For the past several days it hasn’t been possible to get complete and consistent reports on COVID in Georgia in general and in Cobb County in our specific case because of problems with what the Georgia Department of Public describes as Electronic Laboratory Reporting, or ELR.
So just what is the ELR system?
The Center for Disease Control and Prevention (CDC) has a set of pages describing ELR.
An overview page on the CDC site entitled How Does ELR Work? describes the system as follows:
Healthcare facilities and laboratories must notify public health agencies, like the state or local health department, of reportable conditions. Historically, these reports are received through mail, fax, or phone calls and manually entered into electronic systems used for disease surveillance and case management. ELR automates a large portion of the reporting process by translating the information in a laboratory system into an electronic message that can be automatically sent to and processed by the public health agency.
Most laboratories have successfully moved from paper and fax to electronic reporting to public health agencies. For hospitals and healthcare systems, this transition successfully made the case for data interoperability. Laboratories communicate regularly with state, territorial, city, and county public health departments and vendors about technical barriers to reporting.
So ELR takes data from a lab, hospital, or other source and writes it into a uniform message format that other systems can read.
The CDC then gives the following steps in the ELR process:
- 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. Information may be manually entered into the LIMS by laboratory personnel, or, in some cases, laboratory instruments may be directly interfaced with the LIMS to automatically transfer the results into the system.
- The information in the LIMS is used to create standardized electronic messages, like 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)external icon and Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT)external icon.
- After these electronic messages are created, they are sent from the laboratory to public health partners, like the state health department or CDC, through secure transport mechanisms.
- The public health agency receives the ELR messages and processes them into electronic systems that store information on reportable conditions. The ELR data may be added to existing case reports or may be used to initiate a new report.
- 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.
So at some point in these steps that populate the Georgia Department of Public Health Daily Status Report (in step 4 or earlier), there was a breakdown.
The Georgia Department of Health describes its ELR in overview as follows:
The Daily Status Report is updated Monday – Friday (except holidays) at 3 p.m. Data are reported to the
Georgia Department of Public Health (DPH) from numerous labs, hospitals and providers in various
Electronic Laboratory Reports (ELR) are data files transmitted to DPH that contain patient identifiers, test
information and results. Individual “case” reports may also be submitted through DPH’s secure web
portal, SendSS, from healthcare providers and other required reporters. These reports often contain
more specific patient information. In either reporting scenario, data may be incomplete.
The Courier has a request to the Georgia Department of Public Health to describe in more detail the point at which the state’s ELR transfer of data broke down, and will report on it when there is a response.
For data on COVID in Cobb County and statewide
Cobb & Douglas Public Health runs the case rate on their home page, although it is not updated frequently.
A more frequently updated summary of the statistics on COVID for Cobb County is the CDC’s County View page for Cobb County. The numbers come from the Georgia Department of Public Health but are displayed in a much easier-to-read way than the sprawling GDPH website. From this page you can get the one-week figures on the number of new cases, case rate per 100,000 of population, hospitalizations, deaths, and the percentage change from the previous 7-day period. It also includes data on testing and vaccination rates.
The Georgia Department of Public Health publishes a daily status report on the pandemic every afternoon at around 3 p.m. It’s a comprehensive report with extensive data and charts arranged statewide and by county, that also includes age breakdowns, racial demographics, and data on vaccination and testing.
It isn’t the easiest system to navigate, but it’s worth spending time learning how to use if you’re interested in getting the latest statewide and local data on the state of COVID-19.
To get an overview of how much the pandemic is stressing the hospital systems in terms of ER visits, hospital bed capacity, and ventilator use, there is a Hospital Bed and Ventilator Use report with interactive maps. The map is organized by hospital region, and Cobb County is part of Region N.
To get data on what percentage of patients in Georgia hospitals were admitted for COVID-19 versus all other causes, there is a Georgia Medical Facility Patient Census. It also reports numbers by statewide and hospital region.