Public Health Case Reporting - CSTE TIG Lab Vocabulary Review May 1 st Week – Bacterial Diseases CRSWg, LMCoP, VMCoP May 6 th, /8/20151

Comments / Discussions General Feedback applicable to all conditions 10/8/20152

Selection of LOINC Lab Tests - XXX or Site/Specimen 10/8/20153 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 10/8/20154

Lab Criteria that involves more than one Lab Test 10/8/20155 * 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 10/8/20156 * 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 10/8/20157 * Two specimens * Two or more Tests * Titer Value * After Onset of Symptoms * Multiple Brucella species

Lab Results 10/8/20158

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. 10/8/20159

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 10/8/201510

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”? 10/8/201511

Lab Result - “Detected”  Use “Detected” instead of “Positive” 10/8/201512

Lab Test Finding Domain of SNOMED -Non-Specific Qualitative Test Results (1)  Findings Value (qualifier value) 10/8/201513

 Results Comments (qualifier value) 10/8/ Lab Test Finding Domain of SNOMED -Non-Specific Qualitative Test Results (2)

Qualitative Lab Test Result – Value Set 10/8/ 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 10/8/201516

LIMSi Feedback (2) 10/8/201517

PHLIP feed back 10/8/201518

Notifiable Condition Criteria related comments 10/8/201519

Notifiable Condition Criteria Code 10/8/ 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. 10/8/201521

“Human Readable” – Detection Algorithm 10/8/ 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 Mottice Utah – Rocky Mountain COE in Public Health Informatics

10/8/201523

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) 10/8/201524

Notifiable Condition Criteria 10/8/201525

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 10/8/201526

Lab Methods or Categories 10/8/ 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.