modernizing public health infrastructure

Modernizing Public Health InfrastructureA State-by-State Look at How Departments of Health Streamline Data Exchange with Lyniate

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State and Local Department of Health /2 32

IntroductionWhile the COVID-19 pandemic exposed vulnerabilities in the U.S. public health system, it also spurred much-needed federal funding for modernizing your infrastructure. President Joe Biden’s National Strategy for COVID Response and Pandemic Preparedness includes a strong focus on public health architecture modernization. The strategy outlines seven goals for recovery, most of which rely on data-sharing as a core tactic. Moving fast and knowing exactly where to start can be a challenge, and we’d like to help. Pre-pandemic, the CDC and most state departments of health were using Lyniate Rhapsody to streamline reporting needs and to connect clinical and public health data. They trusted Rhapsody to enable bi-directional data flow for:

• Electronic Lab Reporting (ELR)• Immunization Registries (or Immunization Information Systems) • Health Information Exchanges (HIEs)• Electronic Case Reporting (eLR)• Public Health Information Network Messaging System (PHINMS)• And more

Read on to get to know Lyniate and understand how public health agencies were already using Rhapsody and Corepoint solutions to address public health data exchange. These same data exchange principles apply to pandemic preparedness. Let us help you put our products and services to work to continue to address your most pressing interoperability challenges. With targeted education and product offerings, Lyniate is helping public health agencies navigate web services, FHIR, and increased volumes. Let’s connect to tell you how. In this interactive eBook, we highlight how 28 states use Rhapsody to power data exchange. A few years ago, we collaborated with our customers to create this eBook as a resource for public health agencies to share information and best practices with one another. This sharing is more important than ever as we work together to respond to this pandemic and prepare for the future. If your state is included in this eBook and you would like to update the information, or if your agency is not included and you would like us to add it, please get in touch.

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Table of Contents04 The Complexities of Tracking COVID-19 Vaccine Data

05 Centers for Disease Control and Prevention

06 Lyniate Rhapsody Public Health Use Cases Use list or interactive map below to navigate 06 Arizona 13 Michigan 23 Philadelphia 06 Colorado 14 Minnesota 23 Rhode Island 07 Delaware 15 Mississippi 24 South Carolina 07 Hawaii 16 North Carolina 24 Tennessee 08 Iowa 17 Nebraska 25 Virginia 09 Idaho 17 New Hampshire 26 Vermont 09 Illinois 18 Nevada 27 Washington 10 Kansas 18 Ohio 28 Wisconsin 11 Kentucky 19 Oklahoma 29 West Virginia 11 Maryland 20 Oregon 29 Wyoming 12 Maine 22 Pennsylvania

30 Glossary

32 Additional Resources

Lyniate Rhapsody Public Health Use CasesTo navigate, simply click on a state for details.

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The Complexity of Managing COVID-19 Vaccine DataWhile departments of health rely on Rhapsody for reporting lab and case data, they can also use the interoperability platform to track COVID-19 vaccine data. Rhapsody can be used everywhere you see an arrow.

The picture below illustrates the complex movement of vaccine data that you are tasked with managing. We know that it’s like this but much more complicated. In reality, there isn’t just one vaccination site, there are thousands. And, in theory, each site is sending data in the same format. In reality, data is arriving in different formats and you have to connect it. The Vaccine Administration Management System looks like a single application but in many states, it’s four separate applications that need to be interfaced with. These are just the beginning of the challenges. Across all of these touchpoints, you and your teams must make sense of the data, resolve any issues, and connect the data with the people who need it. All of this must work, in order to help your citizens stay well.

Lyniate can help. We connect data and make information sharing easier so that you can juggle competing priorities today and in the future. In the cloud, on-premises, we can deploy anywhere and help you manage the integration as much as you need.

Integrate Health Data

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Centers for Disease Control and Prevention

Message Processing• Rhapsody is used for a Data Message Brokering service at CDC that

currently processes de-identified ELR from public health laboratories and case notifications for some nationally notifiable diseases.

National Healthcare Safety Network (NHSN)• Secure, internet-based surveillance system that integrates patient and

healthcare personnel safety surveillance systems managed by the Division of Healthcare Quality Promotion (DHQP) at the CDC. Over 9,000 acute care hospitals, long term acute care hospitals, psychiatric hospitals, rehabilitation hospitals, outpatient dialysis centers, ambulatory surgery centers, and long term care facilities are currently entering data into NHSN with substantially more facilities expected within the coming year.

• Leading an effort to utilize Clinical Document Architecture (CDA) documents for automated data entry; and is seeking Health Information Service Provider (HISP) services to facilitate the secure transport of these data from healthcare facilities via the NwHIN Direct Protocol.

Public Health Laboratory Interoperability Project (PHLIP)• The accurate and rapid exchange of information about reportable diseases,

such as influenza and COVID-19, among public health laboratories and their partners is essential to the prevention and control disease outbreaks.

• APHL offers technical assistance to public health laboratories to retrieve data from their Laboratory Information Systems, anonymize, and transform these data to a standardized HL7 2.5.1 ORU message for secure transmission via PHINMS to CDC.

National Electronic Disease Surveillance System Modernization Initiative (NEDSS)• NEDSS modernizes the systems and processes used to receive nationally

notifiable disease data to provide more comprehensive, timely, and higher quality data for public health decision making.– The Association of Public Health Laboratories (APHL) offers technical

assistance to health departments to build and update Rhapsody routes used to transform data from individual systems to standardized HL7 2.5.1 OR messages.




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AR Arizona Department of Health ServicesConfiguration and Environment• Lyniate Rhapsody.

Electronic Laboratory Reporting (ELR)• The Arizona State Lab uses Rhapsody to produce outbound HL7 files for Electronic Lab Reporting.• Internal Electronic Lab Reporting (ELR) System uses Rhapsody to down-convert

2.5.1 HL7 files to 2.3.1 HL7 files.

Colorado Department of Public Health & EnvironmentDisease Control & Environmental Epidemiology Division

Configuration and Environment• Lyniate Rhapsody running on windows server 2012.

ELR• Broad use of custom .net/nhappi parsers - every new lab feed means a new

custom parser; Rhapsody provides consistency and shortens development.

Physician Tracking• Incoming provider information from a myriad of

federal and state sources, all handled by Rhapsody.

Syndromic Surveillance and Clinician Reports• Clinician reports for non-lab reportables (animal bites, certain zoonotics, varicella,

hospitalized flu) received via fax or otherwise (line lists, etc.) that include symptoms or treatment for a range of potential diagnoses (e.g., sexually transmitted infections, etc.) must be manually reported.




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Delaware Department of Health and Social ServicesConfiguration and Environment• Lyniate Rhapsody.

Health Information Exchange (HIE)• Use Rhapsody to channel HL7 messages from system to system and agency to agency.

“Source” folders are made available to different systems or agencies to download HL7 messages into. Rules configured in the Rhapsody software then control the automated passing of the HL7 messages to designated “Destination” folders of other systems or agencies.

• Rhapsody handles the processing and passing of HL7 acknowledgement messages so that a system or agency knows whether the HL7 messages were successfully received and/or processed by the “Destination” system or agency.

• Rhapsody currently handles HL7 messages containing information on Medical Lab Results, Immunizations, Patient Demographic Information, and Medical Diagnosis Information.

Hawaii Department of HealthConfiguration and Environment• Lyniate Rhapsody on Windows 2012 Servers.

HIE• Rhapsody is the primary data integration and transport engine for

Hawaii Laboratory’s standard message development, validations, and routing to various internal and external partners.

• All interfaces to the disease surveillance application (MAVEN) use automate data exchange between several state agencies: State Laboratory Division, Death Registry, Immunization, and Sanitation Department.

ELR• Tests requests (orders) are submitted for influenza and sexually transmitted diseases

to the State Lab, and finalized results are viewed online. Bi-directional data exchange is done by transforming application extracts to XML (HL7) for the laboratory information system (STARLIMS), then transforming the results back XML for MAVEN integration for epidemiologists as well as the physicians to view results in real time.




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Iowa Department of Public HealthConfiguration and EnvironmentPublic Health Agency• Lyniate Rhapsody.

Public Health Lab• Lyniate Rhapsody.

ELRPublic Health Agency• In-bound ELR to determine jurisdiction (either Iowa or another jurisdiction) and re-routing, if

appropriate. Working with several states to promote this “ELR Redirect” as a national project.• Receive and route in-bound ELR for disease surveillance. Rhapsody routes messages to 6

different destinations (both test and production).

Public Health Lab• ELR interface to Iowa Department of Public Health.

CDC Reporting and PHINMSPublic Health Agency• Use Rhapsody to send outbound messages of 2 types:

‒ Send “Case Notification” messages to the CDC.‒ Send “ELR Redirect” to other state public health jurisdictions.

Public Health Lab• CDC Influenza Branch - PHLIP Influenza Interface (Rhapsody used to emulate PHINMS).• Hospital Interfaces

‒ Ordering/Resulting (22 facilities).‒ 1 Resulting only (4 facilities).

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Idaho Department of Health and WelfareConfiguration and Environment• Lyniate Rhapsody.

ELR• Receive ELRs from commercial and hospital labs. Messages are standardized, validated,

mapped to nationally recognized code sets, converted (XML for NBS and CSV for eHARS), deduplicated, and routed to the appropriate receiving systems. This process includes counting by facility and disease category.

• Special projects require anonymization, conversion and routing to CDC (LIMSi, PHLIP and PHLIS).• ELRs are exchanged between ID and OR for out-of-state

residents using PHINMS via the APHL AIMS hub.

eCR• Receive specific case reports from a provider, validate, transform

and load the case reports into the surveillance system.

Future Work• Send and Receive electronic laboratory orders and results to the state lab information system.

Illinois Department of Public HealthConfiguration and Environment• Lyniate Rhapsody.

NNDSS• Production level TB and Varicella case reports (HL7); beginning

work on Generic V2 mapping via the NMI project to CDC.

ELR• State lab uses STARLIMS and uses Rhapsody




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Kansas Department of Health and Environment, Division of Public HealthBureau of Epidemiology & Public Health Informatics

Configuration and Environment• Lyniate Rhapsody.

ELR• 41 Meaningful Use compliant facilities, 3 Reference Labs and State Lab

in production resulting in 89.4% of lab volume received via ELR.• Accept STD, HIV, Hepatitis, Lead/Toxic, Enteric, General Communicable,

Zoonotic, VPD, Influenza and TB ELR messages.• Messages are received using Rhapsody by TCP/IP, PHIN- MS (Direct, APHL, CDC)

and messages from a proprietary KDHE Web Services program.• Filters, JavaScript modifications, search and replace functions have been added

to make facility messages compliant with surveillance system requirements.

Lead Program• Blood lead reports are received on the Rhapsody Lead Route which separates elevated

and non-elevated blood lead reports. Elevated reports are routed to the surveillance system. Child and adult non-elevated lead level reports, are converted them to a .csv file and stored them for insertion to an alternate recording program.

• Adult lead HL7 reports are sent via email. Lead program places the files in a folder where Rhapsody picks up the files and automatically processes through the Lead Route.

Infectious Disease• MU2 Infectious Disease reports are received into Rhapsody through the same feed as ELR

from our Kansas Hospital Information Network, filtered by reportable disease condition and routed accordingly.

Birth Defects• MU2 Birth Defect reports are received into Rhapsody through the same feed as ELR from their

Kansas Hospital Information Network. The reports are routed to the Birth Defects program.

Kansas Health & Environment Laboratory HIV (KHEL - State Lab)• A TCP/IP transmission from KHEL feeds into Rhapsody which separates ELR messages,

PHLIP and LRN Reports. ELR messages are sent to an ELR Route, and PHLIP and LRN reports are sent to the PHINMS for transmission to CDC.

Varicella Case Notification Reporting• Rhapsody picks up varicella data created from the surveillance system, maps the data

in accordance to the Varicella message mapping guide, creates an HL7 Varicella Case Notification report for transmission to CDC.

HIV• HIV reports are separated by Rhapsody and sent to the staging area of the surveillance

system. HIV staff transfer the messages to eHARS.




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Kentucky Department for Public HealthEpidemiology & Health Planning / Surveillance & Health Data Branch


ELR• ELR processing to and from NEDSS application.• PHLIP messages processing.

Maryland Department of Health and Mental HygieneConfiguration and Environment• Lyniate Rhapsody.

Meaningful Use• All Rhapsody routes are devoted to receiving, transforming

and transmitting Meaningful Use data.

ELR• Receive ELR in various HL7 versions from multiple entities (hospital, commercial, and state

labs) via PHINMS, sftp and web services. Rhapsody transforms, validates and filters messages according to program needs. Messages are then routed to various Public Health Programs in formats compatible with the system.

Syndromic Surveillance• Receive, transform and process syndromic surveillance

messages from hospitals to the SS interface.

CDC Reporting• Send Case Notification (NNDSS) messages to CDC from the disease surveillance system.




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Maine Department of Health and Human ServicesMaine Center for Disease Control & Prevention


HIE• The Rhapsody HL7 Hub is a series of routes which receives all of the HL7 in

the Department. Messages are analyzed for content and sent to specific routes as needed. Inputs include HTTPS, database polling, SFTP, and Rhapsody Connector.

• The Consult Database route receives emails from the Exchange server, parses them, updates a database based on the content, and notifies a recipient of the activity.

ELR• Receive HL7 via PHINMS and SFTP, send them to lab specific routes,

perform mapping as needed, and send them to the surveillance system.

Syndromic Surveillance• HL7 are received, filtered for Test or Production, codes are mapped as needed,

and then inserted into the syndromic surveillance application’s tables.• Receipt of syndromic surveillance data via CSV from legacy systems are mapped to

a standard format and inserted into a table. One of the department’s oldest projects.

Cancer Registry• CDA files are processed for the cancer registry.

Immunization Registry• Currently processing immunization doseage files.• Planning to expand to support Immunization messages as well.

CDC Reporting• Send NND notifications to the CDC.




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Michigan Department of Health and Human ServicesConfiguration and Environment• Lyniate Rhapsody.

Immunization Reporting (Michigan Care Improvement Registry – MCIR)• Providers submit immunization information (HL7 2.x VXU) when they administer an immunization.• Providers initiate a query to retrieve a patient’s

immunization history and forecast (HL7 2.5.1 QBP).

ELR (Michigan Disease Surveillance System – MDSS)• Labs, Hospitals and health care providers submit HL7 ORU messages for any positive reportable

result; data are used to monitor related outbreaks and ensure patients are tracked and treated.

Syndromic Surveillance (Michigan Syndromic Surveillance System – MSSS)• Hospitals (primarily the emergency departments), Urgent care facilities, and some Primary Care

sites submit deidentified HL7 ADT chief complaint (i.e., reason for visit) messages for each episode of care.

Cancer Reporting (Michigan Cancer Surveillance Program – MCSP)• Providers (primarily Oncologists) submit a CDA document (often encapsulated

in a HL7 ORU message) with cancer case and treatment plan information.• Labs, hospitals and some providers submit HL7 ORU

messages with pathology results related to cancer cases.• Data are used for statistical and research purposes.

Birth Defects (Michigan Birth Defects Registry – MBDR)• Providers submit a CDA document (often encapsulated in a HL7 ORU message) with birth defect

case and treatment plan information; data are used for statistical and research purposes.

Newborn Screening (Critical Congenital Heart Defects – CCHD)• Birth hospitals submit HL7 ORU messages for every baby screened to collect pulse oximetry

screening information for Congenital Heart Defect and facilitate patient tracking and follow-up.• There can be up to three screenings/ORU messages per baby.

Additional Interfaces• Newborn Screening – Early Hearing Detection and Intervention• Newborn Screening – Blood Spot Orders and Results• StarLIMS – Orders and Results.• Peace of Mind Registry (Advanced Directives).• Michigan Childhood Lead Poisoning Surveillance.• CareConnect360 for ADT.• Michigan Automated Prescription System.• Behavioral Health Treatment Episode Data Set.




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Minnesota Department of HealthInformation Technology Services


ELR• Validate incoming HL7 ORU messages before import into the electronic disease surveillance

system.• Transform and translate incoming HL7 ORU to formats (i.e., CSV) used by other systems

in the agency such as eHARS and our Blood Lead information system for consumption.

CDC Reporting• Transform and translate data in the databases of internal systems to meet format and

encoding standards of the CDC. The electronic disease surveillance system generates some reporting tables in a database; Rhapsody reads data from those tables and then builds HL7 before sending it off to PHINMS and the CDC.

Other Use Cases• Uses within health: Family Home Visiting, Blood Lead, HIV/STD, and PHINMS via (DB).• Non-health uses: Billing (Retrieve from DB, deliver to FTP).

Future: HIE• Developing use cases to integrate internal health information systems.• Exploring the work need to integrate the Refugee Health Information System

with the Immunization Registry.• Exploring ways to integrate any number of systems with their Vital Records System.• CDC Reporting: Hepatitis reporting and Newborn screening records to CDC.• Additional direct email implementations.




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Mississippi State Department of HealthConfiguration and Environment• Lyniate Rhapsody.

CDC Reporting and PHINMS• Use Rhapsody PHIMMS components to transmit data (TB, PHLIP, Enteric, BT).

ELR• Accepts messages from HIE and routes data to the appropriate disease authority. For the

applications that accept HL7, no modifications are performed. Custom mappers are built for applications that receive txt, csv, etc. Custom Validation for required field in HL7 ELR messages.

Immunization• Receives immunizations and route HL7 messages to correct environment in MIIX.

Syndromic Surviellance• Transform and deliver syndromic messages to BioSense.

Various FTP connections• Various FTP connections are used to either receive or

distribute data from different hospitals or organizations.




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North Carolina Department of Health and Human ServicesDivision of Public Health


ELR• Validate and transform incoming ELR destined to the North Carolina Electronic Disease

Surveillance System (NC EDSS) and the North Carolina Lead Surveillance System (NCLEAD).• Transform ELR data from the North Carolina State Laboratory of Public Health

to HL7 formats for transmission to North Carolina Division of Public Health.

CDC Reporting• Transform disease case notification data from NC EDSS to HL7

format (NMI) for transmission to CDC.• Transform ELR data from the North Carolina State Laboratory

of Public Health to HL7 formats for transmission to CDC (PHLIP).

No Transport• Do NOT use Rhapsody for external transmissions in or

out due to limited number of Communication Points.• All incoming transmissions are required to use PHIN-MS, and use a java program

that extracts messages from the PHIN-MS worker queue tables and places them in a directory for input to Rhapsody.

• All outgoing transmissions are sent via PHIN-MS, using Rhapsody to insert into the PHIN-MS transport queue tables.

Future Use• Transform case notification data for additional diseases, per the

MMG guides, from NC EDSS to HL7 format for transmission to CDC.




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State of NebraskaDivision of Public Health


Syndromic Surveillance• Inserts and updates syndromic surveillance patient visit rows with inbound HL7 2.5.1 data.• Generates HL7 messages from Nebraska syndromic surveillance database for insertion into

NSSP(BioSense 2.0) Nebraska locker.

ELR (NEDSS)• Convert all ELR HL7 2.3.1 messages to HL7 2.5.1.• Convert all ELR HL7 2.5.1 messages for XML to be imported into NEDSS.

New Hampshire Department of Health and Human ServicesConfiguration and Environment• Communication Points.• Rhapsody Engines.

ELRIncoming• Database comm points• Database Message Extraction filter• Filters• HTTP comm points• TCP comm points• Dynamic Router comm points• Rhapsody Connector Comm Points• Directory comm points• FTP

Case Notification (to CDC and World Health Organization) Incoming• Database Message Extraction filter• Dynamic Router

Syndromic SurveillanceIncoming• HTTP Comm point• TCP• Directory• Dynamic Router

Outgoing• HTTP Comm point• Directory comm points• Database lookup filters• E-mail comm points

Outgoing• Database comm point (PHINMS)

Outgoing• HTTP Comm point• sFTP




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Nevada Division of Public and Behavior HealthConfiguration and Environment• Lyniate Rhapsody.

ELR• Receive HL7 messages from PHINMS and their SFTP site and input into CDC’s NBS applications.

Ohio Department of HealthBureau of Infectious Diseases

Configuration and Environment• Lyniate Rhapsody running on Windows 2012.

CDC Reporting• Only used for CDC Flu reporting (PHLIP). This flow was setup by APHL.

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Oklahoma State Department of HealthConfiguration and Environment• Lyniate Rhapsody.

ELR• Historically utilized Rhapsody as a message translation tool for ELR messaging.

HIE• OSDH and other State Agencies have undertaken• a Health-e-Oklahoma (HeO) Project focusing on interoperability and information

sharing among State Agencies. Rhapsody was selected as the central message hub and will be used to connect “stove pipe” State information systems using an eMPI.

• Orion will be providing hosted Rhapsody and eMPI services to all 3 HeO environments.• Internally, Oklahoma is moving towards using FHIR/ JSON interfaces with

core information systems.

MU• Meaningful Use (MU) message validation, parsing, routing,

and translation are within the HeO umbrella.




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Oregon Health AuthorityOregon Public Health Division


CDC Reporting• Oregon’s State Public Health Laboratory (OSPHL) delivers

multiple files to the same directory communication point.• Standard HL7 2.3.1 ORU messages for reportable conditions are ingested by an ELR repository.• PHLIP files are deidentified, translated, and delivered to an outbound PHINMS client for CDC.• LIMSi files are simply routed to PHINMS server for delivery to CDC.• An Excel file of all test performed from the previous day is parsed

and inserted into a database that state epidemiologists can query.

MU• Immunization Program uses Rhapsody for Meaningful Use test message

validation – they poll a database that is populated from web entry, validate the message, and return validation results to the database for display on the web.

ELR (Orpheus)• Data are retrieved from an SFTP server via Windows script and deliver to a single directory

communication point to process, and an inbound PHINMS database is polled for new data.• Various versions of HL7 (2.3.1, 2.4, 2.5.1) ORU messages are mapped to 2.5.1, and then

inserted into an ELR repository (part of the Orpheus suite) via Java Database Connectivity (JDBC) for processing by local and state epidemiologists.

Syndromic Surveillance (ESSENCE)• HL7 2.5.1 ADT messages for every emergency department visit in Oregon in the past

24 hours are retrieved from an SFTP server via Windows script and deliver to a directory communication point to process. These data are transformed to fit the standard, but are then denormalized and inserted into ESSENCE.

• A nightly query is sent to the National Poison Data Center for all Oregon calls in the previous 24 hours. These results are then parsed and inserted into ESSENCE.

• And a nightly export from Orpheus is delivered to a directory communication point and inserted into ESSENCE.

HIE• Poll a table in Orpheus via JDBC that is populated with a fully formed HL7 QBP (immunization

history query message) when users make a request. This message is then sent to their immunization registry (ALERT-IIS) via SOAP web- service; when the response is received, it is inserted back into the database (which then processes for the end user).




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Oregon Health Authority (continued)

EHDI• Their Early Hearing Detection and Intervention program receives HL7 2.7 ORU messages

which are transformed into a CSV which can then be imported into their database.

Future Work• Connecting Rhapsody to the Prescription Drug Monitoring Program (PDMP) database and the

statewide HIE (the noun) so providers can query PDMP from their EHRs.• Connecting the state Public Health Meaningful Use Registration System

(PH-MURS) to each of the MU Program onboarding and contact management systems.




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Pennsylvania Department of HealthConfiguration and Environment• Lyniate Rhapsody

HIE• Use Rhapsody as a web service to send data and parse various file types (csv, HL7, XML)

to process in their various internal processes and update databases where applicable.

CDC Reporting• Use Rhapsody to create files that will be written to a file directory. The file is then

picked up by CDC PHINMS Windows service software to send the file to CDC and update our internal database tables.

• Routes were developed for both TB and Varicella to submit hl7 messages to CDC on a weekly basis. TB data is currently being sent however Varicella data is not (CDC reporting requirements and Philly jurisdiction and state jurisdiction data merge capabilities prevent the use of the Varicella).

• We are in process of building a case notification service that will handle all Message Mapping guides and send the data in the current HL7 2.5.1 format. Once complete this service will eventually replace the existing TB and Varicella routes.

ELR• After onboarding process, then approval from program area

departments for test messages using one of two methods:• Manual upload via the PA-NEDSS web site ELR file upload

web page using an account and password.• Using a Windows service that PA supplies the MSI to install it. Using this method, a Windows

service connects to our public ELR Microsoft Windows Communication Foundation (WCF) service polling a file folder and electronically sends the file to PA-ELR and the same username and password like they were manually uploading.

• Either way, the ELR WCF Service accepts the file from the manual file upload web page or Windows service, connects to the Rhapsody web service, parses the file, etc., and then writes the file out to a file directory.

• ELR receives messages in a number of formats, Standard 2.3.1, messages from Lab Corp that contain a ZLR segment (a type of message) that needs special processing, 2.3.1 messages from CDD that require special processing, xml, csv and Standard 2.5.1.

• Rhapsody is also used to receive and process Negative STD lab results. Rhapsody is responsible for all aspects of message processing for negative reports. Rhapsody completes database look-ups to map standard codes to NEDSS codes, translates the hl7 message to a format that can be written to the data base, writes the data to the data base and translates the message to a .csv message that is exported and can be used by the program area until the data gets into the data warehouse.




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Philadelphia Department of Public HealthConfiguration and Environment• Lyniate Rhapsody.

ELR• Receipt, translation and routing of ELR data with input from 1 TCP/IP connection

(real-time) and monitored folder file transfers (daily/weekly files).• Receive HL7 from commercial labs (Quest and Labcorp)• as well as several hospital based LIS, and the City’s Public Health Lab;

processing a couple hundred messages per day.• Processed labs are routed to 3 separate database applications.

Future Work• Performing a lot of testing and configuration for other routes.• As with many of the Public Health departments PHI is dependent on SAIC to finish

configuring and testing their application with Rhapsody version 3.X so they can upgrade.• In the near future we will be using Rhapsody to support the processing of CDC

message-mapping guides (MMG).

Rhode Island Department of HealthConfiguration and Environment• 2 Rhapsody Engines running.

ELR• Used by state public health lab to send ELR to the RI-NBS.• Receipt of ELR by RI-NBS.• Any work related to ELR and ETOR (Electronic Test Ordering and Reporting).

CDC Reporting• Direct reporting of specific lab results to the CDC. • Reporting cases of disease to CDC.

Future Work• Transforming HL7 messages to other formats (will be done this year, with HIV).




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South Carolina Department of Health and Environmental ControlConfiguration and Environment• Lyniate Rhapsody.

ELR• Use Rhapsody to get ELRs into the CDC NBS system.

CDC Reporting• Send case notifications to the CDC.

Future• Use Rhapsody to send ELRs from the Lab to Public Health,

and sending results to outside Hospitals etc.• Long term goal to send newborn screening results to hospitals.• Plan on taking electronic orders.

Tennessee Department of HealthConfiguration and Environment• Lyniate Rhapsody.

ELR• Rhapsody used to receive, validate, manipulate and translate, and route HL7 ELR messages

and other electronic lab report files for reportable laboratory observations to respective surveillance systems. Currently working on implementation of error generation and application acknowledgments.

Syndromic Surveillance• Rhapsody used to receive, validate, manipulate and translate, and route syndromic

surveillance messages to related BioSense and the TN instance of ESSENCE. Currently working on implementation of error generation and application acknowledgments.

Electronic Case Reporting• Developing and testing C-CDA routing and validation in Rhapsody. C-CDA will be routed

to the integrated disease surveillance system. Out-bound reporting and communication acknowledgements for in-bound receipt of C-CDA.

State Public Health Laboratory• Rhapsody implemented to support standards based

electronic orders and results, ELR, and other lab- related interfaces.

CDC Reporting• Rhapsody supports case notification message transmission to CDC.




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Virginia Department of HealthConfiguration and Environment• Production environment in approximately 100 routes.• 2 Rhapsody Engines (Test and Prod) running.• Rhapsody is the Central point for all messages coming into Virginia Department of Health

for all validation, translation, formatting and filtering.• Some internal divisions (12-15 program areas) get messages delivered based on message

type (e.g., one division needs reportable diseases, another send or receive Vital records, etc.)• A Message Tracking application was built for users using

some Rhapsody Rest API featuresCustom routing rest api.• Support different transport options to partners like HTTPS. Web services, SFTP and PHINMS.

Syndromic Surveillance• Rhapsody is used for incoming Syndromic messages processing and validation.• Use Mirth for BioSense cloud – this is the only way Mirth is

used and it was in place before Rhapsody was adopted.

MU• Receiving MU2 messages from HIE using web service.

Immunization Registry• Immunization start/stop particular interface remotely USING Rhapsody REST API.

ELR – HL7 2.5.1, 2.3.1 and flat files• Incoming ELR messages are validated and routed based

on the filter criteria defined in database tables.• Translate messages from HL7 format to different

destination system acceptable formats using mappers.

Cancer registry – Hl7 2.5.1 and Legacy file format• Receives incoming messages and after decryption send it to eMarc system folders.

Future Work• Enhance Message Tracking Features to provide more reporting.• Active Passive Clustered environment setup for Rhapsody.




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Vermont Department of HealthConfiguration and Environment• Lyniate Rhapsody.

CDC Reporting• PHIN-MS – indoor/outdoor gate – TCP/IP – dev by CDC – primary users to receive data from DOHs.• Serves two purposes – primary portal out door to CDC + 4-5

different data providers sending data to them.

HIE• Sometimes one message to multiple.• Infant new born and infant hearing -> held at DOH for those divisions.

ELR• HL7 ORU into NEDSS for ELR; various labs statewide and

UVM and gets migrated into NEDSS for surveillance.• Incoming -> NEDSS, gets filtered by epidemiologist -> reports to CDC.• Some from VT Lab and going to FDA.

Immunization Registry• Immunization records from all sorts of data providers -> internal group that

keep those records + birth & death records.




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Washington Department of HealthInformatics Office


ELR• Electronic transmission (hl7) for laboratories to report notifiable conditions to public health.

Syndromic Surveillance• Early event detection and monitoring of the health of a community. Emergency departments

and urgent care data exported from their EHR and reported to public health.

Cancer Registry• Washington Cancer Registry collects data about cancer diagnosis, treatment

and deaths. Cancer case reports are submitted by providers under meaningful use and be processed through Rhapsody.

Lead• WA DOH is receiving blood lead tests. Rhapsody’s engine is reconfiguring

the message to an application readable file close to (hl7).

• Immunization: Rhapsody will be used to import vaccination history from the statewide HIE into our Immunization Information System database. Point to point connections are currently in place.

• Newborn screening: Newborn screening tests babies born in WA for treatable conditions; may be a future option.

• eCR: electronic submission of case reports ( symptom, sign, diagnosis, treatment, follow up of an individual for public health reporting.




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Wisconsin Department of Health ServicesConfiguration and Environment• Lyniate Rhapsody

DHS• Hybrid agency - Separate Medicaid and Public Health

divisions.Just starting - Planning, piloting, and training.• Prefer to maintain transformation and final delivery of data

from external feeds and re-use standard transport mechanisms.• Anticipate production readiness in September 2016.

Cancer Reporting• Pediatric Early Case Capture.

‒ Evaluating DIRECT messaging and SFTP feeds.• Evaluating adding in a layer of abstraction between registries

and PHIN-MS data feeds to insert pre-processing business rules.

Future Work• Adding service layers, automating, and enhancing the security of internal registry flows.• Building capacity for increased Meaningful Use reporting.

Immunization Reporting• Exchange is outsourced to HP (the IIS vendor); not using Rhapsody.

Syndromic Surveillance• Data are sent from hospitals directly to BioSense via ER/EMR system.




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West Virginia Department of Health and Human ResourcesBureau for Public Health / Division of Epidemiologic Informatics & Evaluation


ELR• Message receipt, translation, and routing.

Wyoming Department of HealthPublic Health Division


ELR• Deliver information from the laboratory information system to:

‒ PHLIP (flu)‒ NEDDS (infectious disease epidemiologists)‒ LIMSi (LRN)




Cancer RegistriesA cancer registry collects detailed information about cancer patients and the treatments they receive. These data are used to answer questions about incidence and prevalence of cancer, as well as identify clusters, and populations at risk.

Early Hearing Detection and Intervention (EHDI)Every newborn is screened for hearing loss prior to hospital discharge; these data are sent to public health to identify and follow-up with infants who have abnormal test results.

Electronic Case Reporting (eCR)An emerging standard for clinician to report cases of communicable disease directly from their electronic health record system to public health within stipulated time frames. This process will use HL7’s clinical document architecture (CDA) for public health case reporting and will one day replace the existing paper-based processes.

Electronic Laboratory Reporting (ELR)Timely, complete, and accurate electronic transmission from laboratories to public health of results which identify reportable conditions.

Health Information Exchange (HIE) – the verbThe movement of data from the clinical environment (i.e., hospitals, clinicians, laboratories, and health systems) to the public health authority for surveillance or public health action.

Health Information Exchange (HIE) – the nounA technology resource, often managed apart from the public health entity, responsible for facilitating health information exchange (the verb).

Immunization Registries (a.k.a., Immunization Information Systems, IIS)Contain consolidated immunization data in a centralized information system. Data are sent by clinicians that administer immunizations, and are queried by clinicians prior to the administration of vaccine. Many are housed within jurisdiction specific public health agencies, but efforts are underway to allow cross-border query of systems to improve population health and ensure complete vaccine coverage, particularly for children.

Glossary




Meaningful Use (MU)The Centers for Medicare and Medicaid Services (CMS) specifies the criteria that eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) must meet in order to participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. To receive an EHR incentive payment, providers must demonstrate that they are meaningfully using their EHRs to improve patient care. One of the objectives they must meet is submission of data to Public Health which can be done by sending data to one or more Public Health information systems, including (but not limited to) ELR, syndromic surveillance, immunization registries, cancer registries, etc.

Nationally Notifiable Disease Surveillance System (NNDSS)States that receive funding from CDC are required to report nationally notifiable diseases on a weekly basis to CDC. Sites may use use a combination of NETSS (National Electronic Telecommunication System for Surveillance) ASCII strings, HL7 2.5.1 messages, and miscellaneous stand-alone reporting mechanisms (i.e., Access Databases, Excel Files, etc.) to report data on special studies (e.g., FoodNet, HUS, ABCs).

Prescription Drug Monitoring (PDMP)State-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. They are designed to monitor for suspected abuse or diversion (i.e., channeling drugs into illegal use), and can give a prescriber or pharmacist critical information regarding a patient’s controlled substance prescription history. This information can help prescribers and pharmacists identify patients at high-risk who would benefit from early interventions.

Public Health Information Network Messaging System (PHINMS)CDC-provided software that allows bi-directional and secure messaging and provides encryption and authentication, as well as a standardized addressing and routing content. PHINMS uses Electronic Business using Extensible Markup Language (ebXML) technology, PHIN MS can securely send and receive any message type over the Internet, facilitating interoperability among myriad public health information systems.

Syndromic SurveillanceSyndromic surveillance allows public health agencies, assisted by automated data acquisition and generation of statistical alerts, to monitor disease indicators in real-time or near real-time to detect outbreaks of disease. Syndromic surveillance helps identify illness clusters early, before diagnoses are confirmed and reported to public health agencies, and to mobilize a rapid response, according to the CDC.

Glossary (continued)




Additional ResourcesIn addition to enabling public health data exchange for these and other states, Lyniate solutions are also used to:

• Save staff time by delivering COVID-19 test results to patients. See the case study• Screen essentials workers before returning to work. See the blog post

Curious to see how Lyniate can help your agency share clinical and public health data?

Let’s talk

https://go.lyniate.com/blog/corepoint-solution-supports-faster-delivery-of-covid-19-test-results-to-nova-scotians?utm_source=pdf&utm_medium=referral&utm_campaign=modernizing-public-health-ebook

https://go.lyniate.com/blog/getting-america-back-to-work-how-rhapsody-can-help?utm_source=pdf&utm_medium=referral&utm_campaign=modernizing-public-health-ebook

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