Public Health Case Reporting - CSTE TIG Lab Vocabulary Review May 2nd Week – Bacterial Diseases

1. Public Health Case Reporting - CSTE TIG Lab Vocabulary Review May 2nd Week – Bacterial Diseases CRSWg, LMCoP, VMCoP May 13th, 2010

2. Archive of May 6th, 2010 - 1st Meeting Lab Vocabulary Review Materials Hyperlink: http://www.phconnect.org/profiles/blogs/call-for-volunteers-review

3. Scope for 2nd Week of CSTE TIG - Lab Vocabulary Review

4. Spreadsheet Overview Note: Includes only the 2nd Week Bacterial Diseases Lab Vocabulary

5. 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 www.phconnect.org • 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).

6. 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” * 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.

7. Diphtheria- SNOMED Results • SNOMED Results can include children of Cornyebacterium diphtheriae (organism)

8. Haemophilus Influenzae Type b 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)

9. 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?

10. Q Fever • Requires decision support especially to analyze the quantitative values. • Is there a need to have the SNOMED Lab Test Finding qualitative concept?

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

12. 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

13. Streptococcal toxic-shock syndrome • Typo in the SNOMED result

14. Streptococcal toxic-shock syndrome • SNOMED organism hierarchy provides a big list of specific Streptococcus Pyogenes which could be included in the results, if available.

15. Tetanus • Tetanus CSTE position statement did not have any lab criteria. • Tetanus CSTE Position Statement link - http://www.cste.org/ps2009/09-ID-63.pdf

16. Tuberculosis • New Code Request to LOINC will be submitted to Regenstrief later (June 2010).

17. Tuberculosis • SNOMED Concept from “Disorder” domain in CSTE TIG. • 113861009Mycobacterium tuberculosis (organism) • Should the providers / lab report “Disease” or “Agent / microorganism”? • Lab result  Organism (Agents) • OBX-3 for conveying “Diagnosis”  Disorder / Disease concepts.

18. Cholera • Lab Criteria: • “Positive serology test for V. cholerae O1 or V. cholerae O139 ”

19. Hansen’s Disease * Acid Fast bacilli is not specific * Results could include more specific SNOMED Code

20. 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)

21. 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 “+”, “+++”, “++” ? SNOMED

22. 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?

23. Notifiable Condition Criteria related comments

24. Notifiable Condition Criteria Code • Comment about the Notifiable Condition Criteria Code: • Should this be linked to NND Code that captures the Nationally Notifiable Condition / Event (i.e. Case Notification)? • 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.

25. 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)

26. Notifiable Condition Criteria

27. 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

28. Lab Methods or Categories • 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?

29. 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”?