Because of the importance of laboratory tests in biosurveillance, biosurveillance organizations are attempting to establish connections between LIMSs and their own biosurveillance computers. At present, however, there are significant technical barriers to connecting a LIMS located in a laboratory with a computer located in a biosurveillance organization. The most difficult technical barrier is data incompatibility. Most laboratories do not use standard coding systems to identify the names and results of laboratory tests. Data standards exist, but few laboratories use them. Most laboratories have evolved their own naming or coding systems for the tests that they perform and the results of those tests. They use these proprietary codes (or free text) to identify the laboratory test, specimen type, organism, or other results of a test. As a result, each LIMS-to-biosurveillance-computer interface requires significant effort to understand the data and to create means to translate the data into a standard format so that it can be integrated with data coming from other LIMS. We discuss standard data formats in detail in Chapter 32.
Outbound communication standards, such as HL7, also exist and we discuss them in Chapter 32. Although most LIMS support these standards, the specific implementations vary. Even if both the biosurveillance computer and the LIMS use the HL7 standard, they will not be able to communicate without significant effort to understand the specifics of the messages and to create a means for extracting the data from the messages. Importantly, a new version of HL7 (version 3.0) will solve this problem, but its penetration in the LIMS market is low at present.
Because of the customization required to connect even a single LIMS to a biosurveillance organization, there are only a few regions that have integrated data from most of the LIMSs that serve their region into biosurveillance. Ultimately, these barriers will be addressed by standardization, but as we discuss in Chapter 32, it takes many years to achieve widespread standardization of any component in a biosurveillance system.
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