Key points
- Learn how the Centers for Disease Control and Prevention (CDC) helps modernize data system interoperability between state public health laboratories and healthcare organizations using electronic test orders and results (ETOR).
Overview
The Centers for Disease Control and Prevention (CDC) is collaborating with public health laboratories (PHLs), healthcare organizations (HCOs), the Association of Public Health Laboratories (APHL), and other partners to promote interoperability of health information systems. CDC and its collaborators are creating reusable tools and processes to facilitate the exchange of electronic test orders and results (ETOR) between HCOs and PHLs.
ETOR solutions are the technical infrastructure supporting this laboratory data exchange. These solutions can be generally categorized into web portals, indirect system integration, and direct system integration. Each solution has specific workflows, technical capabilities, and implementation approaches. In general, ETOR solutions modernize test ordering and result-delivery processes by replacing manual workflows and outdated technologies with secure, interoperable, standards-based solutions.
Learn more about How ETOR Solutions Work.
Why ETOR Matters
Manual or paper-based test ordering and result-delivery can introduce transcription errors, delay time-sensitive test results, resulting in inefficient workflows. ETOR solutions address these problems by streamlining data exchange and improving interoperability between HCOs and PHLs, leading to:
- Reduced errors and delays in test orders and results
- Faster clinical decision-making
- Greater efficiency for laboratories and providers
- Strengthening of public health surveillance and response
Resource
Healthcare providers: Learn more about how you, your practice, and your patients will benefit from ETOR in this report from CDC's Division of Laboratory Systems, Public Health Electronic Test Orders and Results (ETOR) Initiative.
What CDC is Doing to Advance ETOR
Coordinating, Monitoring, and Advancing ETOR Adoption
- Raising awareness of ETOR through outreach and engagement, including participation in conferences, symposiums, and other forums
- Monitoring the national ETOR landscape, including tracking progress, challenges, and outcomes of jurisdictions
- Collaborating with partners to align them with the CDC’s ETOR strategy:
- Public health laboratories
- Electronic Health Record (EHR) systems vendors
- Laboratory Information Management System (LIMS) vendors
- Standards Developing Organizations (SDOs)
- Other federal agencies
- Promoting the use of web portals and leveraging intermediaries (e.g., Health Information Exchanges, Health Data Utilities, and the APHL Informatics Messaging Service (AIMS)) to exchange data between partners.
Enhancing intermediaries
- Detor is a secure, cloud-based intermediary ETOR solution, funded by CDC, hosted on the AIMS platform.
- CDC and APHL provide PHLs and HCOs with technical assistance and project management support to implement ETOR.
- Numerous jurisdictions are now exchanging testing data electronically using the Detor solution, and several more partners are in the implementation phase.
Impact Across Public Health and Clinical Care
Over the past two years, ETOR has been successfully implemented via Detor through collaborations with PHLs, HCOs, APHL, and technology partners. Initial implementation has focused on priority public health use cases such as newborn screening, and testing for tuberculosis and sexually transmitted infections, with the goal of expanding to any orderable test.
The image below highlights the impacts observed across jurisdictions participating in Newborn Screening ETOR.
Administrative burden refers to manual tasks such as entering test orders and results, validating data, correcting incomplete information, and contacting submitters for missing details.
The following data shows
What These Metrics Mean for Public Health Programs and Patient Care
- Improved data completeness and accuracy
- ETOR nearly eliminates manual data entry, minimizes transcription errors, reduces incomplete information, and decreases the number of missing orders. This results in more complete, reliable, and usable laboratory-related data for clinical care and public health surveillance.
- Increased Laboratory Efficiency and Readiness
- ETOR streamlines laboratory workflows by reducing manual steps and improving specimen submission. This enables laboratories to better anticipate testing needs and allocate resources in advance.
- Using ETOR during periods of increased testing demand, laboratory professionals are less burdened with submitting orders and test result data entry manually, allowing staff to focus on other priority activities. In addition, the use of established ETOR connections supports the rapid implementation of new tests and partners, strengthening readiness during public health emergencies.
- Faster turnaround supports timely treatment
- ETOR enables the timely availability of test results, supporting early diagnosis and medical intervention. This results in improved patient outcomes and enhanced disease surveillance.
Success Stories
Florida
Orlando Health and Florida Department of Health are the first in the nation to use Detor, an ETOR solution funded by the CDC.
"Before Detor, test results were received as a paper document that was challenging to share with all providers involved with an infant's care. This new digital format creates easy accessibility within Orlando Health's electronic records system, which is available throughout the infant's healthcare journey. We are grateful to be the first healthcare system in the U.S. to use this innovative resource that enhances the high-quality care provided to our patients and streamlines the workflow of our clinical team members."
- Senior Director, Orlando Health's Information Technology/Clinical Engineering department
Reference:
Association of Public Health Laboratories partners with Orlando Health, Florida Department of Health to launch system that enables faster test results sharing and enhances patient care. (2026). Retrieved from APHL Web Site
Iowa
Before Fairbanks Memorial Hospital implemented Detor, newborn screening in Alaska relied on manual data entry and mailed paperwork to the Iowa Public Health Laboratory that took on average 12 days to receive test results. By electronically transmitting laboratory information between their EHR and LIMS, Detor reduced turnaround time in half to six days, improving timeliness, reducing administrative burden, and accelerating access to critical laboratory results for newborns and their families.
Reference:
Campisano, D. (2025, September 2). Detor at One Year: From Implementation to Growing Impact. Retrieved from APHL Blog Web Site
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