Lab Culture Ep. 20: 20 Years of the Laboratory Response Network

Stefan Saravia and Maureen Sullivan at the Minnesota Public Health Laboratory

This year marks 20 years since the inception of the Laboratory Response Network (LRN). Founded by APHL, CDC and the FBI, the LRN exists to protect the public from biological and chemical threats. How did the LRN get its start? And how has it evolved over the past 20 years? This episode of Lab Culture features an interview with two public health laboratory scientists and LRN experts.

Listen here or wherever you get your podcasts:

Maureen “Moe” Sullivan
Emergency Preparedness and Response Laboratory Supervisor
Public Health Laboratory, Minnesota Department of Health

Stefan Saravia
Biomonitoring and Emerging Contaminants Unit Supervisor
Public Health Laboratory, Minnesota Department of Health

Links:

Minnesota Laboratory Emergency Preparedness
About the Laboratory Response Network (APHL.org)
The Laboratory Response Network Partners in Preparedness (CDC.gov)
What is biomonitoring? (Video)
“Pine County man charged with government center threats, more” (StarTribune)

 

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APHL Newborn Screening Systems Quality Improvement Projects Award Recipients Announced

Newborn screening laboratory scientist at work

The Association of Public Health Laboratories (APHL) is pleased to announce the recipients of the Newborn Screening Systems Quality Improvement Projects awards. Funded through a cooperative agreement with Genetic Services Branch of the US Health and Human Services Health Resources and Services Administration (HRSA), these awards will provide funding to support continuous quality improvement (CQI) initiatives led by state newborn screening programs.

The Newborn Screening Systems Quality Improvement Projects build on the combined success of previous HRSA Maternal and Child Health Bureau funded cooperative agreements for NewSTEPs, NewSTEPs 360 and the NewSTEPs Timeliness Collaborative Improvement and Innovation Network (CoIIN). However, the Newborn Screening Systems Quality Improvement Projects are unique in that agencies are able to identify specific system challenges within their programs and request the funding necessary to work through their challenges using CQI methods. The ultimate goal is to improve their state or territorial newborn screening program thus improving health outcomes for newborns.

A total of 14 project proposals from 12 agencies were selected to participate in the QI projects, with focus areas including newborn screening timeliness, improvements to long- and short- term follow-up, patient and provider education, health information technology (HIT) and improvements to results reporting. These agencies include:

  • Alaska Department of Health and Social Services
  • Colorado Department of Public Health and Environment
  • Georgia Department of Public Health Laboratory
  • Georgia Department of Public Health Laboratory
  • Heluna Health in partnership with the California Department of Health
  • Iowa Department of Public Health
  • Louisiana Office of Public Health Laboratories
  • Minnesota Department of Health
  • New York State Department of Health
  • Puerto Rico Newborn Screening Program
  • Puerto Rico Newborn Screening Program
  • South Carolina Department of Health and Environmental Control
  • Tennessee Department of Health
  • Virginia Department of General Services/Division of Consolidated Services

In addition to funding support, awardees of the Newborn Screening Systems Quality Improvement Projects participate in a multidisciplinary collaborative network focused on improving newborn screening. They will receive customized coaching and technical assistance on designing and implementing their quality improvement project; support around data and reporting; and opportunities to disseminate their projects to other members of the newborn screening community.

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This program is 100% funded through Cooperative Agreement # UG8MC31893 from the Health Resources and Services Administration. All publications and presentations are solely the responsibility of the authors and do not necessarily represent the official views of HRSA.

The Association of Public Health Laboratories (APHL) works to strengthen laboratory systems serving the public’s health in the US and globally. APHL’s member laboratories protect the public’s health by monitoring and detecting infectious and foodborne diseases, environmental contaminants, terrorist agents, genetic disorders in newborns and other diverse health threats.

 

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Supporting rapid exchange of public health data is urgent, crucial and laden with challenges

By Jody DeVoll, advisor, communications, APHL 

In an era when digital communications move at blazing speeds, public health laboratories still have to resort to fax, email or phone to exchange data with some partners. Yet, this is only one of the obstacles to rapid exchange of critical public health laboratory data needed for public health surveillance, emergency response and patient care.

The volume of public health laboratory data presents an obstacle in and of itself. Infectious diseases, environmental toxins, foodborne illnesses, radiological exposure, hazardous chemicals, high consequence pathogens, antibiotic resistance: public health laboratories test them all. Add to this exponential increases in volume from the expansion of advanced molecular technologies like next-generation and whole genome sequencing, and the result is terabytes of data that public health laboratories must manage, interpret, store and share.

In addition, dozens of different, stand-alone systems make programming and maintenance of laboratory reporting systems labor-intensive and costly. For example, the US Centers for Disease Control and Prevention (CDC) maintains over 100 surveillance programs, each with its own reporting system. Dari Shirazi, APHL’s health information technology manager, explains how these many systems affect public health laboratory operations: “It’s as though you have a houseful of furniture to arrange in dozens and dozens of different houses and, periodically, you receive shipments of additional furniture that also has to be arranged.”

Of course, CDC is not public health laboratories’ only data exchange partner. Other federal partners, state and local health agencies, hospitals and others also require laboratory data, and they too want it parsed and transmitted through their proprietary systems.

With all these demands, data scientists at public health laboratories face a mountain of work, yet their numbers are few. The number of graduates in public health informatics has not kept pace with demands for workers from public and private sector institutions. As a result, graduates can choose from an array of positions, and they often choose private sector jobs which tend to be higher paying and longer-term than lower-salaried, time-limited positions at a public health laboratory.

Huge data volumes, a multitude of reporting systems and a shortage of public health data scientists make data exchange a laborious, costly and frustrating enterprise for public health laboratories. However, the implications extend beyond laboratories to the populations the data is intended to protect, in other words, us. According to Peter Kyriacopoulos, APHL’s senior policy director, “We are fast approaching the confluence of events on the management of public health data that threatens the very relevance of governmental public health. The volume of data generated by new laboratory technologies adds to the burden of over 100 inefficient data reporting systems that each have been designed to move specific information to a point at CDC, which constrains the utility of that information.

Fortunately, there are signs of change. Four national health organizations — APHL, the Healthcare Information and Management Systems Society (HIMSS), the Council of State and Territorial Epidemiologists (CSTE) and the National Association for Public Health Statistics and Information Systems (NAPHSIS)  – launched the Data: Elemental to Health campaign calling for a $1 billion investment in congressional funding over the next decade to modernize public health data/IT systems and develop a skilled workforce of data/IT specialists. Under the plan, state, local, tribal and territorial health departments would receive direct funding for these purposes through the CDC.

Over the last six months, the campaign has convened stakeholders, made the case for improved data systems to congressional and administration staff, appeared before the House Appropriations Subcommittee, hosted Hill briefings and organized a Day of Digital Action. Already there are results:

  • The House appropriations bill includes $100 million in fiscal 2020 for public health data systems and workforce modernization
  • The House LIFT America Act authorizes $100 million per year for five years to develop public health data systems and train staff
  • The Senate Saving Lives Through Better Data Act authorizes $100 million per year for five years for systems and people
  • The Senate Lower Health Care Costs Act authorizes “such sums as may be necessary” over five years to modernize data systems.

How would legislation initiated through the campaign support public health laboratories? First and foremost, it would help them to strengthen their LIMS. Shirazi explains, “A LIMS is a living, breathing thing that has to grow with lab needs. These needs change every year as the lab takes on new and novel types of testing.” Building LIMS capacity would enable laboratories to expand capability for data capacity, exchange and analytics; eliminate manual entry of test results; and provide secure, instantaneous communication of results to health partners. In addition, legislation initiated through the campaign would underwrite laboratory systems for exchange of electronic health records, National Notifiable Disease Surveillance System data, vital health records (e.g., notices of births and deaths) and other public health surveillance data.

Looking forward, the US would do well to complement the advances initiated under the Data: Elemental to Health campaign with a data transfer solution that consolidates all public health data systems into one. Kyriacopoulos notes that: “the creation of a single reporting site, that multiple data providers and users can report to and receive information from, would be a significant improvement that would allow for the efficient and comprehensive use of this data throughout the federal/state/local public health system.”

 

Photo credit: James Marvin Phelps

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New Lab Matters: A game-changer in the fight against antibiotic resistance

New Lab Matters (cover): A game-changer in the fight against antibiotic resistance

Given the global rise of drug-resistant pathogens over the past few decades, some physicians and scientists warn of a possible antibiotic apocalypse—a scary, post-antibiotic era. But a $160 million CDC effort now aims to keep antibiotic resistance rare. And as our feature article shows, the “game-changing” keystone of this effort is the Antibiotic Resistance Laboratory Network.

Here are just a few of this issue’s highlights:

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Lab Culture Extra: Progress in Sierra Leone

APHL's Sierra Leone team

APHL has a long history of involvement in Sierra Leone where we’ve provided technical assistance to strengthen the nation’s laboratory system for over a decade. Following the 2014-2015 Ebola outbreak, we were invited back to build laboratory response capability for Ebola and other highly infectious diseases.

We found there was a lot to be done: a strategic plan for the laboratory system, renovation of the central lab, training and mentoring of lab staff, reducing turnaround time for Ebola testing, and much more.

With the engagement completed earlier this year, APHL Executive Director Scott Becker and Manager of Global Health Sherrie Staley share insights from APHL’s on-the-ground experience, which include the value of a healthy ram.

Listen here or wherever you get your podcasts.

Links:

Photo album — Progress in Sierra Leone

APHL joins partners in Sierra Leone to strengthen lab capacity in Ebola’s wake

High profile APHL team explores MOHS public health laboratory priority needs

APHL in Sierra Leone: Building a resilient lab system

Sierra Leone and Guinea: Building a resilient lab system

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APHL workshop advances integration of HIV, HCV and syphilis testing

Attendees of the testing algorithms pre-HIV Diagnostic Conference workshop listen to a presentation.

Integrating HIV, hepatitis C virus (HCV) and syphilis testing is a laboratory best practice that improves detection of common co-infections and expedites treatment, but integrating these tests is not always easy. Each health department is unique, so they must take a customized approach to implementation based on their distinct set of requirements. To succeed, a health department and its public health laboratory must share common goals and be willing to work together to forge a mutually acceptable agreement.

Until recently, laboratories aiming for test integration had no venue to discuss the practical issues involved. This changed in 2019 when APHL sponsored a one-day workshop prior to the HIV Diagnostics Conference to review HIV, HCV and syphilis testing algorithms; discuss diagnostic testing challenges for each of the three pathogens; and compare recommended methods and protocols to those in use at attendees’ laboratories.

Modeled upon similar APHL workshops for influenza, the workshop brought together representatives from 20 states, the three CDC divisions that funded the workshop and professionals from related areas of public health. Participants exchanged information on common issues such as educating providers and submitters about HIV and syphilis algorithms, appropriate use of nucleic acid testing (NAT) for confirmation of HIV infection, access to ribonucleic acid (RNA) testing for confirmation of HIV and HCV infection, and selection of the optimal syphilis algorithm. Participants like Mary Louise Walmsley, MT(ASCP)—a public health microbiologist in the Alaska State Virology Laboratory’s Department of Immunology—were enthusiastic about the workshop: “Because of the workshop, new and pertinent information regarding HCV and syphilis will be incorporated into the programs at our facility. This was a fantastic workshop, and I hope APHL hosts another one.”

Pending available funding, APHL hopes to continue to sponsor this workshop at future conferences, with a possible return to the HIV Diagnostics Conference, which is held every two to three years. However, given this interval between conferences, APHL is also exploring options at conferences of partner organizations whose work relates to HIV, HCV and STD testing.

In related efforts, APHL has urged the US Department of Health and Human Services (HHS) to develop an STD Federal Action Plan that aligns with other HHS initiatives to combat overlapping epidemics. Additionally, APHL is supporting the Ending the HIV Epidemic plan and efforts to eliminate HCV.

The post APHL workshop advances integration of HIV, HCV and syphilis testing appeared first on APHL Lab Blog.

APHL workshop advances integration of HIV, HCV and syphilis testing

Attendees of the testing algorithms pre-HIV Diagnostic Conference workshop listen to a presentation.

Integrating HIV, hepatitis C virus (HCV) and syphilis testing is a laboratory best practice that improves detection of common co-infections and expedites treatment, but integrating these tests is not always easy. Each health department is unique, so they must take a customized approach to implementation based on their distinct set of requirements. To succeed, a health department and its public health laboratory must share common goals and be willing to work together to forge a mutually acceptable agreement.

Until recently, laboratories aiming for test integration had no venue to discuss the practical issues involved. This changed in 2019 when APHL sponsored a one-day workshop prior to the HIV Diagnostics Conference to review HIV, HCV and syphilis testing algorithms; discuss diagnostic testing challenges for each of the three pathogens; and compare recommended methods and protocols to those in use at attendees’ laboratories.

Modeled upon similar APHL workshops for influenza, the workshop brought together representatives from 20 states, the three CDC divisions that funded the workshop and professionals from related areas of public health. Participants exchanged information on common issues such as educating providers and submitters about HIV and syphilis algorithms, appropriate use of nucleic acid testing (NAT) for confirmation of HIV infection, access to ribonucleic acid (RNA) testing for confirmation of HIV and HCV infection, and selection of the optimal syphilis algorithm. Participants like Mary Louise Walmsley, MT(ASCP)—a public health microbiologist in the Alaska State Virology Laboratory’s Department of Immunology—were enthusiastic about the workshop: “Because of the workshop, new and pertinent information regarding HCV and syphilis will be incorporated into the programs at our facility. This was a fantastic workshop, and I hope APHL hosts another one.”

Pending available funding, APHL hopes to continue to sponsor this workshop at future conferences, with a possible return to the HIV Diagnostics Conference, which is held every two to three years. However, given this interval between conferences, APHL is also exploring options at conferences of partner organizations whose work relates to HIV, HCV and STD testing.

In related efforts, APHL has urged the US Department of Health and Human Services (HHS) to develop an STD Federal Action Plan that aligns with other HHS initiatives to combat overlapping epidemics. Additionally, APHL is supporting the Ending the HIV Epidemic plan and efforts to eliminate HCV.

The post APHL workshop advances integration of HIV, HCV and syphilis testing appeared first on APHL Lab Blog.

Self-directed regional networks: Connecting neighbors strengthens labs

The Pacific Rim Consortium met in person for the first time at the Hawaii Public Health Laboratory in March, 2019.

(Photo: The Pacific Rim Consortium met in person for the first time at the Hawaii Public Health Laboratory in March, 2019.)

How can a public health laboratory with limited resources sustain and expand its capabilities? One strategy is to leverage the resources and expertise of its neighbors.

With support from the US Centers for Disease Control and Prevention (CDC), APHL is assisting with development of self-directed regional laboratory networks (SDRN) to facilitate collaboration and resource management among neighboring public health and environmental laboratories. SDRNs operate independently, establishing their own governance and strategic priorities based on their unique needs. Soon these networks will be linked through a Coordination Council, which will bring together representatives from each of the SDRNs for joint planning and resource development.

A growing community of networks

Today, 48 states and one territory, Guam, are members of an SDRN. The original SDRN was founded over forty years ago when laboratory directors in New England came together in the mid-1970s to share common concerns around newborn screening legislation then pending in multiple states. This group evolved to become the New England Public Health Laboratory Directors Group (NEPHLD), and then became NEEPHLD when it expanded its constituency to include laboratories responsible for environmental testing.

However, the regional model did not pick up momentum until a review by APHL and CDC demonstrated its value in the early 2000s. This provided the impetus to form the Northern Plains Consortium in 2006, the Southeast Consortium in 2015, the Mid-Atlantic Consortium in 2017, and the Midwest, Pacific Rim, Four Corners and Central Plains networks in 2018 and 2019.

Members “have our back”

SDRN member laboratories report many benefits from participation. Members share technical expertise, technologies and capacity, and they forge relationships with colleagues at other laboratories, making it easier to collaborate when emergencies arise or a testing system goes down. Emily Travanty, PhD, scientific director of the Laboratory Services Division at the Colorado Department of Public Health and Environment reports: “Our fellow consortium members have our back when we need them. For example, the Utah Public Health Laboratory did TB testing for us when our laboratory was in the midst of renovations. Because of them, we were able to still meet our test turn-around times and keep our customers happy.”

Members also collaborate on fundraising, informatics systems, training and leadership development, as well as recruitment and retention. According to Denise Toney, PhD, director of the Virginia Division of Consolidated Laboratory Services:

“The Mid-Atlantic Consortium provides a venue to share ideas, resources and expertise across our region so we don’t have to reinvent the wheel. One project we worked on collectively was a compensation study, funded by CDC and APHL. Our members are using this data to educate their own state leaders about the salary levels needed to recruit and retain top-notch scientific staff in our region.”

SDRNs show strong prospects for the future, with planning in progress within and across networks. With sustainability a perennial challenge for state and local laboratories, that’s good news for public health.

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New Lab Matters: The promise and challenge of newborn screening in 2019

New Lab Matters cover depicts a newborn baby

Newborn screening is a public health success story, ongoing for 56 years. On the one hand, new treatment and laboratory testing options open up the possibility of expanded screening panels. On the other hand, testing laboratories and follow-up providers are generally under-resourced and straining to keep pace with growing workloads. But as our feature article shows, scientists are working diligently to improve the accuracy and precision of existing tests and to bring on new disorders, even as they continue the high-stakes work of screening tens of thousands of infants a year.

Here are just a few of this issue’s highlights:

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Lab Culture Ep. 19: Dr. Mona Hanna-Attisha- Storytelling and the Flint Water Crisis

Michelle Forman interviewing Dr. Mona Hanna-Attisha.

Dr. Mona Hanna-Attisha, author of What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope in an American City, joins us for an interview about the importance of storytelling in public health. Did Dr. Mona’s successful use of narratives allow Flint’s story to be as resilient as the people who lived it?

Listen here or wherever you get your podcasts.

Links

Is water in Flint safe to drink? It’s not just a question of chemistry. [Op-ed by Dr. Mona Hanna-Attisha]

What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope in an American City

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