The Association of Public Health Laboratories (APHL) is a national non-profit, member-based organization representing governmental laboratories of all levels in all aspects of operation. APHL is especially active as the primary advocate for PHLs by promoting workflow improvements and refining laboratory science operations within the laboratory. It provides a forum for member collaboration, education, and workforce development . The fruits of this collaboration are evident in the success of APHL’s Informatics Committee in identifying and subsequently improving many of the functions required of LIMS and in the domain of laboratory informatics in general. One such example is the effort to standardize LIMS functionality across vendors. APHL LIMS user groups provide ways to prioritize and consolidate development efforts among customers of a specific vendor, which in turn can be easily compared to overall standardization approach. In partnership with other PH organizations, under the umbrella of the Joint Public Health Informatics Taskforce (JPHIT), APHL also influences national e-health policy.
Internationally, APHL helps to build laboratory capacity in developing countries, including the selection and implementation of information systems.
As part of every implementation, validation testing according to test cases also employs informatics principles. Having identified the need to harmonize the adoption of standards across federal programs and PHL functional areas, APHL is actively involved in national standards harmonization activities for laboratory-related use cases (information exchange standards for laboratory orders and results, reporting in clinical and public health settings, as well as functional standards for Electronic Health Record System (EHR-S) interactions with PHLs). Due to limited informatics funding at PHLs and the ongoing struggle for these laboratories to support informatics trained specialists, APHL provides hands on informatics technical assistance to PHLs and their partners. These services include project management, national standards implementation and technical architecture support.
PHLs are continually providing expertise to support the standards development process. They were instrumental in creating an implementation guide for newborn screening; working alongside Standards Development Organizations (SDOs) like the Regenstrief Institute to develop the required vocabulary and to make sure the HL7® message contained all the data elements needed for proper newborn screening result reporting. APHL provides leadership for the Laboratory and Messaging Community of Practice (LabMCoP), assisting PHLs and partners in harmonizing terminology and related standardized vocabulary to properly describe the specimen submitted for testing.
On a national scale, when the Office of the National Coordinator for Health Information Technology (ONC)’s certification process for commercial Electronic Health Record products was announced, PHL expertise was utilized by providing real-world testing scenarios to ensure that specific result formats are properly represented in this information exchange paradigm. By ensuring a basis in reality, this effort will ensure greater patient safety, and improve public health’s response to emerging diseases, terrorism, and natural disasters.
In summary, PHLs are a critical public health resource and service. They detect, identify and monitor infectious disease outbreaks, chemical or biological contamination in people, animals, food and the environment. They provide testing that other labs cannot provide and screen for diseases that haven’t even shown symptoms yet (i.e. newborn screening). PHL testing supports food and environmental safety law enforcement and their data contributes vital information to support local, state and federal health policies. PHLs are at the forefront of population based health threats due to bioterrorism, newly emerging disease and natural disasters and they continue to ensure quality service by inspecting and certifying other laboratories in their jurisdiction.
Information systems enable PHLs, or any laboratory for that matter, to more predictably forecast testing demand and assist with human resource utilization during an outbreak or response. Auditing functionality help to monitor the quality of testing and this analysis can be used to improve laboratory workflow over time. Data derived from these systems can assist with both state and federal efforts to forecast disease, help with outbreak management as well as health policy development.
But to ensure the long term operational capacity of our PHLs to provide these services and remain relevant in patient and population care, informatics must be considered a pivotal core business function.
The use of electronic test orders, communicating between disparate systems about order statuses and specimen results as well as contributions to both electronic health records and personal health records submitters all require use and continual development of national data exchange standards. The work in this field has barely begun, yet the continual evolution of standards will drive greater collaboration and cooperation between all levels of PHLs – local, state and federal as well as their commercial partners.
List at least 6 of the 11 core PHL functions and discuss how each of them can be supported by informatics.
How does the workflow in a PHL change when an emergency arises – for example a disease outbreak, a bioterrorism event or a natural disaster?
List the different partners of a PHL and their importance for Public Health.
Contrast the differences and similarities between a PHL and a commercial clinical lab.