Electronic Laboratory Reporting

Electronic Laboratory Reporting (ELR) is the electronic transmission from laboratories to public health of laboratory reports that identify notifiable conditions. The Washington State Department of Health maintains an ELR system (WELRS), which provides data to public health disease investigators across the state.

Expansion of ELR through meaningful use will improve public health surveillance capabilities.

ELR-specific Notifiable Conditions Rule Revision Implementation

Supplemental guidance is available to assist production ELR submitters with the WAC changes to electronic laboratory reporting requirements upcoming on January 1, 2023.

Information for Eligible Hospitals

Hospitals interested in pursuing the ELR meaningful use objective may work through the onboarding process below.


Eligible hospitals must continue traditional reporting practices (i.e., fax, mail, web submitter) during implementation of electronic laboratory reporting until they complete all onboarding and quality assurance processes. Do not turn off traditional reporting methods until notified to do so.

Onboarding Process

Step 1. Registration

Register intent to submit electronic laboratory reporting data to public health.

Step 2. Pretesting

Create ELR messages following the below requirements:

Map LOINC and SNOMED codes:

Follow Washington Administrative Code (WAC) reporting requirements:

Generate and pretest ELR test messages using the National Institute of Standards and Technology (NIST) validation tool. Please test each of the following result types:

  • Coded result
  • Numeric result
  • Structured numeric result (if produced by your system)
  • Text result (if produced by your system)

Once the context-free validation reports indicate the test messages are free of errors, send copies of the reports to ELR@doh.wa.gov.

  • Email is not a secure mechanism of data transfer. Do not email personally identifiable health information.

Step 3. Connectivity

The OneHealthPort Health Information Exchange (HIE) is the required method of ELR data transport for Medicaid-eligible hospitals. Work with OneHealthPort to set up your HIE connection, then test connectivity by transmitting at least one ELR message. Once messages route correctly, you will be given the go ahead to continue sending ELR data for validation purposes.

Step 4. Validation Queue

Eligible hospitals who are successfully submitting ELR messages via the HIE are placed into the validation queue. We anticipate the length of the queue will grow as meaningful use progresses; wait times will increase over time. Once an eligible hospital reaches the front of the queue, they will be invited by agency staff to move on to validation.

Step 5. Validation

Structural Validation

In the first stage of validation, Department of Health staff will review the structure of your ELR messages. This review checks to make sure your messages follow HL7 standards as required in the HL7 Version 2.5.1 ELR Implementation Guide; WA supports ELR 2.5.1 release 1.

Content Validation

Once any structural validation issues are addressed, the second stage of validation can begin. Content validation consists of ongoing parallel validation of your ELR messages. ELR messages must meet reporting requirements established in the HL7 Version 2.5.1 Implementation Guide (ELR 2.5.1 release 1 is supported) and WAC Chapter 2456-101. During content validation, ELR messages will be assessed for accuracy of data, completeness of reporting, timeliness of reporting, and correct jurisdictional routing.

All issues identified during the validation process must be addressed before an eligible hospital can move to production reporting. If you have any questions or would like further information about validation, please contact us.

Step 6. Production

Once an eligible hospital has completed validation they will receive an acknowledgement of their success and be placed into production status. At this point, eligible hospitals may discontinue traditional reporting of non-immediately notifiable conditions, as well as discontinue sending parallel paper for validation.


ELR does not meet the time frame required by Washington State law for reporting immediately notifiable conditions.

  • Even if an eligible hospital is participating in ELR, all results that are immediately notifiable must continue to be reported by phone.

Eligible hospitals will be required to participate in periodic quality assurance checks to ensure accuracy of reporting. Department of Health staff will contact data providers to schedule these activities.