TY - JOUR AU - Augustini, Emily AU - Trick, William AU - Hoferka, Stacey PY - 2017/05/02 Y2 - 2024/03/28 TI - Mapping Laboratory Reports to Illinois’ Extensively Drug-Resistant Organism Registry JF - Online Journal of Public Health Informatics JA - OJPHI VL - 9 IS - 1 SE - Data sources, standards, exchange, visualization, and quality DO - 10.5210/ojphi.v9i1.7622 UR - https://ojphi.org/ojs/index.php/ojphi/article/view/7622 SP - AB - <div style="left: 89.1818px; top: 332.706px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.08186);" data-canvas-width="63.1985303030303">Objective</div><div style="left: 104.045px; top: 347.521px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02723);" data-canvas-width="377.8309113636361">To streamline carbapenem-resistant enterobacteriaceae (CRE)</div><div style="left: 89.1818px; top: 364.036px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00194);" data-canvas-width="392.15937424242406">surveillance by integrating electronic laboratory reporting (ELR)</div><div style="left: 89.1818px; top: 380.551px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.974745);" data-canvas-width="391.4251931818181">data and electronic case reports (eCR) automatically into Illinois’</div><div style="left: 89.1818px; top: 397.066px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00588);" data-canvas-width="302.9374242424242">extensively drug-resistant organism (XDRO) registry.</div><div style="left: 89.1818px; top: 428.494px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.11811);" data-canvas-width="81.88294696969696">Introduction</div><div style="left: 104.045px; top: 443.309px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01364);" data-canvas-width="375.4851818181819">CRE are drug-resistant bacteria that have a mortality rate of up to</div><div style="left: 89.1818px; top: 459.824px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.988895);" data-canvas-width="120.43096212121215">50% in those infected</div><div style="left: 209.552px; top: 460.195px; font-size: 8.42273px; font-family: serif;">1</div><div style="left: 213.761px; top: 459.824px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.983833);" data-canvas-width="264.979">. Several clusters of CRE have been detected in</div><div style="left: 89.1818px; top: 476.339px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01561);" data-canvas-width="265.8704053030303">Illinois, often in long-term acute care hospitals</div><div style="left: 355.044px; top: 476.71px; font-size: 8.42273px; font-family: serif;">2</div><div style="left: 359.255px; top: 476.339px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02192);" data-canvas-width="120.50115151515152">. In response Illinois</div><div style="left: 89.1818px; top: 492.854px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02758);" data-canvas-width="390.8917537878787">created the XDRO registry, a mandatory reporting system designed</div><div style="left: 89.1818px; top: 509.369px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.0033);" data-canvas-width="296.32558333333344">to aid inter-facility communication concerning CRE.</div><div style="left: 104.045px; top: 525.885px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.999265);" data-canvas-width="377.77195227272705">Despite being a high priority for control in the US, the case</div><div style="left: 89.1818px; top: 542.4px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.04925);" data-canvas-width="289.13818939393934">definition for CRE has been the subject of debate</div><div style="left: 378.211px; top: 542.771px; font-size: 8.42273px; font-family: serif;">3</div><div style="left: 382.472px; top: 542.4px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.06014);" data-canvas-width="97.8159393939394">. There are over</div><div style="left: 89.1818px; top: 558.915px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01782);" data-canvas-width="392.70965909090893">70 Enterobacteriaceae which can have different mechanisms of</div><div style="left: 89.1818px; top: 575.43px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02308);" data-canvas-width="129.2832484848485">carbapenem resistance</div><div style="left: 218.435px; top: 575.801px; font-size: 8.42273px; font-family: serif;">3</div><div style="left: 222.693px; top: 575.43px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03948);" data-canvas-width="257.5669999999999">. Criteria for carbapenem resistance include</div><div style="left: 89.1818px; top: 591.945px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.987185);" data-canvas-width="391.8631749999998">susceptibility results, and phenotypic or genotypic detection. The</div><div style="left: 89.1818px; top: 608.46px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.997547);" data-canvas-width="389.70836060606064">case definition for the XDRO registry is intentionally more exclusive</div><div style="left: 89.1818px; top: 624.976px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03474);" data-canvas-width="393.47893484848487">(specific) than that used by CSTE (Table 1). CSTE utilizes a</div><div style="left: 89.1818px; top: 641.491px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.9878);" data-canvas-width="389.2591484848486">definition designed to maximize sensitivity. Illinois’ XDRO registry’s</div><div style="left: 89.1818px; top: 658.006px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01414);" data-canvas-width="390.29233636363637">definition is more specific, meant to reduce unnecessary adoption of</div><div style="left: 89.1818px; top: 674.521px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.984481);" data-canvas-width="389.4935810606061">contact precautions and the negative consequences some patients may</div><div style="left: 89.1818px; top: 691.036px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00246);" data-canvas-width="64.30752272727273">experience.</div><div style="left: 104.045px; top: 707.551px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.04125);" data-canvas-width="375.8571856060606">Currently, case reporting to the XDRO registry is a manual data</div><div style="left: 89.1818px; top: 724.066px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.971613);" data-canvas-width="389.22826515151525">entry process, which has important advantages. However, transitioning</div><div style="left: 89.1818px; top: 740.582px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.042);" data-canvas-width="391.1682999999998">to automatic ELR integration will streamline the reporting process</div><div style="left: 89.1818px; top: 757.097px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.980729);" data-canvas-width="389.18615151515127">and minimize data entry effort. Unfortunately, the clinical information</div><div style="left: 89.1818px; top: 773.612px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.990014);" data-canvas-width="389.6199219696969">needed to investigate XDROs is often not captured by ELR. The eCR</div><div style="left: 89.1818px; top: 790.127px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.944362);" data-canvas-width="391.1233787878787">is a new message type being piloted in Illinois that contains many</div><div style="left: 89.1818px; top: 806.642px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.981219);" data-canvas-width="389.44585227272694">clinical data elements. We examined the feasibility of combining ELR</div><div style="left: 89.1818px; top: 823.157px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03925);" data-canvas-width="391.0180946969695">and eCR into reports for the XDRO registry. In the construction of</div><div style="left: 89.1818px; top: 839.672px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00526);" data-canvas-width="390.03965454545437">these reports we examined the impact of using CRE definitions from</div><div style="left: 89.1818px; top: 856.188px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00673);" data-canvas-width="171.94997727272727">CSTE and the XDRO registry.</div><div style="left: 89.1818px; top: 887.615px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.07334);" data-canvas-width="57.70971969696969">Methods</div><div style="left: 104.045px; top: 902.43px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01238);" data-canvas-width="378.0751704545454">We obtained sample HL7 CRE messages from Illinois’ ELR</div><div style="left: 89.1818px; top: 918.945px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01596);" data-canvas-width="390.5843242424242">database. Using these messages and the HL7 Implementation Guide</div><div style="left: 89.1818px; top: 935.46px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00318);" data-canvas-width="389.96806136363637">for Electronic Laboratory Reporting, we mapped ELR fields to those</div><div style="left: 89.1818px; top: 951.976px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03939);" data-canvas-width="390.9830000000002">in the XDRO registry. Specific codes corresponding to the registry</div><div style="left: 89.1818px; top: 968.491px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.959965);" data-canvas-width="391.32973560606047">fields were found though a systematic keyword search of LOINC,</div><div style="left: 89.1818px; top: 985.006px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.0315);" data-canvas-width="390.71628030303054">SNOMED, and sample messages. When there was no match for an</div><div style="left: 89.1818px; top: 1001.52px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03752);" data-canvas-width="390.9900189393938">XDRO field in ELR, we referred to the HL7 CDA Implementation</div><div style="left: 89.1818px; top: 1018.04px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03819);" data-canvas-width="393.6642348484848">Guide for the Electronic Initial Case Report and sample eCR</div><div style="left: 89.1818px; top: 1034.55px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.999801);" data-canvas-width="389.8389128787879">messages. A collection of fields and codes was created to correspond</div><div style="left: 89.1818px; top: 1051.07px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00459);" data-canvas-width="285.0531666666665">to both the CSTE and Illinois CRE case definition.</div><div style="left: 89.1818px; top: 1082.49px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.08498);" data-canvas-width="50.70481818181818">Results</div><div style="left: 104.045px; top: 1097.31px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00781);" data-canvas-width="377.7621257575757">The XDRO registry has 37 unique fields. Twenty-six can be</div><div style="left: 89.1818px; top: 1113.82px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.05034);" data-canvas-width="391.2679689393938">populated from ELR, four can be found in the eCR, and seven are</div><div style="left: 89.1818px; top: 1130.34px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.990198);" data-canvas-width="389.61009545454544">generated within the system. In sample ELR and eCR messages all of</div><div style="left: 89.1818px; top: 1146.85px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01439);" data-canvas-width="390.38919772727274">the necessary fields were populated with appropriate text and codes.</div><div style="left: 89.1818px; top: 1163.37px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01528);" data-canvas-width="392.86407575757573">The mapping process was straightforward for demographic and</div><div style="left: 89.1818px; top: 1179.88px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01894);" data-canvas-width="390.67978181818177">facility information, but more complicated for culture and organism</div><div style="left: 89.1818px; top: 1196.4px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03104);" data-canvas-width="390.9689621212122">information. Some XDRO tests do not have corresponding LOINC</div><div style="left: 505.364px; top: 331.006px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.999426);" data-canvas-width="389.8094333333331">or SNOMED codes, so we will develop a logic statement to fill these</div><div style="left: 505.364px; top: 347.521px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02373);" data-canvas-width="390.82437196969687">based on free-text. Addition of the eCR adds important information</div><div style="left: 505.364px; top: 364.036px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.980634);" data-canvas-width="389.0991166666667">to the registry report, notably encounter type and encounter/admission</div><div style="left: 505.364px; top: 380.551px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.998032);" data-canvas-width="392.4260939393943">date. We were able to create separate mapping schemas for the</div><div style="left: 505.364px; top: 397.066px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.02406);" data-canvas-width="390.7120689393938">CSTE and XDRO registry definitions for CRE. Using each of these</div><div style="left: 505.364px; top: 413.582px; font-size: 14.0379px; font-family: serif; transform: scaleX(0.978026);" data-canvas-width="391.92774924242406">definitions, we will quantify how many ELR messages would be</div><div style="left: 505.364px; top: 430.097px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00677);" data-canvas-width="188.33218181818182">committed to the XDRO registry.</div><div style="left: 505.364px; top: 461.524px; font-size: 14.0379px; font-family: sans-serif; transform: scaleX(1.10288);" data-canvas-width="84.24131060606061">Conclusions</div><div style="left: 520.227px; top: 476.339px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.01317);" data-canvas-width="375.4149924242423">By combining the data captured in ELR and eCR, it is possible to</div><div style="left: 505.364px; top: 492.854px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.00157);" data-canvas-width="389.80943333333335">populate the fields of the Illinois XDRO registry. When this merge is</div><div style="left: 505.364px; top: 509.369px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.03255);" data-canvas-width="390.9240409090908">completed it should result in more complete and better quality data</div><div style="left: 505.364px; top: 525.885px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.04272);" data-canvas-width="390.91702196969646">on CRE in Illinois. As intended, the definition of CRE used by the</div><div style="left: 505.364px; top: 542.4px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.04027);" data-canvas-width="390.70785757575754">registry is less inclusive than that used by CSTE. Future work will</div><div style="left: 505.364px; top: 558.915px; font-size: 14.0379px; font-family: serif; transform: scaleX(1.0039);" data-canvas-width="363.7635530303029">show the number of CRE lab results captured by each definition.</div><div style="left: 505.364px; top: 806.33px; font-size: 12.3864px; font-family: serif; transform: scaleX(1.01461);" data-canvas-width="122.14193181818183">Table 1: CRE Definition</div> ER -