City of Omaha, Omaha Police Department
In September of 2017, UNMC entered into an agreement with the City of Omaha and the Omaha Police Department to begin expanded services for forensic testing services through the Pathology and Microbiology Department. This agreement allows for faster test results. Our accredited lab will routinely return results within four to five days. Visit Omaha.com for additional details.
Dept of Pathology and Microbiology Informatics Program
The pathology informatics team led by Dr. W.S. (Scott) Campbell began researching enhancements to SNOMED CT content and scope in 2014. The goal was to optimize the process for using SNOMED CT in knowledge capture processes in pathology reporting. In this case, reporting refers to the creation of documents that describe patient specimens and includes the key morphologic findings and final diagnosis using technical terminology, often referred to as the “path report’. In 2015, NIH awarded UNMC investigators funding under the Big Data to Knowledge (BD2K) program which included development of extensions to SNOMED CT terminology for pathology data capture and reuse. [U01HG009455 – Deploying ONC National Standards in Support of Metadata for Big Data Research Warehouse Management of Repurposed Laboratory, pathology and Patient Findings Data from the EHR.] The SNOMED CT content development work begun with that effort has grown into an international project led by Dr. Campbell in collaboration with a large group of experts. Multiple international requests were received to promote this SNOMED CT content into a release of SNOMED CT for broad use worldwide.
The ongoing nature of this work is the development of SNOMED CT content necessary to represent all data elements specified in the College of American Pathologist Cancer Protocols and additional data elements represented by other pathology societies including The Royal Colleges of Pathology (e.g., UK, Canada, Australasia) such that each data element is fully computable and context independent (i.e., fully representative of pathologist original intent). This effort supports pathology data capture as part of the standard pathology case reporting and exposes such data to be reused indefinitely in the EHR, registries and clinical data warehouses. In collaboration with the CAP, these SNOMED CT concepts are to be aligned with the CAP data element identifiers to normalize historic data and current data captured using CAP cancer worksheets for use in research, public health registries and clinical medicine.
NULIRT in Action
After the state public health laboratory (PHL) was relocated to the University of Nebraska Medical Center (UNMC) campus, it was quickly learned that reporting of lab data to federal agencies was not a uniform process. In some situations such as during follow up to the Anthrax attack, it was discovered that the reporting process required hand-entering data into paper forms. Equally important, many federal agencies and national laboratories could not return the reports of their analysis through electronic means and often mailed or faxed the results. This led to a local effort to seamlessly provide for collection of patient or client information from the field or public health event, transportation of the data electronically into the state PHL and following the addition of a test result using English text and appropriate SNOMED or LOINC codes, the entire data package could be sent to the State Health Department Epidemiologist and then the Centers for Disease Control and Prevention (CDC). This effort quickly merged with an effort by the CDC in their development of what became known as the National Electronic Disease Surveillance System (NEDSS).
The first version of the software program to meet the needs of Nebraska was called the Public Health Laboratory Information Project (PHLIP). As more types of data were accommodated and electronic transfer protocols become more sophisticated the program became integrated into efforts lead by the CDC and the Association of Public Health Laboratories to collect laboratory data associated with Influenza virus control programs. A complete rewrite of the program in 2015 resulted in the version now referred to as NULIRT.
The advent and rapid spread of COVID19 in the US exposed public health professionals to unforeseen and immense workloads. In particular, the testing of communities for COVID19 required the mobilization of large quantities of human resources and testing material to multiple geographic areas. Furthermore, computer resources typically available to established clinics and laboratories to facilitate patient test scheduling, test result communication to both patient and public health authorities were not available to support rapidly constructed drive thru testing centers, walk in testing centers, work-place testing and other non-traditional patient/clinic settings. This paucity of computer-based resources forced rapid innovation to adapt existing systems to the current and rapidly changing environments. At the Nebraska Public Health Laboratory (NPHL) and the University of Nebraska Medical Center (UNMC), this scenario drove (and continue to drive) informatics implementation innovation. Beginning with the combination of the NPHL/UNMC electronic lab order/result system (NULIRT) with RedCap, and eventually, fully integrated workflow technologies, the NPHL/UNMC laboratories have addressed the wide array of clinical informatics use cases ranging from drive thru testing centers, scheduled walk-in testing, public health center testing, public school screening, athletic conference screening, screening for civil servants (fire/police), electronic results reporting to State Health organizations, secure email of test results to patients (including full, legal consent signature capture), support of multiple testing platforms (PCR by various specimens, antigen screens and antibody testing). Throughout the COVID pandemic, NULIRT was used in multiple situations and provided unique capabilities beyond what was originally imagined.
Foundation for the Accreditation of Cellular Therapy
The Foundation for the Accreditation of Cellular Therapy (FACT), the premiere international accrediting organization of cellular therapy programs, sets standards for and inspects cell transplant centers to ensure patients around the world receive the best possible care. Emphasizing the critical relationship between laboratory practice and clinical care, FACT supports teamwork between laboratory scientists and clinicians. FACT Standards include cells collected from bone marrow, peripheral blood and cord blood, which are rich in cells that can be used to treat blood cancers and disorders. Cellular therapy is an exploding field, and more diseases and conditions can potentially be treated by these lifesaving sources of cells. By joining scientists and clinicians through FACT accreditation, our department plays a role in advancing the options physicians have to treat their patients. To learn more about FACT, please visit their website.
Nebraska Department of Health and Human Services
UNMC benefits from a long relationship with the Nebraska Department of Health and Human Services (NE-DHHS) that includes activities related to public health, education, preparedness, and response. The Nebraska Biocontainment Facility is a 10 bed high containment medical facility located within Nebraska Medicine. Outstanding programs in public health education occur through a collaboration with NE-DHHS and the College of Public Health at UNMC. The Nebraska Public Health Laboratory (NPHL) is a cooperative partnership between the Department of Pathology and Microbiology at the University of Nebraska Medical Center (UNMC), NE-DHHS, and Nebraska Medicine. This partnership was formed in 1997 when the state legislature and Governor approved transfer of testing of human clinical specimens from Lincoln, NE to UNMC.
The Nebraska Public Health Laboratory (NPHL) is a cooperative partnership among UNMC, the NE-DHHS, and Nebraska Medicine. This partnership was formed in1997 when the state legislature and Governor established the NPHL in Omaha. The original focus of testing was to provide support for state-sponsored prevention programs for the detection of sexually transmitted diseases, enteric diseases such as salmonellosis, and respiratory diseases such as influenza. In 1999, testing at NPHL was expanded to include testing for biothreat agents in environmental samples and the detection of chemical agents in human specimens through grant funding from the Centers for Disease Control and Prevention.
This unique arrangement between UNMC and NE-DHHS has resulted in a saving of millions of tax dollars and has leveraged expertise of existing UNMC personnel and state-of-the-art equipment for the benefit of all Nebraskans. The laboratory facility is located on the eighth floor of the Durham Research Center II tower. The management and operation of the laboratory is overseen by individuals within the Department of Pathology and Microbiology and include Dr. Peter Iwen, Director, and Tony Sambol, Manager. Today, the NPHL performs a variety of routine and specialized testing for the State including blood leads, surveillance for novel influenza viruses and West Nile virus testing in mosquitoes. The NPHL has an extensive outreach and education program throughout the entire state, and helps facilitate the transportation of specimens across the state to the NPHL. Two special projects include the STAT-PACK program that provides for the secure long distance consultation with clinical laboratories, and the FTIR-RAMAN spectroscopy proficiency testing program.
The NPHL played a critical role in providing support to the Nebraska Medicine Biocontainment Unit during the recent treatment of patients with Ebola. The effort took advantage of over 10 years of planning and preparedness efforts for emerging infectious diseases including pandemic influenza, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and antibiotic resistance organisms.
Regional Pathology Services
Regional Pathology Services (RPS) was formed in 1974 to facilitate development and regional access to cutting edge testing technologies at University of Nebraska Medical Center (UNMC) and to provide an avenue for pathology consultation with UNMC pathologists. We have experienced significant growth and change in the last 30 years of operation but remain committed to our initial goals. RPS provides marketing, client services, specimen triaging and billing services for the UNMC Department of Pathology and Microbiology and Nebraska Medicine Clinical Laboratories. To connect directly with RPS, please visit their website.
Nebraska Medicine is the clinical partner for UNMC and affiliated physicians. Other affiliated partners include the Bellevue Medical Center, Grand Island Health Center, Kearney Regional Medical Center and Village Pointe Health Center,