NEW YORK – The Association of Public Health Laboratories has developed a new electronic system for ordering tests and reporting their results that it said will streamline the sharing of lab data between public health laboratories and healthcare providers.
Launched in December, the system, called Detor, is currently used by healthcare system Orlando Health and the Florida Department of Health for reporting newborn screening results.
According to Rachel Shepherd, senior specialist of informatics at APHL, four additional states are scheduled to go live with the system in the next several weeks. She said that APHL aims to have the system live in 10 states by the end of the year.
Shepherd noted that while electronic exchange of orders and results is "a regular occurrence" in the commercial laboratory world, public health laboratories have varying and inconsistent levels of connectivity.
"It can be a fully manual process where a lab might receive a sample in the mail and have to fax back results. It could be partly electronic where they might have to log into a web portal to send back results," she said. "The bottom line is it varies drastically from laboratory to laboratory."
The Detor system provides a single connection point that allows public health labs to exchange orders and results with all of their health system partners without requiring the labs themselves to set up direct connections with those partners.
"Rather than building and maintaining 20 connections, they just have to do that one, and [APHL] can manage it all centrally," Shepherd said.
Dari Shirazi, principal specialist of health IT at APHL, said that while the organization has in the past tried to establish better connectivity between public health labs and providers, the Detor project represents a fundamentally different approach. Previously, APHL tried to establish standards for test ordering and result reporting that all parties could follow, allowing for easier interconnectivity. With Detor, on the other hand, the organization has created a system that can translate the codes and data structure used by different providers to those used by the public health labs, and vice versa.
"We can take whatever the hospital sends and translate it to whatever the laboratory wants, both in structure and vocabulary," he said. For instance, "if the [laboratory information management system] in the lab can only put out local codes as opposed to standard codes, we can take those local codes and map them to standard codes that go to the hospital."
"That creates an enormous amount of flexibility," Shirazi said. "We're trying to make life easier for both lab and hospital."
This lack of interconnectivity was a major challenge during the COVID-19 pandemic, he said, noting that much of the testing backlog was due less to the time required to run the samples than the time required to do the data entry associated with them.
COVID-19 is what is termed a "reportable condition," meaning that potential cases must be reported to state public health labs along with the address and contact information of the individuals being tested.
"Imagine you are getting 7,000 or 8,000 samples to the public health laboratory every day," Shirazi said. "That is 7,000 to 8,000 pieces of full address information that you have to manually enter off a paper with bad handwriting and so forth. It's time-consuming."
Detor lets hospitals transmit this information electronically to public health labs along with samples for testing while also returning results in a format that allows them to be smoothly integrated into the patient's record.
Orlando Health is using Detor to facilitate ordering and receiving the results of newborn testing screening. Prior to the launch of the system, the state lab returned these results in a PDF which then had to be scanned into the patient's electronic medical record, said Eric Rose, assistant VP of provider optimization at Orlando Health.
However, Rose noted, that scanned PDF didn't reside in the patient's record as a discrete result clinicians could access easily. Instead, doctors would have to know to look for them in the scanned document.
The Detor system also reduces turnaround time by several days, Rose said, adding that this is important for an application like newborn screening where the goal is in many cases to detect "obscure metabolic genetic disorders" quickly so they can be addressed before they cause developmental or other issues.
The previous ordering and reporting process "was probably 15 or 20 years behind from a technology standpoint," he said. "From a safety and continuity of care perspective, [the Detor system] is a huge win."
Rose added that having APHL standardize the process across states, labs, and providers provides a significant benefit.
"Every state has a different public health agency. Every state has a different newborn screening partner. Every healthcare facility has a slightly different platform," he said. "Having APHL step into the middle and build a solution that standardizes the process and modernizes it for everyone is huge from a public health standpoint."
Shepherd said APHL launched Detor with newborn screening as the initial use case because for many public health labs this is their highest volume activity. Moving forward, the organization plans to follow the guidance of its public health lab partners as to what additional applications would be most useful. She said that tuberculosis and STI testing are areas that labs have expressed interest in using Detor.
Development of Detor was funded by the US Centers for Disease Control and Prevention. A nonprofit with the mission of supporting the nation's public health labs as well as global health initiatives, APHL receives roughly 95 percent of its funding from the federal government. According to the organization's most recent annual report, it had $117.2 million in revenue in 2023.
The Trump administration has targeted roughly 10 percent of CDC staff for layoffs. Michelle Forman, manager of media at APHL, acknowledged the uncertainty of the current funding environment but said that the organization has not received any indication that its funding is at risk.
"For now there is funding, and we are continuing to do the work that we're doing," she said.