E-mail: cdcinfo@cdc.gov | Web: www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

CS219012

Reporting Nationally Notifiable Conditions (NNC): Vocabulary AspectsReporting Nationally Notifiable Conditions (NNC): Vocabulary Aspects

Office of Surveillance, Epidemiology, and Laboratory Services

Division of Informatics Solutions and Operations

1Northrop Grumman Consultant to CDC; 2Office of Surveillance, Epidemiology and Laboratory Science (OSELS), Centers for Disease Control and Prevention (CDC); and 3iConnect Consulting Sundak Ganesan1, MD; Nikolay Lipskiy2, MD, DrPH, MBA; Ulrike Merrick3, MPH; Cynthia Vinion1, MEA

ABSTRACTElectronic 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).

BACKGROUNDApplying 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.

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).

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 (Figure 3).

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*.

RESULTSThe 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:1. Add a Microorganisms/Agents section to CSTE position statements.2. Define the process for developing and maintaining CSTE TIGs.3. Clarify the use of paired serology tests.4. Add qualitative results to reports and develop the needed

vocabulary.5. 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.

Acknowledgement: The authors would like to acknowledge the excellent participation of CSTE, SDO and members of CRSWg, Vocabulary and Lab Messaging Community of Practice.

TB

STD

Flu

Malaria

Laboratory

Public Health Filter

Results

Results that are of interest to public health

agenciesNotifiable

Condition Mapping Table (NCMT)

Program Areas

Figure 1. Role of standards in NNC vocabulary for filtering and routing ELR data

Figure 2. Notifiable Condition Mapping Table (NCMT)

Notifiable Conditions (National/State)

Influenza

Lab Test(LOINC)Influenza A, B,C – Ag, Ab

Lab Results – Organism (SNOMED)Influenza Virus - A, B,C, Subtypes

Lab Test List Organism List

Case Reporting Standardization Workgroup (CRSWg) facilitated the CSTE TIGs review and

provided feedback back to CSTE

Figure 3. Subject Matter Experts Panel (SMEP)

SMEP

CDC

LIMSi

NHSN

NPCR

APHL

PHLIP

CoPs

CRSWg

LMCoP

VMCoP

SDOs

SNOMED

LOINC

CSTE

Figure 4. SMEP NNC Vocabulary Review Process

Nationally Notifiable Condition Vocabular

y

CSTE Position

Statement

CSTE Technical

Guide(TIG)

General Lab

Methods

Lab Test Codes

(LOINC)

Lab Result Codes

(SNOMED)

CONCLUSIONSThere 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.

NCMT State SpecificImplementation

CSTETechnical

Implementation Guide (TIG)

Extending TIG with feedback

from CRSWg,

CoPs (lab, Vocab)

Extending with SDO

input

Extending with State Notifiable Conditions

and its associated

lab test/result.

CSTEPosition Statem

ent

*CRSWg PHConnect forum: http://www.phconnect.org/profiles/blogs/call-for-volunteers-review

Figure 5. Content source for an updated NCMT