Supplemental guidance to ELR submitters

WAC changes January 1, 2023

Supplemental guidance to ELR submitters for compliance with WAC changes January 1, 2023 (PDF)

ELR Appendix Guidance Value lists, December 2022 (XSLX)

Overview

ELR submitters to WA DOH should continue to follow the HL7 implementation guide HL7 Standards Product Brief - HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 (US Realm) | HL7 International  and all associated Washington Administrative Code (WAC) requirements with existing ELR feeds.  The following information is supplemental guidance to assist submitters with the specific changes upcoming on January 1, 2023.  Do not implement changes related to the updated requirements prior to January 1, 2023.

  • Additional reportable health conditions
  • Patients visiting Washington state
  • Patient’s ethnicity
  • Patient’s race
  • Patient’s preferred language
  • Pregnancy status (Hepatitis B &C)
  • Medicaid number (Child Blood Lead)
  • Additional submitter information
Additional reportable health conditions

Summary: Several new laboratory-tested conditions become notifiable, and some previously grouped conditions have been specified.  See the Table in WAC link above for complete list and details of agents, results, and timeframes.  WA DOH ELR recognizes that laboratory directors have the responsibility and expertise to determine which of the tests and results performed at their facility are reportable conditions. Reference: WAC 246-101-201 (Effective January 1, 2023) (1)(a)(i) Table Lab-1 Notifiable conditions and laboratories. “This section describes the conditions about which Washington's laboratories must notify public health authorities of on a statewide basis. The board finds that the conditions in Table Lab-1 of this section are notifiable for the prevention and control of communicable and noninfectious diseases and conditions in Washington.”

Technical instructions:  Use appropriate LOINCS and SNOMEDs to report the testing methodology performed and result in ELR.
Patients visiting WA state

Summary:  In addition to current submission of ELR messages for patients with address within Washington state, also submit notifiable conditions reports for patients with address other than Washington state AND with:

  • Ordering Provider address is within Washington state
  • OR
  • Ordering Facility address is within Washington state
Reference: WAC 246-101-205 (Effective January 1, 2023) (1)(b)(ii) “The notifiable test result pertains to a patient who resides outside of and is visiting Washington state as indicated by information provided by the requesting health care provider or health care facility.” Technical instructions: 
  • Address in ORC-24 (Ordering Provider Address) is used to determine if Ordering Provider address is within Washington state
  • Address in ORC-22 (Ordering Facility Address) is used to determine if Ordering Facility address is within Washington state
Patient’s Ethnicity

Summary: All submitted ELR messages shall contain one of the specified values for the existing ELR data element of patient’s ethnicity.  Correctly formatted values from Appendix A are accepted. Reference: WAC 246-101-011 (4)(a-d) (4) Patient's ethnicity shall be identified by the patient and reported using one of the following categories:

https://app.leg.wa.gov/WAC/default.aspx?cite=246-101-011 Technical instructions:

  • Use HL7 segment PID-22
  • Value code set: see Ethnicity tab in file ELR Appendix Guidance Value lists August 2022.xls
  • Example highlighting ethnicity section:  PID|1|||||||||||||||||||||2186-5^Not Hispanic or Latino^CDCREC
Patient’s Race

Summary: All submitted ELR messages shall contain one or more of the specified values for the existing ELR data element of patient’s race.  Correctly formatted values from the WAC list or the national standardized list Code System Details (cdc.gov) are accepted. Reference: WAC 246-101-011 (5)(a-ttt) “Patient's race shall be identified by the patient and reported using one or more of the following categories; if the patient self-identifies as more than one race, each race shall be reported”

Technical instructions:
  • Use HL7 segment PID-10
  • Value code set: see Race tab in file ELR Appendix Guidance Value lists August 2022.xls
  • Example highlighting race section:  PID|1|||||||||2106-3^White^CDCREC||||||||||||
Patient’s preferred language

Summary: All submitted ELR messages shall contain one of the specified values for the existing ELR data element of patient’s primary language. Correctly formatted values from the WAC list or the national standardized list Download Tables | ISO 639-3 (sil.org) are accepted. Reference: WAC 246-101-011(6) (a-xx) “Patient's preferred language shall be identified by the patient and reported using one of the following categories:”

Technical instructions:
  • Use HL7 PID-15
  • Value code set: see Language tab in file ELR Appendix Guidance Value lists August 2022.xls  & TECHNO
  • Example highlighting language section:  PID|1||||||||||||||ara^Arabic^ISO6392|||||||
Pregnancy status (Hepatitis B virus & Hepatitis C virus only)

Summary: All submitter ELR messages for hepatitis B virus and hepatitis C virus shall include pregnancy status. Refer to the linked references below and/or contact Hepatitis@doh.wa.gov for additional information about when to report pregnancy status for hepatitis B and C results.” Reference: WAC 246-101-205 (4)(a)(vii) “For hepatitis B virus tests, pregnancy status (pregnant, not pregnant, or unknown) of patients twelve to fifty years of age”.

and WAC246-101-201 (3) Table Lab-1 Hepatitis B virus and Hepatitis C rows, “What to submit in a Laboratory Report” column “Pregnancy status”

https://app.leg.wa.gov/WAC/default.aspx?cite=246-101-201 Technical instructions:  use COVID AOE pregnancy formatting to report pregnancy in HL7
  • HL7 data element: OBX-3
    • LOINC 82810-3^Pregnancy status^LN
    • LOINC 11449-6^Pregnancy status reported^LN
  • Value code set: OBX-5
    • HL70136: Y – YES, N – NO, UNK – Unknown
    • SNOMED-CT: 77386006 Patient currently pregnant(finding), 60001007 Not pregnant, UNK Unknown
  • Example OBX:
    • OBX||CWE|82810-3^Pregnant^LN||N^No^HL70136|
    • OBX||CE|11449-6^PREGNANCY STATUS REPORTED^LN||77386006^Patient currently pregnant (finding)^SCT
Medicaid number (Child Blood Lead only)

Summary:  All submitted ELR messages for blood lead level tests for patients <72 months of age, shall include Medicaid status

Reference: WAC 246-101-205 (Effective January 1, 2023) (4)(a)(x) “For blood lead level tests, Medicaid status of patients less than seventy-two months of age;”

Technical instructions: Use the Patient Identifier value paired with a Patient Identifier Type of Medicaid for the collection of Medicaid identification number/Provider One number. A populated Patient Identifier with the type of Medicaid would indicate a Medicaid status of “yes”; if unpopulated then status is “no or unknown”. Provider One numbers are 9 digits followed by “WA” which matches the Patient Identifier format.
  • Use HL7 PID-3.1 and 3.5 (ID number and Identifier type code)
  • Example:  PID|1||111111111WA^^^^MA^|||||||||||||||||||
Additional submitter information

HL7 2.3.1 and other old versions are not 2023 WAC compliant, contact ELR@doh.wa.gov to arrange for upgrading to HL7 2.5.1 COVID-only via ELFF template – contact ELR@doh.wa.gov to arrange for upgrading to 2023 WAC compliant ELFF template or to transition to HL7 reporting.