About ELR

ELR Quick Fact:

In calendar year 2013, 67 % of laboratory reports to public health for notifiable conditions were transmitted electronically.

Contact CDC regarding ELR:


Electronic Laboratory Reporting (ELR) generally refers to the automated messaging of laboratory reports sent using one or more electronic communication protocols. ELR improves the reporting of notifiable conditions pdf icon[PDF – 2 pages]external icon, which in turn benefits public health surveillance and preparedness efforts. ELR is a public health objective for  ELR Meaningful Use Stage 1 and Stage 2.


ELR improves the quality of laboratory report data received by public health.

Data improvements 1 include:

  • Improved timeliness from electronic transmission,
  • Increased accuracy by reduction of manual data entry errors,
  • Reports are more complete, and
  • Reports are more consistent across various data sources

Receiving timely, accurate, complete, and consistent information improves the effectiveness and efficiency of public health responses to outbreaks and cases of notifiable conditions.

In addition to the public health benefits, eligible hospitals that use ELR to fulfill public health requirements for Meaningful Use receive financial incentives if they successfully attest under Stage 1 or Stage 2.

For more information, see Publications.

ELR and Surveillance

Accelerating ELR is one of four major surveillance initiatives at CDC.

Read more about the CDC’s surveillance strategy pdf icon[PDF – 6 pages] and surveillance initiatives at www.cdc.gov/surveillance/.

ELR Formats

“ELR” is a generic term referring to several formats for laboratory reports for reportable conditions transmitted electronically from laboratories to public health departments or between public health departments.

ELR formats include the following:

  • Laboratory reporting via HL7 2.3.1 or 2.5.1 compliant messages.
  • Web-based entry from the laboratory into a public health system. Reports entered manually by public health departments are not considered to be ELR.
  • Proprietary extract/transform/load (ETL) processes that automatically move data from a laboratory system to a public health system.

For more information, see ELR Technical Standards.

ELR and Meaningful Use

When ELR takes place via a compliant HL7 2.5.1 message, it enables eligible hospitals to fulfill the ELR public health menu objective (Stage 1, menu measure 9 pdf icon[PDF – 3 pages]external icon) or core objective (Stage 2, core measure 14 pdf icon[PDF – 3 pages]external icon) towards Meaningful Use. ELR is not the only requirement under Meaningful Use that must be met to receive government financial incentives.

In 2013, 90% of ELR consisted of HL7-compliant messages. Approximately 71% of these messages were 2.3.1 messages, and 29% were 2.5.1 messages suitable for Meaningful Use attestation. At the end of 2014, over 1,800 hospital labs were testing 2.5.1 HL7 messaging capabilities, more than double the previous year.

For more information, see ELR Meaningful Use.

ELR and Preparedness and Outbreaks

ELR provides an essential tool in the response to outbreaks. Outbreaks can be identified more quickly and managed more effectively with ELR, allowing limited human resources to leverage their information systems as needed to respond effectively.

As an example, in Iowa ELR implementation has streamlined surveillance for reportable diseases at the Iowa Department of Public Health (IDPH)external icon. With ELR in place, IDPH handled a large 2012 Pertussis outbreakexternal icon (1,736 Iowa cases) and two concurrent 2013 outbreaks of Cryptosporidiosis (1,486 Iowa cases) and cyclosporiasis (148 Iowa cases) without the need to divert additional staff or resources from other public health activities. In contrast, during a 2006 national Mumps outbreak (1,965 Iowa cases) – before ELR in Iowa – the disease monitoring team required significant temporary reassignment of staff and acquisition of temporary help for data entry.


ELR implementations by state, territorial, and large city and county jurisdictions are funded by CDC’s Epidemiology and Laboratory Capacity (ELC) cooperative agreement.

In 2013 and 2014, approximately $13 million in annual funding was awarded to all 50 U.S. states, 6 large local health departments (Los Angeles County, Philadelphia, New York City, Chicago, Houston, and the District of Columbia), U.S. territories (Puerto Rico, Guam, U.S. Virgin Islands) and other U.S. affiliates in the Pacific (the Republic of Palau, Federated States of Micronesia, the Republic of the Marshall Islands, the Commonwealth of Northern Mariana Islands).

ELR Task Force

The CSTE-APHL-CDC Joint ELR Taskforceexternal icon was formed in 2009 and concluded work in 2012. Its goal was to further ELR implementation in the U.S. The ELR Taskforce developed white papers, training materials, tools, and informative documents. These resources are available on the CSTE ELDR pageexternal icon. Overview pdf icon[PDF – 12 pages]external icon and workgroup pdf icon[PDF – 43 pages]external icon presentations are available on the Association of Public Health Laboratories’ (APHL) website.

More Information

For more information about ELR, read about progress, partners, meaningful use, technical assistance, technical standards, or publications. Or view website and email contacts by jurisdiction.

To request an addition or change to this page, contact elr@cdc.gov.

1 Articles linked on the ELR publications page address the timeliness, accuracy, completeness, and consistency of ELR data. Two representative publications are Statewide System of Electronic Notifiable Disease Reporting From Clinical Laboratories: Comparing Automated Reporting With Conventional Methodsexternal icon and Improvements in Timeliness Resulting from Implementation of Electronic Laboratory Reporting and an Electronic Disease Surveillance Systemexternal icon.