Transcript Reportable Conditions Knowledge Management System (RCKMS) VMCOP Workgroup Sep 17, 2013 RCKMS Meeting Agenda • Overview • Architecture • Pilot – CDC R&D Lab • Information Requirements • Production implementation •

Reportable Conditions
Knowledge Management System
(RCKMS)
VMCOP Workgroup
Sep 17, 2013
RCKMS Meeting Agenda
• Overview
• Architecture
• Pilot
– CDC R&D Lab
• Information Requirements
• Production implementation
• Questions
Overview
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)
Policy Driver for RCKMS – Stage 3 Draft recommendations - Improve Population and Public Health
ID
SGR
P402
B
Stage 1 Final Rule
Stage 2 Final Rule
More
information
from RFC New
More
information
from RFC New
Stage 3
Recommendation
s
More
information
from RFC - New
Undetermined
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.
Changed threshold
to 10% from 20%
for consistency
5
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
Public Health Need





6
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
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)


7
Provide machine readable rules to allow systematic
detection and reporting via ELR
Communicate rules changes to reporters as they
occur
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
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
Stakeholders
Current 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
RCKMS Long term Scope
PH
Reports
Public Health
State, Local,
Territorial
Agencies
RCKMS
Authoring Framework
PH Reporters
Hospital Labs
LIMS
EHR
National, Clinical &
Public Health
Laboratories
LIMS
Ambulatory Care
Query/View
Web
Service
Database
Including
Notifications
Who, What, When,
Where, How
Other Web
Services
(3)
Open
CDS
Local
HeD
EHR
Subscription
Management
DSS
Web
Service
(2)
Open
CDS
(1) HeD
Output file Options
1) HeD file download
2) OpenCDS in Cloud
3) OpenCDS Locally Deployed
Structured
Output
Generator
HeD Compliant
format
- Triggering Criteria
- Reporting Actions
- Links
Context Use Case - Release 1
System
*
*
Assess Impact of
Changes to External Code Sets
*
*
* *
**
*
Vocabularist
PHIN VADS
Jurisdictional/
Condition/
Criteria Ontologies
*
Conduct Initial
Data Loads
Manage Operations
*
*
CPT Codes
***
ICD-9/ICD-10 Codes
***
*
Manage
System-level Value Sets
*
*
*
*
*
«extends»
TIGs
Manage emails
SRCA
*
Univ of Utah
Prototype data
System Administrator
«extends»
Manage Security
*
Manage
Jurisdiction-level Value Sets
*
*
«extends»
*
*
**
Manage
jurisdictional emails
View/Query
Knowledge
*
Content Viewers
*
*
*
*
Jurisdicitonal Administrator
*
Setup Workflow
*
Manage
Jurisdictional Security
*
Monitor workflow
*
«extends»
*
On-line
Registration
**
*
*
PH Reporters (people)
*
*
Author Reporting
Spec
*
Subscribe for
Notifications
*
«extends»
«extends»
*
«extends»
*
Send Notifications
PH Knowledge Managers
Review/Update
Reporting Specs
*
Publish Reporting
Specs
Generate Reporting
Spec Exports
**
*
PH Reporter - system
RCKMS Component View
RCKMS Public Portal
HTML
• Subscriber
• Viewer
WS
• Public Health Dept.
• Laboratories
• Hospitals
• HIE
•
•
•
•
Portal
Views / Query
Export (HR / MC)
Subscription/Notif
Profiile Mgmt
Web Services
• Query
• Export (HR / MC)
RCKMS Private Portal - Authoring
Portal
HTML
• Knowledge Manager
• System Admin
• Jurisdiction Admin.
•
•
•
•
Authoring
Views / Query
Workflow
Administration
RCKMS Services
• Store Access
SQL / XML
RCKMS Store
• Application <SQL>
• Knowledge <XML>
Publish
RCKMS Store
• Application <SQL>
• Knowledge <XML>
• Reference <Ontology>
Jurisdictional
Ontology
ConditionReportable Event
Ontology
Lab/Clinical LOINC
Ontology
PHIN VADS
SQL / XML
RCKMS Services
• Knowledge Access
• Criteria Validation
• Workflow
• Ontology Mgt.
• Document ETL
• Bulk Load
Univ. of Utah
SRCA
Jurisdictional
TIGs
• Lab
• Clinical
• Code Maps
Pilot
RCKMS Pilot - Development Environment
Information Requirements
Criteria
• Lab Detection
• Epidemiologic
• Clinical
o Diagnostic
o Signs & Symptoms
• Demographic
• Jurisdiction
Timeframe
Reporting Actions
References and Links
17
Example Criteria
If the results matter, what are the result
requirements?
LAB DETECTION
CRITERIA
Isolation of Bordetella
pertussis from a
clinical specimen
Results from any test
specific for pertussis
CLINICAL CRITERIA
Suspect or confirmed
diagnosis of pertussis
Pertussis as cause of
death
Pertussis as a
significant condition
contributing to death
18
lab Test
finding/metho
d
Test value
Classification set
Culture
Pertussis by
any method
Tst_BPert_C
ult
no
Tst_BPert
Data Element Value Set
Diagnosis
Cause of
death
send all
results ?
DX_Pert
Dth_Pert
Contributing to Dth_Fact_Pe
death
rt
yes
numeric
ValueRe
quireme
interpretati interpretat organis organis nt
onRequire ion value mRequir mRequi
ment
set
ement
rement operator
"positive"
[leave
blank]
Observati
on/Qualifi
er/Findin Finding
g
Value Set
Status
Stat_case
Int_pos
operator
Bordetell
a
Rst_BP
pertussis ert_Pos
Preliminary
results
physical
quantity
Should
reporters
send
suspecte
d cases
as well
unit of as
measur confirme
e
d cases?
yes
no
no
Variation in Reporting Time Frames
Jurisdiction
Type of
reporting
facility
Reporting time frames
Immediately
Colorado
Laboratories
Hospitals
Providers
Utah
Laboratories
Hospitals
Providers
Washington
Laboratories
Hospitals
Providers
24
hours
2
days
3
days
7
days
Monthly
Variation in Elevated Blood Lead
Level Criteria
Relevant
Jurisdiction
Blood lead level
Patient’s Age
Reporting timeframe
Utah
≥10mg/dL
< 10mg/dL
Any
Any
60 days
No action – not
reportable
Colorado
≥10mg/dL
< 10mg/dL
≥ 25mg/dL
< 25mg/dL
≤18 years
≤ 18 years
> 18 years
> 18 years
7 working days
30 days
30 days
No action – not
reportable
Washington
≥ 10mg/dL
< 10mg/dL
≥25mg/dL
< 25mg/dL
≤15 years
≤ 15 years
Any
> 15 years
2 working days
1 month
2 working days
1 month
Reporting Actions & Links
Reporting Actions
lab reporting
clinician reporting clinican reporting -with lab data
no lab data
title
no
no
A
A
A
NA
P
A
A
A
P
NA
no
Immediate phone call required
A
A
A
P
NA
REPORTING ACTION
fax to epi program at SDDHHS
phone to epi program at SDDHHS
mail to epi program at SDDHHS
manual entry into webform WebCMR
elr to SDDHHS
References and Links
Disease Reporting Requirements
for Health Care Providers
http://www.sdcounty.ca.gov/hhsa/programs/phs/community_epidemiology/disea
se_reporting_requirements_for_health_care_providers.html
Clinical Laboratory Reporting and http://www.sdcounty.ca.gov/hhsa/programs/phs/community_epidemiology/disea
Specimen Submission Guidelines se_reporting_requirements_for_laboratorians.html
21
Production Implementation


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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
NNDSS
http://wwwn.cdc.gov/nndss/document/NNDSS_event_code_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
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
Added
2008
Added
2008
11091
Ehrlichiosis/Anaplasmosis,
undetermined *
11089
11088
Ehrlichia ewingii*
Ehrlichia chaffeensis*
Replaced
by
retired
2008
Replaced
by
11086
11087
Added
2001
Ehrlichiosis, human monocytic
(HME)
Ehrlichiosis, human, other or
unspecified agent
Scope of original term splits
Added
2008
Anaplasma
phagocytophilum*
Replaced
by
Retired
2008
Added
1998
Major
taxonomic
revision
1999
Anaplasmosis is a new disorder
11091
Added
2008
Retired
2008
11085
Ehrlichiosis, human granulocytic
(HGE)
Ehrlichia phagocytophila
Added
1998
Reportable event
1998
2001
2007
2008
2013
Ehrlichiosis, human
granulocytic (HGE)
Utah
Utah
Ehrlichiosis, human monocytic
(HME)
Utah
Utah
Ehrlichiosis, human, other or
unspecified agent
Utah
Utah
Ehrlichiosis/Anaplasmosis,
undetermined
Ehrlichia ewingii
Ehrlichia chaffeensis
Anaplasma phagocytophilum
In Washington, Ehrlichiosis is a rare condition, with no granularity. It is mentioned on a
separate page and unknown for 2007
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