Reportable Conditions Knowledge Management System

1
Reportable Conditions Knowledge Management
System (RCKMS)
VMCOP Workgroup Sep 17, 2013
2
RCKMS Meeting Agenda

• Overview
• Architecture
• Pilot CDC RD Lab
• Information Requirements
• Production implementation
• Questions

3

• Overview

4
History

• PHSkb A knowledgebase to support notifiable
  disease surveillance Timothy J Doyle, Haobo Ma,
  Samuel L Groseclose and Richard S Hopkins, 2005
• Many other attempts to promote a knowledgebase
• ELR Task Force Priority Recommendation - Advance
  Reportable Conditions Knowledgebase (RCKB)
  (collection of resources that contain what our
  partners need to electronically know what to
  report and when and how to report it)

5
Policy Driver for RCKMS Stage 3 Draft
recommendations -- Improve Population and Public
Health
ID Stage 1 Final Rule Stage 2 Final Rule Stage 3 Recommendations Undetermined
SGRP402B More information from RFC - New More information from RFC - New More information from RFC - New RFC ONLY (Stage undetermined) EP Objective (new) Capability to use externally accessed or received knowledge (e.g. reporting criteria) to determine when a case report should be reported and then submit the initial report to a public health agency, except where prohibited, and in accordance with applicable law and practice. Measure Attestation of submission of standardized initial case reports to public health agencies on 10 of all reportable disease or conditions during the entire EHR reporting period as authorized, and in accordance with applicable state/local law and practice. Certification criteria The EHR uses external data to prompt the end-user when criteria are met for case reporting. The date and time of prompt is available for audit. Standardized (e.g., consolidated CDA) case reports are submitted to the state/local jurisdiction and the data/time of submission is available for audit
RFC ONLY
Changed threshold to 10 from 20 for consistency
6
Public Health Need

• Reporting of conditions is confusing, disjointed,
  labor-intensive and largely manual
• Each jurisdiction creates its own rules for
  reporting at different levels of specificity and
  are typically available in human-readable format
  only
• Reporters have great difficulty finding,
  interpreting and implementing the correct rules.
• Rules changes are not communicated timely or
  effectively to reporters
• Automated detection and electronic reporting is
  very difficult to implement and maintain under
  current methods

6
7
RCKMS Scope

• Include information about the who, what, when,
  where, and how of reportable condition reporting.
  
• For the purposes of this project, reportable
  conditions are those for which reports
• Are based on individual cases or individual
  laboratory tests/results
• Are about human subjects (not animals, drugs or
  devices)
• Contain personally identifiable information,
  including person names
• Are governed by jurisdictional law (statute or
  rule/regulation)
• Provide machine readable rules to allow
  systematic detection and reporting via ELR
• Communicate rules changes to reporters as they
  occur

7
8
Reporting Specifications

• Who, What, When, Where and How of Reporting
• Who is required to report (e.g., Hospital,
  Healthcare Provider, Lab)
• What- information should be used to decide if a
  report needs to be made
• When should the report be sent (e.g., 2 hr, 24
  hr, 10 days)
• Where should the report be sent (e.g., local
  HD, state HD, and where within the HD)
• How should the report be sent (e.g., ELR,
  phone, fax, mail)
• What link to specification for information that
  should be included in the report

8
9
Key Components of RCKMS

• In authoring framework
• Reporting Actions, Reporting Criteria and Links
• Collaborative development environment with
  lifecycle management
• Unambiguous representation of attribution and
  ownership
• Out information access methods
• View and query interface
• Human-readable and machine-processable output
  files
• Flexible
• e.g., single or multiple jurisdictions,
  conditions, reporters
• Push and pull modes
• Middle knowledge representation

10
StakeholdersCurrent List

• Content Viewer
• Governance / Policy
• Jurisdictional
• Public
• System Users
• Knowledge Curators
• Jurisdictional Administrators
• Vocabularists
• Public Health Reporters

This list will be evolving. Any adjustments
should be made within the Requirements Subgroup
11

• Architecture

12
RCKMS Long term Scope
Public Health State, Local, Territorial Agencies
PH Reports
RCKMS
Authoring Framework
Query/View
Database Who, What, When, Where, How
Subscription Management Including Notifications
Other Web Services
Structured Output Generator
DSS Web Service
(2) Open CDS
HeD
HeD Compliant format - Triggering Criteria -
Reporting Actions - Links
(1) HeD

• Output file Options
• HeD file download
• OpenCDS in Cloud
• OpenCDS Locally Deployed

13
Context Use Case - Release 1
14
RCKMS Component View
RCKMS Public Portal

• Portal
• Views / Query
• Export (HR / MC)
• Subscription/Notif
• Profiile Mgmt

• RCKMS Services
• Store Access

HTML
SQL / XML

• Subscriber
• Viewer

• Application ltSQLgt
• Knowledge ltXMLgt

RCKMS Store

• Web Services
• Query
• Export (HR / MC)

WS
Jurisdictional Ontology
Condition- Reportable Event Ontology

• Public Health Dept.
• Laboratories
• Hospitals
• HIE

Publish
RCKMS Private Portal - Authoring
Lab/Clinical LOINC Ontology

• Portal
• Authoring
• Views / Query
• Workflow
• Administration

• Application ltSQLgt
• Knowledge ltXMLgt
• Reference ltOntologygt

RCKMS Store
HTML
PHIN VADS

• Knowledge Manager
• System Admin
• Jurisdiction Admin.

SQL / XML
SRCA Jurisdictional
Univ. of Utah

• RCKMS Services
• Knowledge Access
• Criteria Validation
• Workflow
• Ontology Mgt.
• Document ETL
• Bulk Load

Integrations
TIGs

• Lab
• Clinical
• Code Maps

Position Statement Criteria Initial Loads
15
(No Transcript)
16

• Pilot
• RCKMS Pilot - Development Environment

17
Information Requirements

• Criteria
• Lab Detection
• Epidemiologic
• Clinical
• Diagnostic
• Signs Symptoms
• Demographic
• Jurisdiction
• Timeframe
• Reporting Actions
• References and Links

18
Example Criteria
  lab Test finding/method Classification   send all results ? If the results matter, what are the result requirements? If the results matter, what are the result requirements? If the results matter, what are the result requirements? If the results matter, what are the result requirements? If the results matter, what are the result requirements?
LAB DETECTION CRITERIA lab Test finding/method Classification   send all results ? interpretationRequirement interpretation value set organismRequirement organismRequirement numericValueRequirement
  lab Test finding/method Classification Test value set send all results ? interpretationRequirement interpretation value set organismRequirement organismRequirement operator
Isolation of Bordetella pertussis from a clinical specimen Culture Tst_BPert_Cult no "positive" Int_pos Bordetella pertussis Rst_BPert_Pos  
Results from any test specific for pertussis Pertussis by any method Tst_BPert yes leave blank        
CLINICAL CRITERIA Data Element Value Set Observation/Qualifier/Finding Finding Value Set operator physical quantity unit of measure Should reporters send suspected cases as well as confirmed cases?
Suspect or confirmed diagnosis of pertussis Diagnosis DX_Pert Status Stat_case       yes
Pertussis as cause of death Cause of death Dth_Pert           no
Pertussis as a significant condition contributing to death Contributing to death Dth_Fact_Pert           no
Preliminary results
18
19
Variation in Reporting Time Frames
Jurisdiction Type of reporting facility Reporting time frames Reporting time frames Reporting time frames Reporting time frames Reporting time frames Reporting time frames
Immediately 24 hours 2 days 3 days 7 days Monthly
Colorado Laboratories Hospitals Providers
Utah Laboratories Hospitals Providers
Washington Laboratories Hospitals Providers
20
Variation in Elevated Blood Lead Level Criteria
Relevant Jurisdiction Blood lead level Patients Age Reporting time-frame
Utah 10mg/dL lt 10mg/dL Any Any 60 days No action not reportable
Colorado 10mg/dL lt 10mg/dL 25mg/dL lt 25mg/dL 18 years 18 years gt 18 years gt 18 years 7 working days 30 days 30 days No action not reportable
Washington 10mg/dL lt 10mg/dL 25mg/dL lt 25mg/dL 15 years 15 years Any gt 15 years 2 working days 1 month 2 working days 1 month
21
Reporting Actions Links

• Reporting Actions
• References and Links

lab reporting clinician reporting -with lab data clinican reporting - no lab data title
no no no Immediate phone call required
      REPORTING ACTION
A A A fax to epi program at SDDHHS
A A A phone to epi program at SDDHHS
A A A mail to epi program at SDDHHS
NA P P manual entry into webform WebCMR
P NA NA elr to SDDHHS
Disease Reporting Requirements for Health Care Providers http//www.sdcounty.ca.gov/hhsa/programs/phs/community_epidemiology/disease_reporting_requirements_for_health_care_providers.html
Clinical Laboratory Reporting and Specimen Submission Guidelines http//www.sdcounty.ca.gov/hhsa/programs/phs/community_epidemiology/disease_reporting_requirements_for_laboratorians.html
22
Production Implementation

• Components to be included
• Partner engagement
• Governance
• RCKMS governance
• Content governance
• Still to come
• External interfaces PHIN VADS, other
  terminology providers
• Integration with Ontology
• Web Services

23
Production Implementation (features)

• Authoring Framework
• Workflow
• Subscription Notification
• Ontology as determined to be necessary
• Automated generation of output file(s)
• Expanded View Query capability
• Profile Management
• Administration

24
Ontology Vocabulary
25
NNDSS

• http//wwwn.cdc.gov/nndss/document/NNDSS_event_cod
  e_list_2013_Revised.pdf
• 19 events deleted
• 56 events added
• 54 case definition changed
• 7 category created
• 10 retired codes
• 12 replaced codes
• 98 nationally notifiable conditions

26
National and state requirements for 3 conditions
in 3 states

• www.doh.wa.gov/notify
• www.cdphe.state.co.ys/dc/index.html
• www.health.utah.gov/epi

27
Added 2008
Added 2008
Added 2008
11091 Ehrlichiosis/Anaplasmosis, undetermined
11089 Ehrlichia ewingii
11088 Ehrlichia chaffeensis
Replaced by
Replaced by
retired2008
Retired 2008
11086 Ehrlichiosis, human monocytic (HME)
11087 Ehrlichiosis, human, other or unspecified
agent
Added 2001
Added 1998
Major taxonomic revision 1999
Scope of original term splits
Anaplasmosis is a new disorder
Added 2008
Retired 2008
Replaced by
11085 Ehrlichiosis, human granulocytic (HGE)
11091 Anaplasma phagocytophilum
Added 1998
Ehrlichia phagocytophila
28
Reportable event 1998 2001 2007 2008 2013
Ehrlichiosis, human granulocytic (HGE)
Ehrlichiosis, human monocytic (HME)
Ehrlichiosis, human, other or unspecified agent
Ehrlichiosis/Anaplasmosis, undetermined
Ehrlichia ewingii
Ehrlichia chaffeensis
Anaplasma phagocytophilum
?Utah
?Utah
?Utah
?Utah
?Utah
?Utah
In Washington, Ehrlichiosis is a rare condition,
with no granularity. It is mentioned on a
separate page and unknown for 2007 Colorado does
not report ehrlichiosis.
29
Analysis of national data

• How does an analyst make a report of a national
  condition spanning time (e.g. 10 years) where the
  scope of the condition and the name of the
  condition changes, forks and merges?

30

• Questions