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RADx® MARS: Hub Data flow

Two hubs are available for reporting over-the-counter (OTC) test results to public health agencies:
    • APHL Informatics Messaging Services (AIMS), supported by an NIBIB contract
    • ReportStream, a free, open-source project created by the CDC

Data Flow

After receiving a test result from a mobile or web application, a RADx MARS compatible hub will route the result to public health agencies.  First, the hub will perform inline validation of the message to confirm that it contains no Errors.  If any Errors found, the message will not be transmitted downstream until the Errors are fixed by the reporting entity.  If there are no Errors:

  • The hub will de-identify the message and send it directly to the federal health system, HHS Protect.
  • The hub will determine if OTC test results are accepted by the state or local jurisdiction where the test taker resides; if so, the identified message will be sent do that state or local jurisdiction.

Multiplex Message Handling

Multiplex tests provide the ability to test for two pathogens at the same time.  Several multiplex OTC tests have been authorized by FDA for simultaneous detection of SARS-CoV-2 and influenza.  Some state or local jurisdictions are willing to accept test results for one condition but not the other; for example, a jurisdiction may opt to receive OTC SARS-CoV-2 test results but not OTC influenza test results.  In such cases, the hub will remove the OBX segments for the unwanted condition (SARS-CoV-2 or influenza) but will add a comment to the NTE segment, per the examples below.  Since NTE segments are not ingested by state or local public health systems, the test results of the unwanted condition will not reach the jurisdiction.

Example NTE segments for multiplex test results for which the influenza results were removed:

  • NTE|1|O|OBX filtered for identifier = 92142-9 - Influenza virus A RNA [Presence] in Respiratory specimen by NAA with probe detection; value = 260385009 - Negative. OBX was removed due to your jurisdictional reporting rules indicating this result is not reportable.
  • NTE|2|O|OBX filtered for identifier = 92141-1 - Influenza virus B RNA [Presence] in Respiratory specimen by NAA with probe detection; value = 260385009 - Negative. OBX was removed due to your jurisdictional reporting rules indicating this result is not reportable.


APHL Informatics Messaging Services (AIMS)

Overview

The AIMS platform was developed by the Association of Public Health Laboratories (APHL) with the support of the Centers for Disease Control and Prevention (CDC) and has long been used to route laboratory test results to government health systems. The AIMS electronic laboratory reporting (ELR) service enables the secure transport of laboratory test results from laboratories, pharmacies, and health care facilities to public health agencies at the federal, state, territorial and local levels.  For the COVID-19 ELR use case, it is currently transmitting the data of over 50 organizations, including laboratory-data-producing federal agencies, with thousands of associated sub-sender facilities. More recently, AIMS added support for COVID-19 self-administered test reporting, including the MARS HL7v2 specification.

The AIMS platform has established connections today to every state and territorial public health agency in the nation and a number of larger local health departments.

How AIMS Works

AIMS is a secure, cloud-based platform that accelerates the implementation of health messaging by providing shared services to aid in the visualization, interoperability, security and hosting of electronic laboratory data and applications.  

Through a single SFTP or AWS S3 connection to the platform, HL7 2.5.1 ELR R1 laboratory data messages are validated, end-to-end tested, then sent out nationally or to a targeted set of states based on where a data sender is required to report.

Benefits of sending OTC data through AIMS:

  • Datapult, an APHL Company, and the implementor of the AIMS Hub under the NIH contract, has deep understanding and ability to work with federal, state, territorial, and local public health agencies and laboratories.
  • AIMS has effectively served the needs of public health since its development in 2007, and APHL has over 100 years of experience in public health.
  • AIMS has the immediate capability to onboard with all states and territories today through a single connection.
  • AIMS is a HIPAA/FISMA-Moderate/EHNAC certified environment that encrypts protected health data during transport.
  • The AIMS platform provides an end-to-end view of messaging transport and other metrics through accessible data visualization dashboards.
  • Once entities onboard with AIMS, they can add use cases to report data to public health for other COVID-19 test types or other reportable conditions.

Additional benefits to using AIMS include:

  • Centralized processing and message routing
  • Real-time monitoring and audit systems
  • Reduced data translation and transformation complexity
  • Vocabulary and HL7 message support
  • Flexible capacity technical infrastructure
  • Reduced development and support costs


ReportStream

Overview

Created by the CDC, ReportStream is a free, interoperable reporting solution for public health data, including COVID-19, mpox, flu, and RSV as of November 2023. ReportStream securely stores and protects test results and patient data by two-factor authentication, database encryption, and HTTPS. Currently, ReportStream is connected to most federal and state public health agencies, as well as some local public health authorities, and they are continuing to add more connections including support for transmission of test orders. In addition to handling reporting for laboratory and over-the-counter tests, ReportStream has added support for the MARS HL7v2 specification.

Check their site for the most up-to-date information on where they are connected and what conditions they accept.

How ReportStream Works

ReportStream streamlines public health reporting by providing a single connection to multiple jurisdictions. ReportStream works with organizations, testing facilities, data aggregators, and manufacturers to make sure they meet reporting requirements without spending unnecessary time or money onboarding to each jurisdiction.

ReportStream also partners with public health departments that need to receive data from health care organizations to make sure that the data sent to them is in the format they require.

Benefits of sending OTC data through ReportStream:

  • Lower costs: All of ReportStream’s capabilities are available for free as a service provided by the CDC.
  • Simple, secure reporting: Use a single connection to share data with public health departments nationwide.
  • Secure, streamlined data routing: Through their secure, cloud-based platform, data is validated and routed to the correct jurisdictions.
  • Expert support and monitoring: ReportStream’s responsive team members are on call and ready to solve any problems that arise.