Public Health Case Reporting - CSTE TIG Lab Vocabulary Review May 2nd Week – Bacterial Diseases CRSWg, LMCoP, VMCoP May 13 th, /11/20161

Archive of May 6 th, st Meeting Lab Vocabulary Review Materials 3/11/20162 Hyperlink:

Scope for 2 nd Week of CSTE TIG - Lab Vocabulary Review 3/11/20163

Spreadsheet Overview 3/11/20164 Note: Includes only the 2 nd Week Bacterial Diseases Lab Vocabulary

CSTE Position Statement  CSTE Position Statement not published in the CSTE website for the following conditions: –Hansen’s Disease –Streptococcal toxic-shock syndrome –Streptococcus pneumoniae, invasive disease (IPD) (all ages)  Post the above mentioned CSTE position statements in  Need to find about the status of the above mentioned position statements (Did not review last year, Planning to review this year, etc..)  CSTE TIG is available for “Toxic Shock Syndrome Non Strep” but there is no CSTE Position Statement (Follow-up with CSTE). 3/11/20165

CSTE position Statement - Listing of Agents (Microorganism)  Request CSTE to explicitly have a section for “Agents / Microorganism”. –Could be in the first page “problem statement” and “background”. –This will provide the scope clearly for the position statement. –If there are any exclusions such as agents primarily related to non- humans (animals), could also be specified in this section. –Since lab tests identify agents, not diseases; it would be very helpful for CSTE to list the causative agent(s) in the position statements. Example / Issue with current CSTE Position Statements “Salmonellosis” and “Salmonella typhi”SalmonellosisSalmonella typhi * When a case of Salmonella typhi is confirmed, should the providers report “Salmonellosis” and/or “Salmonella typhi”. * CSTE position statement does not provide any clear guidance regarding the reporting. 3/11/20166

Diphtheria - SNOMED Results  SNOMED Results can include children of Cornyebacterium diphtheriae (organism) 3/11/20167

Haemophilus Influenzae Type b 3/11/20168 CSTE Criteria can be more specific to H.Influenzae Type b instead of being generic. “Isolation of H. influenzae from a normally sterile body site “ CSTE TIG included the following criteria which are missing from CSTE position statement (Reconcile the criteria)

Q Fever  CSTE Lab Criteria has very specific methods (ELISA and dot-ELISA).  CSTE TIG repeated the same LOINC tests associated with these criteria.  Is LOINC going to specify the “dot-ELISA” lab method? 3/11/20169

Q Fever  Requires decision support especially to analyze the quantitative values.  Is there a need to have the SNOMED Lab Test Finding qualitative concept? 3/11/201610

Q-Fever  “elevated liver enzyme levels” lab criteria was not found in CSTE position statement (Reconcile the CSTE TIG and position statement). 3/11/201611

Streptococcal toxic-shock syndrome  Reconcile the following lab criteria that are present in CSTE TIG with the CSTE position statement. –Elevated serum creatinine –Thrombocytopenia –Elevated serum AST –Elevated serum bilirubin 3/11/201612

Streptococcal toxic-shock syndrome  Typo in the SNOMED result 3/11/201613

Streptococcal toxic-shock syndrome  SNOMED organism hierarchy provides a big list of specific Streptococcus Pyogenes which could be included in the results, if available. 3/11/201614

Tetanus  Tetanus CSTE position statement did not have any lab criteria.  Tetanus CSTE Position Statement link /11/201615

Tuberculosis  New Code Request to LOINC will be submitted to Regenstrief later (June 2010). 3/11/201616

Tuberculosis  SNOMED Concept from “Disorder” domain in CSTE TIG. – Mycobacterium tuberculosis (organism)  Should the providers / lab report “Disease” or “Agent / microorganism”? –Lab result  Organism (Agents) –OBX-3 for conveying “Diagnosis”  Disorder / Disease concepts. 3/11/201617

Cholera  Lab Criteria: –“Positive serology test for V. cholerae O1 or V. cholerae O139 ” 3/11/201618

Hansen’s Disease 3/11/ * Acid Fast bacilli is not specific * Results could include more specific SNOMED Code

Typhoid  RELMA includes more specific Salmonella typhi tests. –Should this be included?  Should we request any specific Salmonella typhi result codes other than Salmonella typhi?. (review the descriptions / synonyms in SNOMED) Salmonella typhi 3/11/201620

Hemolytic Uremic Syndrome  Need for a good Lab Test Finding value set with a list of concepts that are commonly used in public health lab reporting of microbiology lab test results.  Should we encourage using the SNOMED Codes for “+”, “+++”, “++” ? 3/11/ SNOMED

Streptococcus Pneumoniae (IPD)  Include serotype / serogroup, if available from SNOMED Hierarchy for Streptococcus pneumoniae  Is SNOMED planning to create the pre-coordinated concepts for serotypes and serogroups? 3/11/201622

Notifiable Condition Criteria related comments 3/11/201623

Notifiable Condition Criteria Code 3/11/ 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.

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) 3/11/201625

Notifiable Condition Criteria 3/11/201626

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 3/11/201627

Lab Methods or Categories 3/11/ 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. Toxins (Substance) : E.g. Cholera  What would be the category?

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”? 3/11/201629