Reportable Conditions Knowledge Management System

(RCKMS)

VMCOP WorkgroupSep 17, 2013

• Overview • Architecture • Pilot – CDC R&D Lab

• Information Requirements• Production implementation • Questions

RCKMS Meeting Agenda

Overview

• 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)

History

5

Policy Driver for RCKMS – Stage 3 Draft recommendations -- Improve Population and Public Health

ID Stage 1 Final Rule Stage 2 Final RuleStage 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

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

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 occur7

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 report8

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

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

Architecture

Public Health State, Local, Territorial Agencies

RCKMS Long term Scope

RCKMS

Authoring Framework

Subscription Management

Including Notifications

DatabaseWho, What,

When, Where, How

Structured Output

Generator

PH Reports

Query/View

HeD Compliant

format- Triggering Criteria- Reporting Actions- Links

DSS Web

Service

Other Web Services

HeD

(1) HeD

(2) Open CDS

PH ReportersHospital Labs

LIMSEHR

National, Clinical & Public Health

Laboratories

LIMS

Ambulatory Care

EHR

Web Service

(3) Open CDSLocal

Output file Options1) HeD file download2) OpenCDS in Cloud3) OpenCDS Locally

Deployed

Context Use Case - Release 1

System Administrator

Jurisdicitonal Administrator

PH Knowledge Managers

ICD-9/ICD-10 Codes

Content Viewers

CPT Codes

PHIN VADS

PH Reporters (people)

PH Reporter - system

ManageSystem-level Value Sets

Manage Operations

ManageJurisdictional Security

View/QueryKnowledge

Send Notifications

Generate ReportingSpec Exports

Manage emails

Manage Security

Assess Impact ofChanges to External Code Sets

Conduct InitialData Loads

Managejurisdictional emails

ManageJurisdiction-level Value Sets

Author ReportingSpec

Review/UpdateReporting Specs

Subscribe forNotifications

Publish ReportingSpecs

On-lineRegistration

System

«extends»

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Univ of UtahPrototype data

TIGs

Vocabularist

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«extends»

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Monitor workflow

Setup Workflow

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SRCA

Jurisdictional/Condition/

Criteria Ontologies

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RCKMS Component ViewPortal

• Views / Query• Export (HR /

MC)• Subscription/

Notif• Profiile Mgmt

• Application <SQL>

• Knowledge <XML>

RCKMS Services• Store Access

PHIN VADS

Web Services• Query• Export (HR /

MC)

• Subscriber• Viewer

• Public Health Dept.

• Laboratories• Hospitals• HIE

RCKMS Public Portal

RCKMS Private Portal - Authoring

SQL / XML

HTML

WS

RCKMS Store

SRCAJurisdictional

Univ. of Utah

• Lab• Clinical• Code Maps

TIGs

Portal• Authoring• Views / Query• Workflow• Administration

• Application <SQL>

• Knowledge <XML>

• Reference <Ontology>RCKMS Services

• Knowledge Access

• Criteria Validation• Workflow• Ontology Mgt.• Document ETL• Bulk Load

SQL / XML

RCKMS Store

• Knowledge Manager

• System Admin• Jurisdiction

Admin.

HTML

Publish

Position Statement Criteria

Initial Loads

Integrations

Lab/Clinical LOINC Ontology

Condition- Reportable

Event Ontology

Jurisdictional Ontology

Pilot

RCKMS Pilot - Development Environment

Information Requirements

Criteria• Lab Detection• Epidemiologic• Clinical

o Diagnostico Signs & Symptoms

• Demographic• Jurisdiction

TimeframeReporting ActionsReferences and Links

17

Example Criteria 

lab Test finding/method Classification

 

send all results ?

If the results matter, what are the result requirements?

LAB DETECTION CRITERIA  

interpretationRequirement

interpretation value set

organismRequirement

organismRequirement

numericValueRequirement

 Test value set

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       yesPertussis 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

Variation in Reporting Time FramesJurisdiction Type of

reporting facility Reporting time frames

Immediately 24 hour

s

2 days

3 days

7 days

Monthly

ColoradoLaboratories

HospitalsProviders

UtahLaboratories

HospitalsProviders

WashingtonLaboratories

HospitalsProviders

Variation in Elevated Blood Lead

Level CriteriaRelevant Jurisdiction

Blood lead level Patient’s Age Reporting

time-frame

Utah ≥10mg/dL< 10mg/dL

AnyAny

60 daysNo action – not reportable

Colorado≥10mg/dL< 10mg/dL≥ 25mg/dL< 25mg/dL

≤18 years≤ 18 years> 18 years> 18 years

7 working days30 days30 daysNo action – not reportable

Washington≥ 10mg/dL< 10mg/dL≥25mg/dL< 25mg/dL

≤15 years≤ 15 yearsAny> 15 years

2 working days1 month2 working days1 month

Reporting Actions & Links

Reporting Actions

References and Links

21

lab reportingclinician reporting -with lab data

clinican reporting - no lab data title

no no no Immediate phone call required

      REPORTING ACTIONA A A fax to epi program at SDDHHSA A A phone to epi program at SDDHHSA A A mail to epi program at SDDHHSNA P P manual entry into webform WebCMRP 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

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

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

Ontology & Vocabulary

NNDSShttp://

wwwn.cdc.gov/nndss/document/NNDSS_event_code_list_2013_Revised.pdf

19 events deleted56 events added54 case definition changed7 category created10 retired codes12 replaced codes98 nationally notifiable conditions

National and state requirements for 3 conditions in 3 states

www.doh.wa.gov/notifywww.cdphe.state.co.ys/dc/index.htmlwww.health.utah.gov/epi

11091Ehrlichiosis/Anaplasmosis, undetermined *

Added 2008

retired2008

11087Ehrlichiosis, human, other or unspecified agent Added

2001

Retired 2008

11085Ehrlichiosis, human granulocytic (HGE) Added

1998

Retired 200811086

Ehrlichiosis, human monocytic (HME) Added

1998

Replaced by

11088Ehrlichia chaffeensis*

Added 2008

11089Ehrlichia ewingii*

Added 2008

Replaced by

11091Anaplasma phagocytophilum*

Added 2008

Replaced by

Scope of original term splits Major taxonomi

c revision

1999

Ehrlichia phagocytophila

Anaplasmosis is a new disorder

Reportable event 1998 2001 2007 2008 2013Ehrlichiosis, 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 2007Colorado does not report ehrlichiosis.

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?

Questions