Message Validation

Message Validation is the process of inspecting (either via automated tools or visual inspection) the HL7 message file to evaluate how closely it adheres to the agreed upon data exchange rules in the conformance profile. During this process, validators may identify errors that must be corrected before the message can be processed.

MOU

Memorandum of Understanding. See the entry in the Tools Appendix for more information.

NBS

Newborn Screening

NDBS

Newborn Dried Bloodspot Screening refers to a panel of laboratory tests performed on specimens of blood from a finger stick or a heel stick that are collected onto absorbent filter paper.

NewSTEPs

The Newborn Screening Technical assistance and Evaluation Program is designed to provide data, technical assistance, and training to NBS programs across the country and to assist states with quality improvement initiatives. For more information, visit https://newsteps.org/.

NHIN

National Health Information Network

NLM

National Library of Medicine

OIDS

An Object Identifier is a numeric string that uniquely identifies an object in a directory. Both data exchange partners (the public health laboratory and the hospital) will need to use an OID in the NBS message to identify their organization and their application. HL7 maintains a registry of OIDs. For more information, visit http://www.hl7.org/oid/index.cfm.

Onboarding

The final goal of onboarding a messaging partner is to implement the HL7 message in production and cease the use of the previous mechanism for data exchange. The onboarding process may include steps to ensure that

1) data in the message adheres to the rules and requirements as defined in the NBS Message Implementation Profiles; and 2) the quality and completeness of the data is sufficient for the end user.

Orders

An NBS laboratory test order defines the specific tests/assays that are to be performed on the sample. The laboratory order also includes demographic information on the submitter and the patient. Information for the order may be drawn from an HL7 Laboratory Order Message, the physical order form or a combination of both.

PHII

Public Health Informatics Institute

PHINMS

The Public Health Information Network Messaging System is CDC-provided software that employs electronic business rules using Extensible Markup Language technology to send and receive any message type over the Internet securely, facilitating interoperability among myriad public health information systems. The PHIN Tools and Resources site provides specific PHINMS configuration and set-up steps. The laboratory may choose to send NBS messages via PHINMS, or via some other transport mechanism, depending on their internal security requirements and those of their messaging partner(s). For more information, visit http://www.cdc.gov/phin/tools/phinms/index.html.

Profile

An HL7 Implementation Profile is a document that specifies the agreed upon rules for data exchange between stakeholders. A profile further constrains an HL7 Standard to provide more granular rules for a specific data exchange agreement.

Results

An NBS laboratory test result message documents the tests/assays and associated conclusions performed by the public health laboratory.

SFTP

Secure File Transport Protocol is a network protocol and encryption standard that allows data exchange partners to securely access, transfer, and manage files.

SME

Subject Matter Expert

Symphonia EDI Parser

The parser performs a specific function within the Rhapsody integration to convert data from one Electronic Data Interchange (EDI) format to another.

TransportQ_out

A set of PHINMS database tables which store incoming and outgoing messages. For more information, visit http://www.cdc.gov/phin/tools/phinms/index.html.

Virginia DCLS

Virginia Division of Consolidated Laboratory Services

VPN

A Virtual Private Network allows users to share data across a shared or public network as if their computing devices were part of a private network.

Web Services

This data exchange mechanism utilizes web technology such as HTTP to securely transfer files between sender and receiver.

XML

Extensible Markup Language; data partners may need to use a data broker to transform HL7 2.5.1 messages into another file format, such as XML, before the file can be consumed by the EHR or LIMS.

XSD

XML Schema Definition

 

· HL7 Version 2.7 Standard: Chapter 02b - Control; Conformance Using Message Profiles. Available at http://www.hl7.org/implement/standards/product_brief.cfm?product_id=191.