Celebrating 20 Years of the Public Health Laboratory Interoperability Project

This year marks the 20th anniversary of the Public Health Laboratory Interoperability Project (PHLIP). PHLIP launched in 2006 to improve information sharing between public health laboratories and the US Centers for Disease Control and Prevention (CDC). PHLIP’s mission was to establish a mechanism to communicate near real-time, specimen-level public health information utilizing standardized methods that were laboratory information management system (LIMS)-agnostic, ensuring a solution that all public health laboratories could utilize through their existing technology. With laboratory, epidemiology and technology experts working collaboratively to develop and pilot these standards, PHLIP has persisted as a reliable reporting mechanism that continues to evolve in supporting public health.

The Origins of PHLIP

PHLIP was created from the need to modernize how laboratory data flows from public health laboratories to CDC. Most laboratory data was sent by manual, non-standardized reporting methods. APHL, CDC and laboratory and IT subject matter experts from six public health laboratories created PHLIP message and vocabulary standards in an effort to demonstrate interoperability and effective electronic data exchange for public health laboratory surveillance. Using influenza data as its first-use case, two public health laboratories piloted the HL7 message with constrained vocabulary via a route-not-read hub that would later become the APHL Informatics Messaging Services (AIMS) Platform. This hub ensured data could be securely sent in a manner that reduced the technical burden on both sender and recipient.

APHL established two technical assistance (TA) teams in 2010 to help public health laboratories onboard to PHLIP. These teams provided project management, terminology, business analysis and technical architecture support. This ensured technical capability and workforce limitations would not hinder a public health laboratory’s ability to participate in PHLIP. This approach resulted in over 30 public health laboratories successfully sending HL7 data through PHLIP within the first four years of creation. Adoption of the platform resulted in an increase in interoperability for public health laboratories across the country, ensuring CDC received high-quality data through faster methods to help inform national influenza surveillance efforts.

Meeting Current Needs

Since establishing itself as a reliable data sharing method between public health laboratories and CDC, the PHLIP infrastructure has expanded its utility beyond influenza. In the past few years, an increasing number of public health laboratories have worked with APHL TA teams to send data for the National Respiratory and Enteric Virus Surveillance System (NREVSS), which include respiratory syncytial virus and adenovirus, among others. The breadth of the PHLIP message has grown to include specimen information, additional assay results, patient demographics and epidemiological data.

APHL continues to ensure PHLIP keeps pace with changing standards and that laboratory feeds utilize modern HL7 standards. Recent efforts by PHLIP TA have transitioned public health laboratories to HL7 v2.5.1, which can send enterovirus sequencing data—a capability not available with the older HL7 standard. 

Widespread adoption of PHLIP has proven invaluable in implementing a quick response to timely detection of emerging infectious diseases. APHL TA teams were able to onboard 58 public health laboratories to send SARS-CoV-2 data within the first few months of the COVID-19 pandemic. As the 2022 mpox outbreak emerged, APHL worked quickly with public health laboratories to add new capability for PHLIP to support sending mpox laboratory-developed test (LDT) data to CDC. Both efforts utilized the PHLIP feed as a rapid response data sharing method to provide valuable information to CDC.

Approximately 60 state and local public health laboratories are in production to send PHLIP data to CDC. APHL TA teams continue to work with new and existing public health laboratories to expand the type and quality of data sent through PHLIP.

The Future of PHLIP

APHL and CDC continue to support PHLIP to ensure it can meet future public health needs. APHL is enhancing the AIMS Dashboard to support public health laboratories with updating data feeds as new tests are brought online and public health laboratory LIMS undergo upgrades and changes. The dashboard provides an interactive environment for public health laboratories to monitor PHLIP and other data streams to ensure their messages are sent to trading partners.

Upcoming enhancements for PHLIP include enabling the APHL TA team to quickly review messages, and for senders to view validation errors while receiving real-time notifications of message failures. With errors impacting messaging, these enhancements will provide faster opportunities to identify and correct issues.

These improvements will empower both public health laboratories and APHL to take faster action to resolve issues impacting data feeds, while ensuring CDC continues to receive high-quality data. Furthermore, they secure PHLIP’s place as a robust platform capable of meeting future public health data needs.

For more information on PHLIP or the AIMS Dashboard, contact APHL at [email protected].

1. Association of Public Health Laboratories. AIMS Platform. https://aphl.org/focus-areas/informatics/aims-platform/overview
2. Association of Public Health Laboratories. PHLIP (Public Health Laboratory Interoperability Project). https://aphl.org/docs/default-source/technical/info-2020-phlip.pdf?sfvrsn=87fe2e85_1
3. US Centers for Disease Control and Prevention. The National Respiratory and Enteric Virus Surveillance System (NREVSS). https://www.cdc.gov/nrevss/php/dashboard/index.html
4. Lazo R, Li W, Meigs M, Abner S, Carroll J, Miller C, Zarcone P, Hinrichs S, Nordenberg D. The APHL/CDC Public Health Laboratory Interoperability Project Portal: a web-based collaborative tool to establish a national harmonized vocabulary for public health data exchange. AMIA Annu Symp Proc. 2006. https://pmc.ncbi.nlm.nih.gov/articles/PMC1839609/