National Center for Public Health Informatics

1. Reportable Condition Mapping Tables (RCMTs) and “the knowledgebase” CSTE Surveillance Practice and Implementation Subcommittee 4 March 2011 National Center for Public Health Informatics

2. Updated Goal for ELR Taskforce - Standards WG Distribute a set of Reportable Condition Mapping Tables (RCMTs) by June 2011

3. Scope of RCMTs • Universe of reportable conditions comprises every condition that is reportable in any jurisdiction. • Reportable conditions include those that are nationally notifiable, and those that are not nationally notifiable. • The RCMTs include LOINC-to-condition and SNOMED-to-condition mapping tables.

4. Scope of RCMTs • Like their predecessors (Dwyer, NCMT), the RCMTs represent the simplest of assertions: • This LOINC code [lab test] is associated with this condition • This SNOMED code [test result] is associated with this condition • More complex assertions and relationships (e.g., expression of reporting criteria and case classification criteria) will be included in “the knowledgebase”

5. RCs, NNCs, TIGs • Based on the SRCA, there are about 300 reportable conditions (RCs) • CDC NNDSS team analysis of web sites  more • About 200 of the RCs have associated laboratory observations • The 2010 CSTE TIG analysis addressed laboratory observations for 67 NNCs

6. Scope of RCMTs • What’s the universe? How does one obtain a complete and accurate list of reportable conditions? • CSTE SRCA 2010/2011 • Source used for June RCMT deliverables • Jurisdictional rules (definitive source) • NNC list is known

7. Scope of RCMTs • RCMT tables include laboratory LOINC, and SNOMED -- so which conditions get included? • Conditions reportable by laboratories? • Conditions for which lab results are used for case ascertainment/case classification? • Conditions for which lab results are useful in investigation? • e.g., toxicology screens in deaths due to injury • ???

8. Scope of RCMTs • June 2011 deliverables • Start with NNDs • NNDs generally represent conditions that are reportable in jurisdictions that account for at least 50% of the US population • List is known • Can build on CSTE TIG work • If time is available, move on to non-NNC reportable conditions, prioritized in a similar manner

9. Scope of RCMTs • Address in subsequent stages • Conditions for which coordination with other initiatives is required (e.g., cancer, NHSN, syndromic) • Genetic testing beyond core newborn screening tests

10. RCMT work group We need you! • Who? • Examples: lab and epi SMEs, jurisdictional staff with operational responsibility for lab messaging or ELR systems. • Familiar with (or want to dive deeply into) LOINC and SNOMED terminology issues related to reporting • What? • Review RCMT content and delivery mechanisms and provide feedback • When?

11. RCMT Demo Schedule (draft) 10 minutes per condition “Show and Tell” of RCMT and 5 minutes discussion. CDC lab and program SMEs will attend. Files posted in forum like phConnect for offline discussion and feedback RCMT information portal will be updated as content gets developed

12. RCMTs vs. “the knowledgebase” • RCMTs • Associate laboratory tests and results with conditions important to public health • An essential part of a public health knowledgebase, but onlya part • Knowledgebase • Contains much more, even if its scope is constrained to be the information necessary to support reporting (primary reporters to PH) and national notification (states to CDC)

13. Original Scope & Purpose of DwyerNCMT RCMT(author: Jerry Sable, 2004) • Applications – Not application or software. Repositories of facts needed by public health applications for filtering. • Breakable – Dwyer tables have information about all the notifiable condition associated lab tests and results. Users could break this or subset for efficient use (e.g. STD subset of Dwyer Table). • Case definitions – Dwyer tables are not laboratory criteria for diagnosing notifiable conditions and cannot be used to confirm cases. All the tests in the Dwyer table are related to notifiable conditions, but the strength of the relationship varies. (e.g., IgG antibody tests  Past infection). • Decision support – Dwyer tables provide facts but does not contain any rules or criteria for ruling in or ruling out various situations. Dwyer table is not a decision support system but could provide facts for a decision support system • ELR – Used for filtering the lab test results and routing the lab results to various public health programs. Dwyer table was designed primarily for ELR. • Finished – Dwyer tables are not finished or complete. Changes in notifiable conditions list, new lab tests, organism taxonomy updates, medical knowledge updates, Coding system updates (LOINC and SNOMED). So, keeping the Dwyer Table up-to-date is an ongoing project.

14. “The knowledgebase” examples of content elements • Jurisdiction • Entities required to report (e.g. clinicians, facilities, laboratories, veterinarians) • Reporting time frame(e.g., immediate, within 24 hours, monthly) • Effective dates of the reporting requirement (start and end) • Reporting criteria, e.g.: • Patient age and/or gender • Specific signs and symptoms • Test result (e.g., blood lead level above 10 ug/dl) • Occupationally related • Outbreak related • Report content (e.g. patient demographics, exposures and risk factors, treatments) • Consumption of undercooked meat • Tattoo or body piercing • …etc…

15. “The knowledgebase” • Needs a name • Needs a formal project • Governance • Scope and requirements • Timeline • Resources/sustainability • Needs a model “bake-off” • Good news: increasing interest/focus