Transcript BMI PowerPoint Presentation 48x36

A Framework for Modeling Data Elements Used for
Public Health Case Reporting
Jason Jacobs, BA1, Catherine Staes, BSN, MPH, PhD1, Rita Altamore, MD, MPH2, Sundak Ganesan, MD3
1 Department
of Biomedical Informatics, University of Utah, Salt Lake City, UT
2 Washington State Department of Health, Olympia, WA
3 Northrop Grumman Consultant to CDC, Atlanta, GA
Background
• CSTE publishes Position Statements
(PS) that specify reporting rules and
case report content for nationally
notifiable diseases
• In the PS, disease-specific data
elements to be included in case reports
are unstructured, and sometimes
ambiguous or redundant
• CRSWg identified a need for
standardization of data elements
• Automated public health (PH) case
reporting requires a standardized
specification for information to be
provided in the case report
Objective
• Propose framework for ongoing
development and maintenance of data
elements requested in PH case reports
Methods
• Reviewed 10 Position Statements
(5 hepatitides, coccidioidomycosis,
cryptosporidiosis, babesiosis, Lyme
disease, Hansen’s disease)
• Harmonized data elements and mapped
them to concepts found in an EHR
• Evaluated the clinical statement model
used in HL7 Public Health Case
Reporting CDA R2 IG as an approach
to handle the requested information
• Explored options for representing the
data elements requested using a
terminology model (question/answer)
vs. an information model (HL7 CDA),
allowing for flexibility in expressing the
time period of interest
Recommended approach for gathering information to support investigation and surveillance
Harmonize and Model Data Elements
Recommended Next Steps
Chronic Hepatitis B
Acute Hepatitis B
Chronic Hepatitis C
Acute Hepatitis C
Disease
Ever
Have long term dialysis
6 Weeks to 6 Months
History of surgery, dialysis, or other
medical procedures or injections
Ever
Have long term dialysis
2 Weeks to 6 Months
Undergo hemodialysis
Time period
Concepts Typically in an EHR
Map to typical EHR modules,
such as:
• Problem List
• Medications
• Procedures
Map to standard vocabulary
For example, map to existing
LOINC, ICD, or SNOMED terms
Assess the time period of
interest to be used to query
for relevant information
Time Period of Interest Related to
Risk of Transmission
Exposure Period
Discussion
Harmonized
concepts (e.g.
dialysis, tattoo)
Concepts NOT Typically in an EHR
Standardize the concepts
• Create standard representations for concepts not typically captured in
an EHR, e.g. “History of tattoos”
Map to LOINC
1. Determine which concepts are represented by existing LOINC codes
• “Number of male sexual partners in 6 months before symptom onset”
2. Request clinical LOINC codes for concepts that are:
• Unlikely to change in meaning
• Not typically found in the EHR
• Not already present in LOINC
• Restructure content in Section VI-C using
the proposed model, with input from local,
state, and federal epidemiologists
• Address "What time period of interest
related to risk of transmission?" should be
used to query for information
• Harmonize current social history questions
and address "What level of specificity is
most useful for the public health
investigator for assessing potential
exposures and transmission risks?"
• Request LOINC codes for well-established
questions needed for investigation but not
typically found in an EHR
Conclusions
Restructure Content of Section VI-C
Example from Acute Hepatitis C Position Statement
Current
Epidemiological Risk Factors
During the 2 weeks to 6 months
prior to the onset of symptoms did
the patient:
Undergo hemodialysis
Receive blood or blood products
Product
Date
Receive a tattoo or body piercing
The number of female sex partners
Revised
Exposure period: 2 weeks to 6 months
Time period of interest related to risk of
transmission: Past 8 months
Information to extract from EHR if present
during the time period of interest:
Procedures
Renal dialysis
Blood or blood product
administration
Information to ask as questions
concerning the time period of interest:
History of tattoos
History of body piercing
Number of female sex partners
Findings
• Some data items in the Position Statements that represent risk factors for disease acquisition
and transmission are not typically gathered by clinicians during patient care.
• A PH investigator may gather evidence within a wider window than the traditional exposure
period, for example, about dialysis within 7 months of acute onset of hepatitis B, not 6 months.
• In 10 Position Statements, we found 106 unique data elements for procedures and exposures
that could be reduced to about 40 unique concepts that better match EHR data elements.
• The strategy will:
• Help epidemiologists create, validate,
and maintain computable specifications
for case report content
• Help implementers map CSTE data
elements and query an EHR
• Avoid need to create LOINC codes for
each disease-specific data element
• This disease-specific information can
supplement a generic case report and is
not required to initiate reporting
Acknowledgements
• NLM Training Grant No. NL5T15LM007124
• CDC Center of Excellence in Public Health
Informatics P01HK000069-03
Contact Information
Jason Jacobs
[email protected]