Public Health Case Reporting - CSTE TIG Lab Vocabulary Review May 1st Week – Bacterial Diseases

CRSWg, LMCoP, VMCoP

May 6th, 2010

04/21/23 1

Comments / Discussions

General Feedback applicable to all conditions

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Selection of LOINC Lab Tests - XXX or Site/Specimen

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Options:• HL7 SPM Segment to convey Specimen Information

• Roll up site or specimen specific LOINC codes in the RELMA hierarchy to XXX.

Selection of LOINC Lab Tests- Combined / Individual

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Lab Criteria that involves more than one Lab Test

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* Clarify with CSTE / Community regarding “And” / “Or” •Implementation Questions – Decision Support• Lab Tests for Anthrax “Spore” That’s not included in CSTE Lab Criteria. Should this be included or ignored?

New LOINC Code Request

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* Few of the lab criteria don’t have LOINC codes. * CDC would submit these requests to Lab LOINC committee

Complex Lab Criteria- Serum Titer – 2 Specimens / Timing

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* Two specimens* Two or more Tests* Titer Value* After Onset of Symptoms* Multiple Brucella species

Lab Results

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SNOMED Lab Results- Microorganism Hierarchy

SNOMED code in TIG is at species level – need to be explicit that all descendents are included and list specific excluded values, where they apply.

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Complex Lab Criteria

Some lab criteria include more criteria beyond test and results in order to be satisfied, so CSTE should consider either:– Pull these criteria out of the lab table and create the interpretative

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Interpretative Test Result- Quantitative Lab Results

Is there a need for qualitative interpretation of lab test result (e.g. Coded comments from “Lab test finding” domain of SNOMED)?

If so, should this be a new lab data element in OBX-3?

Should we use the OBX-8 “Abnormal Flags”?

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Lab Result- “Detected”

Use “Detected” instead of “Positive”

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Lab Test Finding Domain of SNOMED-Non-Specific Qualitative Test Results (1)

Findings Value (qualifier value)

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Results Comments (qualifier value)

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Lab Test Finding Domain of SNOMED-Non-Specific Qualitative Test Results (2)

Qualitative Lab Test Result – Value Set

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PHIN VADS Value Set Link

LIMSi Feedback (1)

Review the comments from spreadsheet provided by LIMSi (Cindy Vinion)

– Complex lab criteria involving multiple lab tests

– Using General “XXX” lab tests

– Lab Test Result – Coded Qualitative Concept (Lab Test Finding)• LRNR059, Evidence of brucellosis at an unknown time • LRNR060, Evidence of chronic brucellosis• LRNR147, Presumptive positive for Y. pestis by DFA from

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LIMSi Feedback (2)

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PHLIP feed back

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Notifiable Condition Criteria related comments

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Notifiable Condition Criteria Code

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Comment about the Notifiable Condition Criteria Code:1. Should this be linked to NND Code that captures the Nationally

Notifiable Condition / Event (i.e. Case Notification)?2. Should we create a separate code system to capture the CSTE Lab

and Clinical Criteria?

Note: Case Notification Criteria on CDC Website are usually based on the CSTE position statement.

Utah Public Health Dept / University of Utah

Provide another layer of presentation to the providers, Lab SME’s and epidemiologist about the CSTE criteria in a structural way “Human Readable – Detection Algorithm”

Catherine Staes / Susan will discuss this topic.

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“Human Readable” – Detection Algorithm

Current mapping tables being reviewed

Position statement Need to define an intermediary step so:• Epidemiologist can be explicit about what they want to receive• Epidemiologist can select the criteria they want to include in their specifications and have the appropriate mapping table rows automatically selected as well.• Lab can understand specifications and apply their own logic as needed.

Catherine Staes and Susan MotticeUtah – Rocky Mountain COE in Public Health Informatics

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Other Metadata that needs to be added to the Notifiable Condition Criteria

NND Code captures the Event based on the criteria provided by CDC Website / CSTE position statement.

– Microorganism Name (e.g. Bacillus Anthracis)• Some NND codes may have relationship with multiple organisms.

– Clinical Disorder Name (e.g. Anthrax – Disorder)• This is a clinical concept or disease name from EMR

Hyperlinks– ?? CDC Case Notification Website

– CSTE Position Statement – 2009 / 2010/ ???

Intent of Table II in CSTE TIG – Discuss with CSTE regarding workflow (see LIMSi issues)

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Notifiable Condition Criteria

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New Latest Lab Tests to be added as CSTE Lab Criteria

Many of the CSTE position statements / Case Notification criteria may have been created few years ago ( 2 to 10 years). During the last few years, there has been several new genetics / PCR lab tests.

Suggest CSTE about adding the new latest lab tests based on genetics, DNA, etc.. as lab criterion.

– Could use RELMA LOINC browser tool to find the new tests

– Could also discuss with the programs / Labs regarding this.

Discuss with Regenstrief / LOINC SDO simultaneously to get these new LOINC codes

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Lab Methods or Categories

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• Currently using the Lab Methods from RELMA to categorize the lab tests present in CSTE TIG.

•This is purely an attribute for categorize the lab tests and also may be used to find any gaps in CSTE lab criteria.

• Lab Criteria may be used in future for the decision support or NCM project.