Improving Speed and Accuracy of Childhood Lead Poisoning Surveillance


Lead poisoning, although largely preventable, is highly prevalent. Known to be extremely toxic, especially for young children, exposure to lead can have deleterious effects on a child’s health. It can cause nervous system damage, learning and behavioral problems, delayed growth and development, and hearing and speech issues.

Tracking lead exposure is imperative if public health intervention programs are to be successful. Yet, gathering and aggregating the necessary data in a timely manner can be challenging for the providers and organizations responsible for leading this critical effort.

The Michigan Department of Health and Human Services (MDHHS) decided to take on this challenge with its Childhood Lead Poisoning Prevention Program (CLPPP). The CLPPP’s mission is to prevent childhood lead poisoning across the state through surveillance, outreach, and health services. To realize this vision, MDHHS turned to Altarum. Since 2014, we have provided the technical support necessary to efficiently gather data on lead poisoning and improve its usability.


Working with MDHHS, providers, and electronic health record (EHR) vendors, Altarum leads efforts to improve the efficiency and accuracy of the data that flow into the Michigan Childhood Lead Poisoning Surveillance System. In 2019, we conducted a systemic technical review of this process and the existing surveillance system. The result was a robust set of recommendations designed to streamline the flow of data as well as improve IT tools and processes. The results of our recommendations included:

  • The implementation of two new data reporting routes to streamline the data flow 
  • The improvement of data quality by routing data through the Altarum-designed Data Quality Tool validation process 
  • Technical assistance to sites reporting blood level results, which significantly increased the number of participating sites 


With these improvements, MDHHS has seen increased interest from providers in participating in CLPPP. As of mid-November 2022, 43 sites were onboarded onto the surveillance system, another 49 are in production, and 221 have had a site ID assigned by the State of Michigan — an initial step in testing and reporting lead levels. Prior to Altarum’s involvement in this project, many health care facilities had to manually input blood lead results before submitting them to the state via a fax or an emailed .CSV file. Thanks to our efforts to streamline this process, we have made it easier for facilities to: 

  • Determine the best data submission tools for their situation, reduce manual labor, and use increasingly available HL7 data 
  • Sign legal documentation, such as data transfer agreements (when required) 
  • Build an interface for data submission (if necessary) 
  • Work with their site’s EHR vendor to create an interface to extract data (if necessary) 
  • Perform system testing 
  • Validate the quality of the data being sent through the system 
  • Promote their final system to production with the state’s approval 

Altarum’s work to efficiently track lead poisoning data for the MDHHS has led to an increase in the number and efficiency of participating providers. In the beginning of October 2023, Governor Whitmore signed a Legislation requiring universal lead screening of all minors in Michigan for lead poisoning starting January 1st, 2024. Previously, the requirements were to test minors enrolled in Medicaid only. We are dedicated to supporting MDHHS’s mission of preventing childhood lead poisoning across the state through surveillance, outreach, and health services as lead testing increases and the demand on the system continues to grow.


Marin Goulas
Manager, Senior Business Analyst, Public Health Interoperability and IT Systems