Michigan

Timely and accurate blood lead test result reporting is vital to ensuring children with higher blood lead levels receive prompt and comprehensive care. Since 2017, the number of facilities that perform LeadCare II¹ testing in healthcare providers’ offices in Michigan has risen significantly to over 300 due to the state’s Childhood Lead Poisoning Prevention Program (CLPPP) efforts to increase blood lead testing of children younger than age 6 years. However, there was not a reliable automated mechanism available to report LeadCare II test results to the CLPPP.

A vast majority of clinics report results through an Excel template that requires clinic staff time to manually enter the data and report it to CLPPP. Results from LeadCare II clinics represent 27% of all test results submitted since CLPPP began to track submission type in September 2020. These files also require 15–20 hours of manual effort by the CLPPP staff to pre-process and clean before entry into the Michigan Childhood Lead Poisoning Surveillance (MICLPS) application, which causes delays in availability of the results to local health departments and other programs within the state who provide services for children younger than age 6 with higher blood lead levels.

As the time and effort required to process LeadCare II files increased, CLPPP expanded the existing partnership with the Altarum Institute (Altarum) to establish an automated reporting mechanism. Altarum is a nonprofit organization that partners with the State of Michigan to provide health information exchange and other data processing services. In 2017, CLPPP created an HL7 reporting route for clinical labs, which sends results through Altarum’s Rhapsody environment and inserts them directly into MICLPS.

CLPPP worked with Altarum in 2021 and 2022 to create a new automated reporting route through Altarum for LeadCare II labs and clinical labs that did not already report through HL7 messaging. This project included the following phases:

• Creation of a new LeadCare II template and electronic medical record extracts
• Creation of a routing structure through Altarum’s secure file transfer and Rhapsody environment to automatically insert results into MICLPS
• Update MICLPS to identify results submitted through the automated route
• Recruit five pilot sites to test the changes and validate the data flow

Labs began to report through the new route in early 2022 and successfully sent messages that were loaded into MICLPS through Altarum.

Since the new reporting mechanism for labs was implemented in April 2021, CLPPP has observed the following as of December 2022.

• 12 new labs reporting (33% increase) through Altarum with 43 additional labs being onboarded
• Manual reporting of LeadCare II results decreased by 4% from 2021 to 2022
• Automated result reporting increased by 3% from 2021 to 2022
• Average days from date received to date reported for all reporting routes decreased by 7.6 days from 15.1 days in 2021 to 7.5 days in 2022
• In 2022, average days from date received to date reported when comparing labs reporting through the legacy LeadCare II route compared to the new automated route
  • Legacy LeadCare II file route: 10 Days
  • New Automated LeadCare II file route: 4.25 days

CLPPP continues to onboard additional labs. CLPPP has taken lessons learned from this project to streamline onboarding and adjust the required data sharing agreements using feedback from the previously onboarded labs with the hope of reducing the time from kick-off to production for new labs. CLPPP also worked with Altarum to develop a quarterly status report on the project to establish metrics for routine reported.

¹ Copyright ©2022 Meridian Bioscience, Inc. Magellan Diagnostics and LeadCare are registered trademarks of Meridian Bioscience, Inc. All rights reserved. Mention of LeadCare is not an endorsement of this product.

Capillary tests are a quick and easy way to test blood lead levels (BLLs) but they can be contaminated and deliver false-positive results. A venous test can confirm whether a child with an elevated capillary test result truly has an elevated BLL. Therefore, a major goal of Michigan’s Childhood Lead Poisoning Prevention Program (CLPPP) is to increase capillary to venous testing rates throughout the state.

Michigan’s Childhood Lead Poisoning Prevention Program (CLPPP) updated reporting requirements for providers and laboratories. Subsequently, the Kent County Health Department successfully increased capillary to venous testing rates by implementing a follow-up protocol for elevated capillary results in 2017. The protocol includes a timeline for regular communication with the family of a child who has an elevated capillary test result to encourage venous testing.

Additionally, CLPPP staff members visited and contacted local providers to raise awareness about testing and reporting in Kent County, thereby assisting the Kent County Health Department in their efforts.

From FY2017 through FY2019, the capillary to venous confirmatory rates in Kent County increased from 35% to 72% in 90 days and from 21% to 56% in 30 days. Other counties throughout Michigan are replicating this protocol to increase capillary to venous testing rates statewide.