Public health laboratory
A public health laboratory is a laboratory that serves regional, national, or in some cases global communities by providing clinical diagnostic testing, environmental testing, disease diagnosis and evaluation, emergency response support, applied research, regulation and standards recommendations, laboratory training, and other essential services to the communities they serve.
A public health laboratory is unlike the average commercial laboratory because it is "integrated into the broader public health system." The public health laboratory must typically meet more stringent requirements, including adhering to the Clinical Laboratory Improvement Amendments (CLIA) (for labs in the United States) as well as regulations laid out by the departments, agencies, and other regulatory bodies of local, state, and/or national governments. Finally, the private medical laboratory focuses on tests that diagnose the diseases of individuals, while the functions of the public health laboratory serve entire populations.
Activities of a public health laboratory
A 2002 Association of Public Health Laboratories (APHL) report helped identify 11 core functions state public health laboratories in the United States should accomplish, giving clearer insight into how the average public health laboratory in most parts of the world should operate. Note that this is not a guarantee every lab will perform these tasks, but its a standard of what the lab should be responsible for doing. Those suggested 11 core functions are:
- disease prevention, control, and surveillance: provide timely and accurate analytical results for the assessment and surveillance of exposures; rapidly recognize and prevent the spread of communicable diseases; detect and identify biologic agents of significance in human disease; provide specialized tests for low-incidence, high-risk diseases;
- integrated data management: accumulate, blend, and disseminate scientific information in support of public health programs; collect, monitor, and analyze laboratory data using national database systems; assist state epidemiologists, other laboratories, and practitioners with data needs
- reference and specialized testing: serve as a primary reference microbiology laboratory for a wide variety of needs
- environmental health and protection: conduct scientific analyses of potentially threatening environmental samples; detect, identify, and quantify toxic contaminants in environmental and biological specimens; provide air, water, soil, and other environmental laboratory testing services; provide environmental chemistry testing; determine the relationship between environmental hazards and human health; determine extent of a community's exposure to environmental hazards; rovide industrial hygiene/occupational health testing
- food safety: test specimens implicated in foodborne illness outbreaks to identify causes and sources; detect, identify, and quantify toxic contaminants in food specimens; monitor radioactive contamination of water, milk, shellfish, and other foods
- laboratory improvement and regulation: coordinate and promote quality assurance programs in other laboratories; act as a standard and leader for other laboratories; develop and oversee quality assurance and laboratory improvement programs; oversee the licensure, certification, and accreditation of other laboratories
- policy development: assist the development of state and federal public health policy; assist in the development of standards for all health-related laboratories
- emergency response: provide laboratory support to state and national disaster preparedness plans and environmental or health emergencies
- public health-related research: evaluate and implement new technologies and analytical methodologies in support of public health and healthcare communities; adapt emerging technologies to public health laboratories; conduct applied studies into new and improved analytical methods and services; assist the private sector with newly marketed tests
- training and education: sponsor training opportunities for public health laboratory staff; provide or facilitate training and workshops for laboratory staff in private and public sectors; provide training opportunities for careers in public health laboratory practice; provide continuing eduction opportunities to staff
- partnerships and communication: develop and strengthen partnerships among state, county, and city entities public and private; emphasize the role and value of the public health laboratory to state public health programs; participate in strategic policy planning and development processes; build and strengthen diverse communication networks
Organization, support, and regulation
In the United States
At the national level, public health laboratories are often embedded in federal agencies like the Centers for Disease Control and Prevention (CDC), Environmental Protection Agency (EPA), Food and Drug Administration (FDA), and the U.S. Department of Agriculture (USDA). These labs often assist state and local labs with outbreaks, special testing, training, and guidance.
At the state level, public health laboratories are typically organized in one of three ways: within a state health department, within or affiliated with a university, or as a consolidated laboratory within another state agency. Regardless of organization, the laboratories are part of both a state public health system and a national public health network. Information from the laboratories may trickle down to the local level, move up to the national level, or be shared with other entities at the state level. State labs most often work with national entities like the CDC, while local labs most often coordinate with state labs.
At the local level, public health laboratories are almost always organized within city or county health departments, and they distribute laboratory-based disease reports and related specimens to state counterparts. Local units may appear in large cities and often rival state-level public health labs in size, complexity, and services.
In 2002, unpublished survey data from the Association of Public Health Laboratories (APHL) showed 50 percent of funding of public health laboratories came from states, 33 percent from fee-for-service transactions, and 15 percent from the federal government. Funding at this time trended away from the states and towards fee-for-service transactions, with federal funding remaining study but with evidence to support the idea of increased funding in the future. That expanded federal funding came to pass with an increase of bioterrorism preparedness activities which expanded from the CDC to the state labs, in addition to other homeland security efforts.
World Health Organization
The World Health Organization (WHO) has supported and expanded the needed skills and infrastructure for world governments to better detect, investigate, and report public health threats. Public health laboratories and/or governments around the world have been targeted by WHO with at least three different programs:
- Health Laboratory Strengthening: strengthen national laboratory systems; support quality laboratory system implementations; improve networking between public health labs and surveillance and response systems; increase domestic testing capacity; support laboratory workforce development
- Biosafety and Laboratory Biosecurity: promote the advancement of biorisk management, including biosafety and laboratory biosecurity; provide tools to better protect people in and around laboratory environments; promote a culture towards responsible biorisk management worldwide
- Laboratory Twinning Initiative: "strengthen laboratory capacity through the establishment of twinning projects between resource limited laboratories and specialized institutions"
Association of Public Health Laboratories
Though primarily a U.S.-based association, the Association of Public Health Laboratories (APHL) has a Global Health Program that aids resource-strapped countries with:
- building national laboratory networks
- implementing laboratory training programs
- planning and managing renovation projects
- implementing laboratory information systems
- procuring laboratory equipment and supplies
- providing advanced training to senior laboratory professionals
The APHL and its Global Health Program are also partners in the WHO's Laboratory Twinning Initiative.
Informatics in the public health laboratory
It wasn't until the 1980s that information technology in the laboratory sector truly expanded. Today web-based and database-centric Internet applications of laboratory informatics software have changed the way researchers and technicians interact with data, with web-driven data formatting technologies like Extensible Markup Language (XML) making the laboratory information system (LIS) a much-needed reality.
Yet because 1. the public health laboratory is integrated into the social structure of a city, state, or country, and 2. public health laboratories have a responsibility to disseminate information up and down the stream, reliable information management technology has increasingly become vital. This critical need was recognized by the APHL, the Public Health Informatics Institute, and many private and public labs in October 2002, collaborating "to determine a more efficient and economically viable manner to address information technology needs" after the bioterrorism events in the United States in September 2001. The collaborators succeeded in creating a set of applicable system requirements for laboratory information systems to better serve the needs of public health laboratories. This activity has led to a continual push to upgrade information systems and data transfer methodologies across the world. Groups like the Robert Wood Johnson Foundation (RWJF) have contributed money, information, and time to public health laboratories in the 2000s and beyond with the goal of improving their information systems and their performance. This drive to upgrade systems has expanded beyond the U.S. into other parts of the world, with continents like Africa and countries like Vietnam and Haiti receiving significant investment in public health laboratories and associated information technology.
Public health informatics organizations, associations, and initiatives
There are numerous entities which promote, support, and provide assistance to public health laboratories and their information technology needs:
- American Medical Informatics Association's Public Health Informatics working group: an AMIA working group dedicated to public health informatics
- Center for Public Health Informatics: a University of Washington - Seattle cooperative that "works to enhance the effective application of information systems and technologies for practice, research, and learning" in the public health sector
- Laboratory Response Network: a CDC-run collaborative effort dedicated to "maintaining an integrated network of state and local public health, federal, military, and international laboratories that can respond to bioterrorism, chemical terrorism and other public health emergencies"
- National Association for Public Health Statistics and Information Systems: a U.S. not-for-profit association which aims to "provide a forum for the study, discussion, and solution of problems ... in the respective members' health departments"
- Public Health Data Standards Consortium: a U.S. not-for-profit dedicated to "empower[ing] the healthcare and public health communities with health information technology standards to improve individual and community health"
- Public Health Informatics Institute: a program dedicated to "transforming health practitioners' ability to apply information effectively in order to improve health outcomes worldwide"
- Public Health Information Network: a CDC-run "national initiative to increase the capacity of public health agencies to electronically exchange data and information across organizations and jurisdictions"
- Public health informatics
- Laboratory information system
- Public health software (open source)
- Public health and service LIMS
- Jenkins, Wiley, ed. (2010). Public Health Laboratories: Analysis, Operations, and Management. Jones & Bartlett Learning. pp. 01–14. ISBN 0763771023. http://books.google.com/books?id=6SDqL72zPRUC.
- Institute of Medicine Committee for the Study of the Future of Public Health (1988). "Chapter 3: A History of the Public Health System". The Future of Public Health. National Academy Press. pp. 56–72. ISBN 9780309038300. http://www.nap.edu/openbook.php?record_id=1091&page=56.
- Short, Kim (18 April 2012). "Behind the scenes of public health labs with APHL’s Scott Becker". Public Health Newswire. http://www.publichealthnewswire.org/?p=3191. Retrieved 12 September 2013.
- ↑ 1.0 1.1 1.2 1.3 Becker, Scott; Perlman, Eva J.; Jenkins, Wiley (ed.) (2010). "Chapter 1: An Introduction to Public Health Laboratories". Public Health Laboratories: Analysis, Operations, and Management. Jones & Bartlett Learning. pp. 01–14. ISBN 0763771023. http://books.google.com/books?id=6SDqL72zPRUC.
- ↑ 2.0 2.1 Committee on Assuring the Health of the Public in the 21st Century, Board on Health Promotion and Disease Prevention (2003). "Chapter 3: The Governmental Public Health Structure". The Future of the Public's Health in the 21st Century. National Academies Press. pp. 136–146. ISBN 0309133181. http://books.google.com/books?id=qa8XYZQprt0C.
- ↑ 3.0 3.1 3.2 3.3 "About Public Health Labs". Association of Public Health Laboratories. http://www.aphl.org/AboutAPHL/aboutphls/Pages/default.aspx. Retrieved 11 September 2013.
- ↑ 4.0 4.1 4.2 4.3 4.4 Becker, Scott J.; Blank, Eric C.; Martin, Robert; Skeels, Michael; Novick, Lloyd F. (ed.); Mays, Glen P. (ed.) (2005). "Chapter 27: Public Health Laboratory Administration". Public Health Administration: Principles for Population-based Management. Jones & Bartlett Learning. pp. 623–627. ISBN 0763740780. http://books.google.com/books?id=bFBPMcQe6ogC.
- ↑ Witt-Kushner, Joyce; Astles, J. Rex; Ridderhof, John C.; Martin, Robert A.; Wilcke, Jr., Burton; Downes, Frances P.; Inhorn, Stanley L.; Kelley, H. Peter; Kimsey, Paul B.; Mills, David E.; Salfinger, Max; Shult, Peter A.; Verma, Mahadeo P.; Becker, Scott J.; Drabkowski, Doug J. (20 September 2002). "Core Functions and Capabilities of State Public Health Laboratories". Morbidity and Mortality Weekly Report 51 (RR14): 1–8. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5114a1.htm. Retrieved 11 September 2013.
- ↑ "Health laboratory strengthening". World Health Organization. http://www.who.int/ihr/lyon/hls/en/index.html. Retrieved 11 September 2013.
- ↑ "Biosafety and laboratory biosecurity". World Health Organization. http://www.who.int/ihr/biosafety/en/index.html. Retrieved 11 September 2013.
- ↑ "Laboratory Twinning Initiative". World Health Organization. http://www.who.int/ihr/lyon/twinning/en/index.html. Retrieved 11 September 2013.
- ↑ "Global Health - About Us". Association of Public Health Laboratories. http://www.aphl.org/aphlprograms/global/aboutus/pages/default.aspx. Retrieved 11 September 2013.
- ↑ 10.0 10.1 "APHL's vision statement: A healthier world through quality lab practice". Medical Laboratory Observer. December 2009. http://www.mlo-online.com/articles/200912/aphls-vision-statement-a-healthier-world-through-quality-lab-practice.php. Retrieved 11 September 2013.
- ↑ Sinard, John H. (2006). Practical Pathology Informatics: Demstifying Informatics for the Practicing Anatomic Pathologist. Springer. pp. 393. ISBN 0387280588. http://books.google.com/books?id=WerUyK618fcC.
- ↑ Kumar, Sameer; Aldrich, Krista (December 2010). "Overcoming barriers to electronic medical record (EMR) implementation in the US healthcare system: A comparative study". Health Informatics Journal 16 (4). doi:10.1177/1460458210380523. http://jhi.sagepub.com/content/16/4/306.abstract. Retrieved 03 June 2013.
- ↑ "Requirements for Public Health Laboratory Information Management Systems: A Collaboration of State Public Health Laboratories, the Association of Public Health Laboratories and the Public Health Informatics Institute" (PDF). Association of Public Health Laboratories. September 2003. http://www.aphl.org/aphlprograms/informatics/Documents/INF_2003Sept_Reqs-for-PHL-IMS.pdf. Retrieved 12 September 2013.
- ↑ "Common Ground: Transforming Public Health Information Systems" (PDF). Robert Wood Johnson Foundation. 30 October 2012. http://www.rwjf.org/content/dam/farm/reports/program_results_reports/2012/rwjf402400. Retrieved 12 September 2013.
- ↑ "East Africa Public Health Laboratory Networking Project". The World Bank Group. http://www.worldbank.org/projects/P111556/east-africa-public-health-laboratory-networking-project?lang=en&tab=overview. Retrieved 12 September 2013.
- ↑ "LIMSfinder Search: APHLGlobalHealth". Laboratory Informatics Institute. http://limsfinder.com/listpage.aspx?showlist=1&author=2128&searchtype=Advanced. Retrieved 12 September 2013.
- ↑ Jones, Jay (2008). "OpenELIS: How a small lab community created a world-wide database" (PDF). PHINews (Centers for Disease Control and Prevention) 2 (4): 6–9. http://www.cdc.gov/phin/library/documents/pdf/PHINews%20Volume%202%20Issue%204.pdf.
- ↑ Short, Kim (18 April 2012). "Behind the scenes of public health labs with APHL’s Scott Becker". Public Health Newswire. http://www.publichealthnewswire.org/?p=3191. Retrieved 12 September 2013.