Data Usability Workgroup

How does your organization exchange data today with public health ?

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    • #32158 Reply
      Hera Ashraf

      How does your organization exchange data today with public health ?
      o HL7v2
      o HL7-CDA
      o HL7 FHIR
      o Other: please describe

    • #33690 Reply
      Andrea Pitkus, PhD, MLS(ASCP)CM

      It depends on the data and from which entity/information system the data are being sent and received.

      Federal law for Electronic Lab Reporting to Public Health and each jurisdiction (state, territory or county) requires HL7 2.51 or Hl v2.3 messaging. HL7 O&O members are unaware of any LIS with FHIR functionality and there’s no specification to send FHIR lab data. O&O is still working on what FHIR resources are needed to support laboratory reporting of common data like cultures and other reflex testing, which also may be reportable to public health. Unclear if public health can even receive in FHIR either.

      EHRs are unable to receive lab results like COVID in FHIR, whether performed via Point of Care testing or the newer home testing kits. FDA Convened the WATERS Connectathon to help develop platforms that may support such widescale reporting needs to public health. This work is ongoing and unclear if widespread production yet.

      Hospitals, long term care facilities, rehab facilities and others are required to report Healthcare Associated Infections (HAI) to CDC NHSN in CDA format in accord with the MU implementation guide. However, the original data from the performing laboratory (which may be reportable to ELR) is “transformed” and remapped as the mapping/coding/data structuring requirements differ between both.

      For example for ELR, a VRE-vancomycin resistant enterococcus is represented as a post coordinated approach from the performing lab with vancomycin antibiotic mapped to LOINC, the result value mapped to a SNOMED CT qualifier value and the organism Enterococcus faecalis mapped to a SCT organism code. These encoded data are sent to public health via ELR and to the EHR via v 2.51 messaging or via a shared data dictionary (if LIS and EHR use same vendor).

      Once these data are in the EHR data dictionary, they are remapped for HAI reporting (and integrated with pharmacy, location data, etc.) in CDA format according to the CDA IG. The VRE for the patient would be mapped to a Pre-coordinated SNOMED CT organism code and not reflect the post coordinated data structure and mappings for ELR. EHRs have tables that are used to “remap” these results and values. If we are to achieve data interoperability, the data should flow across systems. Information maybe lost as remapping occurs. In this case the exact organism may be lost in favor of the species level (enterococcus).

      This example applies to data duplication question as well.

    • #34589 Reply
      Riki Merrick

      Second try,so hopefully I don’t forget anything (the submit button is NOT easily hidden at the bottom – pressing the I am not a robot checkmark seems to not submit it – maybe for the next iteration put them next to each other, so that folks don;t have to retype their answer?):
      Lab to PHA:
      APHL helps PHAs connect with reporters by providing techincal assistance in implementation of HL7 V2.5.1 ELR R1 messages (MU). reporters that have been connected for a while use older versions of V2 messages. Reporters that are not able to create V2 messages can submit csv files, use a web portal form, fillable pdf forms or faxes. For some diseases the reporting must be done by phone. Each PHA has their own rules and regulations. APHL and CSTE are working on the Reportable Conditons Knowledge Management System (RCKMS), where jursidictions can author their specific rules – for now focused on case reporting.

      Provider to PHA:
      APHL supports case reporting using CDA for the electronic Case report (eCR): trigger codes are available to EHRs that indicate a potentially reportable condition – when one of these codes is used in a patient record an eCR is sent to the AIMS platform, where RCKMS decides the owning jurisdiciton and then evaluates the content against that jurisdiction’s rules: If reportable the eCR is forwarded to that PHA and a reportability response (RR) is sent back to the provider’s EHR; if not reportable the RR will state that; if unable to determine, the RR will identify the data that is needed to make the determination. This was being rolled out via Digital Bridge effort when COVID pandemic strated – I know there is also a FHIR IG, but I am not up to date on the breadth of implementation for either CDA and FHIR.

      PHAs to CDC:
      PHAs send information about notifiable conditions to CDC using V2.5.1 ORU messages with specific vocabulary for each condition. There is also a legacy cvs file format and an older V2 message format still in use.

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