Reporting Nationally Notifiable Conditions (NNC): Vocabulary Aspects

1. Reporting Nationally Notifiable Conditions (NNC): Vocabulary Aspects Sundak Ganesan1, MD; Nikolay Lipskiy2, MD, DrPH, MBA; Ulrike Merrick3, MPH; Cynthia Vinion1, MEA 1Northrop Grumman Consultant to CDC; 2Office of Surveillance, Epidemiology and Laboratory Science (OSELS), Centers for Disease Control and Prevention (CDC); and 3iConnect Consulting Office of Surveillance, Epidemiology, and Laboratory Services Division of Informatics Solutions and Operations • ABSTRACT • Electronic Laboratory Reporting (ELR) plays a key role in Public Health Case Reporting and Case Notification. This paper will discuss the current status, problems and future direction of the laboratory vocabulary associated with Nationally Notifiable Conditions (NNC). • BACKGROUND • Applying standards to NNC vocabulary facilitates the routing and filtering of laboratory data to various public health programs (Figure 1). Implementation of these vocabulary standards requires subject matter experts with a good knowledge of laboratory domain and vocabulary standards. • METHODS • In May 2010, the Subject Matter Experts Panel (SMEP) was formed with members from CSTE, CDC programs such as National Program of Cancer Registry (NPCR), SDO, Association for Public Health Laboratories (APHL) and Communities for practice such as Case Reporting Workgroup (CRSWg), Lab Messaging (LMCoP) and Vocabulary Messaging Communities of Practice (VMCoP). SMEP compared the laboratory criteria in the current CSTE position statements to the laboratory tests and results in the TIGs and a list of general microbiology laboratory methods (i.e., microscopy, antigen detection, antibody detection, DNA methods etc.). This was done to identify if there were any gaps in CSTE position statements lab criteria (Figure3). • Laboratory test (LOINC) codes present in CSTE TIG were compared against the LOINC codes associated with the microorganism in LOINC browser and mapping tool (RELMA). • Laboratory result (SNOMED) codes present in TIG were compared against the SNOMED codes present in SNOMED microorganism hierarchy using CDC vocabulary server (PHIN Vocabulary Access and Distribution System) and National Library of Medicine (Unified Medical Language System) tree browser. • Both LOINCs and SNOMED codes were compared to existing laboratory vocabulary implementations such as Public Health Lab Interoperability Project (PHLIP), Laboratory Information Management Systems integration (LIMSi), CDC National Healthcare Safety Network (NHSN) and North American Association of Central Cancer Registries (NAACCR) (Figure 4). • The CSTE TIGs were grouped into bacterial, viral, parasitic and miscellaneous to better facilitate expert review. • Vocabulary specialists facilitated review of these CSTE TIGs in detail with the SMEP on several conference calls. • All the CSTE TIGs and the issues associated with them including the final recommendations to CSTE were posted in the CRSWg Public Health Connect forum*. • RESULTS • The SMEP concluded that the laboratory vocabulary present in CSTE TIG can be implemented after minor updates including the addition of some new LOINC and SNOMED codes associated with the new lab tests and results. • The SMEP also suggested the following: • Add a Microorganisms/Agents section to CSTE position statements. • Define the process for developing and maintaining CSTE TIGs. • Clarify the use of paired serology tests. • Add qualitative results to reports and develop the needed vocabulary. • Develop applicable specimen related vocabulary. • NEXT STEPS • Incorporate the CSTE TIG content into the future NCMT based on CSTE position statement and SDO vocabulary updates. • Encourage state-specific extensions to the NCMT and sharing of state NCMT mappings using CRSWg (PH Connect) forum which also improves the quality of lab vocabulary mapping. • Follow-up with SDOs to discuss the possibility of adding new standard codes in a timely manner as well as the use of temporary codes and SDO extensions. Figure 3. Subject Matter Experts Panel (SMEP) Case Reporting Standardization Workgroup (CRSWg) facilitated the CSTE TIGs review and provided feedback back to CSTE • SMEP • CSTE Figure 1. Role of standards in NNC vocabulary for filtering and routing ELR data • CDC • APHL • CoPs • SDOs Public Health Filter • Laboratory • LIMSi • PHLIP • CRSWg • SNOMED Results Program Areas • NHSN • LMCoP • LOINC • TB Results that are of interest to public health agencies • STD • NPCR • VMCoP • Flu Notifiable Condition Mapping Table (NCMT) • Malaria Figure 4. SMEP NNC Vocabulary Review Process Figure 5. Content source for an updated NCMT • Whitehouse E-Gov Consolidated Health Informatics (CHI) initiative recommends using the following Standard Development Organization (SDO) standards : (a) Logical Observation Identifiers Names and Codes (LOINC) for lab tests (b) Systematized Nomenclature for Medicine (SNOMED) for lab results, specimen and body sites and (c) Health Level 7 (HL7) version 2.x standard for messaging. • In 2008, Council of State and Territorial Epidemiologists (CSTE) developed 67 Technical Implementation Guides (TIGs) that are associated with notifiable condition CSTE position statements. In 2009, a few TIGs were added and updated to reflect CSTE 2009 updates. • Notifiable Condition Mapping Table (NCMT) maps Nationally Notifiable Conditions to their associated lab tests and results (Figure 2). Extending with State Notifiable Conditions and its associated lab test/result. • CSTE Position Statement Extending with SDO input Extending TIG with feedback from CRSWg, CoPs (lab, Vocab) CSTE Technical Implementation Guide (TIG) CSTE Position Statement • Lab Result Codes (SNOMED) • CSTE Technical Guide • (TIG) • Nationally Notifiable Condition Vocabulary NCMT State Specific Implementation Figure 2. Notifiable Condition Mapping Table (NCMT) • CONCLUSIONS • There is notable progression in the standardization of vocabulary for NNC reporting. The SMEP found existing problems (development of TIGs, vocabulary gaps, evaluation of laboratory results, etc.) that may be eliminated by having a good collaboration between CSTE, public health departments, laboratories, lab system vendors and standard development organizations. Notifiable Conditions (National/State) Influenza • General Lab Methods • Lab Test Codes (LOINC) Lab Test (LOINC) • Influenza A, B,C – Ag, Ab Lab Results – Organism (SNOMED) Influenza Virus - A, B,C, Subtypes • Acknowledgement: The authors would like to acknowledge the excellent participation of CSTE, SDO and members of CRSWg, Vocabulary and Lab Messaging Community of Practice. *CRSWgPHConnect forum: http://www.phconnect.org/profiles/blogs/call-for-volunteers-review Lab Test List Organism List