reportable conditions knowledge management system (rckms)
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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
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