Electronic Laboratory Reporting (ELR)

What is ELR?

Electronic Laboratory Reporting (ELR) for public health is the transmission of digital laboratory reports, often from laboratories to state and local public health departments, healthcare systems, and CDC.

How Does ELR Work?

The Process

1. When laboratory tests confirm infection with a reportable condition, such as measles, HIV, or rabies, information about the patient, specimen(s) collected, test(s), and result(s) are entered and stored securely in a Laboratory Information Management System (LIMS). LIMS is a software-based system that supports key laboratory functions like workflow, specimen and result tracking, and electronic data exchange with other parts of the healthcare and public health system. Information may be manually entered into the LIMS by laboratory personnel, or, in some cases, laboratory instruments may directly connect with the LIMS to automatically transfer the results into the system.
2. The information in the LIMS is used to create standardized electronic messages (such as HL7 v2.5.1 or other ELR formats) that can be processed and understood by other electronic systems. The tests and results may also be translated to standardized codes, such as Logical Observation Identifiers Names and Codes (LOINC).
3. After these electronic messages are created, they are sent from the laboratory to public health partners, like the state health department or CDC, through electronic data systems.
4. The public health agency receives the ELR messages and processes them into electronic systems that store information on reportable conditions. The ELR data can be linked with existing case reports or may be used to initiate a new report, enhancing data sharing between epidemiology and laboratory programs.
5. Depending on the condition, the state or local health department may reach out to the patient or healthcare system to perform a case interview, initiate contact tracing, release medical countermeasures from the Strategic National Stockpile, or take other public health action.

Why is ELR Important?

ELR and Outbreak Preparedness

ELR provides an essential tool in the response to outbreaks. Outbreaks can be identified more quickly and managed more effectively with quickly delivered, high-quality ELR data. This allows health departments to leverage health information systems to inform response activities.

ELR Improves Laboratory Report Quality

Receiving timely, accurate, complete, and consistent laboratory report data can improve the effectiveness and efficiency of public health responses to outbreaks and cases of state reportable conditions. Using standardized formats promotes interoperability and improves exchange, integration, sharing and retrieval of data. Data improvements include:

• Faster electronic transmission
• Increased accuracy by reduction of manual data entry errors
• More complete reports
• Improved consistency across various data sources

ELR Foundations Strengthen COVID-19 Laboratory Reporting

As early as 2005, CDC, in partnership with the Association of Public Health Laboratories (APHL), began paving the way for what is now the COVID-19 Electronic Laboratory Reporting (CELR) program. In 2009, APHL created a secure, cloud-based platform to help state health departments, state laboratories, regional commercial laboratories, and federal agencies report their data. State health departments have increasingly used this platform, supported by ongoing financial and technical support from CDC, to increase the reportable disease results shared with CDC.

The COVID-19 pandemic necessitated timely access and dissemination of de-identified electronic healthcare data to guide the domestic response. Previous investments CDC made into reporting systems infrastructure allowed the CELR program to quickly enable detailed data reporting from public health departments to CDC for approximately 90 percent of the COVID-19 testing volume conducted nationwide. This robust dataset informs public health decision-making to help reduce disease in communities.