Florida

All blood lead level (BLL) results are reportable in Florida; however, only results associated with lead poisoning levels meeting the state case definition (BLL ≥10 μg/dL) have been historically stored and managed within the state’s reportable disease surveillance application, called Merlin. Non-identifiable screening results that do not meet the surveillance case definition have been housed in a separate electronic laboratory reporting (ELR) database that few people are able to access. Analyzing and characterizing lead screening data has been extremely difficult due to the structure of the databases, the need to combine data from multiple databases (Merlin and ELR), and the inherent difficulties with de-duplicating records. This approach has made it challenging to access data at the county level to identify gaps in screening.

In 2017, Florida implemented system enhancements in Merlin to automate processing and create records of all BLL results. All laboratory results received either create an identifiable record within Merlin or are associated with an existing person-centric record without user intervention. Sophisticated matching algorithms within Merlin that were developed and fine-tuned over years can now be used for person matching of all BLL results. When a person-centric record is created, the system assigns a case classification of “confirmed”, “suspect”, or “not a case” based on the laboratory results associated with the record. Any record determined to be “not a case” is automatically closed in the system without any end-user involvement. BLLs between 5 μg/dL and 10 μg/dL can be counted as a confirmed or suspect case, but the system closes the case without requiring end-user involvement. However, end users can access and view these cases if they choose to do additional follow-up.

Improvements to Merlin enable effective tracking of children over time, as well as increase the ability to estimate the number of children screened, rather than just the number of screening tests performed. These system enhancements have allowed for back-loading of previous years’ data and the creation of 723,692 person-centric records with 1,068,564 laboratory results. Staff members are currently working on entering all previous data. Since any Merlin user can now access these records to better assess lead screening practices in their counties, the time to respond to data requests from the public has decreased from days to hours. Florida was able to use these data to characterize screening rates to identify and address gaps.