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Public Health Lab Association's Cloud Platform Streamlines Clinical Data Collection, Reporting

NEW YORK (360Dx) – Clinical labs burdened with reporting diagnostic data to different states in different formats can now securely send data to a cloud-based platform run by the Association of Public Health Labs, which transforms clinical data into messaging formats that different public health agencies can consume.

The platform, called APHL Informatics Messaging Services, or AIMS, is the latest evolution of a system first created in the wake of the 2009 pandemic influenza outbreak, when labs had trouble transmitting and sharing flu data effectively, APHL executives said.

"Because of the phenomenal success it had in moving flu data from our member laboratories to the [Centers for Disease Control and Prevention], people began to realize if we can do this with flu, we can do something just as good with everything else that is currently being faxed or emailed, or God help us, snail mailed," said Peter Kyriacopoulos, senior director of public policy for APHL.

For clinical labs, particularly lab companies with a presence in multiple states, using the AIMS platform enables them to outsource the work of tailoring data differently for different states, Kyriacopoulos said.

"Every single state defines [its] own set of reportable conditions within that state. If you are a laboratory, or you are a clinician, and you identify a specific pathogen or disease, you are mandated by law to report that to the appropriate state public health agency," said Michelle Meigs, APHL manager, informatics operations.

One very large clinical lab partner is currently using the service to transmit appropriate clinical data to 27 different state public health agencies, according to Meigs, though she declined to identify the lab. APHL hopes to have the AIMS platform configured to deliver mandated clinical reporting data to all 50 state public health agencies by the end of the year, she said.

For APHL, the AIMS platform has grown exponentially to meet clinical lab data transmission needs, Meigs said. The original version of the platform, involved hosting point-to-point electronic connections between public health labs in six states and the CDC. The original six public health labs – in Virginia, Colorado, Iowa, Minnesota, Nebraska, and California – were members of APHL's informatics committee and agreed to form a coalition to use technology to share flu information with the CDC more seamlessly, she said.

"We had this great cooperation in the influenza program at the CDC. Our colleagues there were helping us and working with us, but then everyone noticed I have to connect to CDC, and Iowa has to connect to CDC, and Virginia has to connect to CDC, and there are six different connections to CDC just for one influenza message," Meigs said. "So what we did is we said let's build something that would sit almost like a post office. Data would come into that service, and we wouldn't open it, we wouldn't do anything with it, we would just read the envelope and send it to the appropriate place," she said.

In 2014, APHL moved what is now the AIMS portal, which it had been hosting on its own infrastructure, to Amazon Web Services, enabling APHL to outsource physical infrastructure maintenance, and devote more attention to other services it could provide through AIMS.

APHL now has both technical and subject matter experts to help participants transform information into both the technical messaging standards and the content requirements needed for the counterparty receiving the information, Meigs said.

Outsourcing the infrastructure to AWS also provided significant additional layers of security to the system, as well as significant compliance adherences, noted Marty Sibley, APHL senior specialist for cloud computing and Amazon Web services.

APHL has supplemented the security layers built into AWS with several third-party security audits, including a "white hat" or ethical hacker audit in which an expert in penetration testing looks for vulnerabilities to the system, he said. In addition, APHL has further tailored security and compliance concerns to clinical data messaging requirements. The system is fully HIPAA compliant, he noted.

"Within AWS you have to make sure you are using appropriate HIPAA services. Not everything within AWS can be used for processing, so we have to use approved services and use them in the right way," he said. "It's really a shared security model, AWS does part and we do the other part."

Since moving to AWS, Meigs said, the number of users of the system has ballooned. "We have grown from six trading partners to 180 since 2014," she said.

Current participants of the system include all 55 public health labs which includes public health labs in each state, as well as other regional labs in the system, several clinical lab partners that are using the platform for electronic laboratory reporting, all 50 state public health agencies, and several CDC partners, according to Meigs.

As the number of participants has grown, so have the number of different use cases for the system, she said.

"If you look at the number of projects that we have been working on, we went from two projects" — one focused on influenza, and another focused on diseases that can be prevented by vaccines — "to 16 projects in two and a half years," Meigs said.

In addition to influenza data transmissions to CDC, and electronic laboratory reporting to state public health labs by clinical labs, AIMS is now supporting the transmission of clinical diagnostic data related to the CDC's rabies program, the CDC's National Notifiable Disease Surveillance System's (NNDSS) Modernization Initiative, which is improving notifiable disease data collection, and the collection and transmission of data related to antibiotic resistance, tuberculosis, and other disease and pathogen areas.

It's a network that APHL hopes to continue to grow, both in numbers of users and possible use cases, according to Meigs.

""We had a single pipe in and a single pipe out that helped to support multiple users, and now we have an underground. If you think about maintaining that long term, if it were all on the backs of the states that is a lot of maintenance and support that states would have to do," Meigs said. "We really have been able to take away the burden and cost at the state level, centralize that, and help support that in a more standardized, centralized way."