An Introduction to theReportable Condition Mapping Tables

Jeremiah SableConsultant, The St. John Group

Contractor to APHL

Resources for public health reporting

What are the Reportable Condition Mapping Tables?

The RCMT tables associate reportable conditions with laboratory tests and results that are indicative of those conditions.

How are they used?

They can be used to filter the output of clinical labs for test results that are of interest to public health.

Which conditions do they include?

The scope of the RCMTs is all conditions that are:• nationally notifiable• reportable at the state level• reportable in sub-state jurisdictions• reportable in US territories

What problem do the RCMTs solve?

Which test results are of public health interest in which jurisdiction?

Clinical LabHospitalsMedical groupsetc.

Test results

Filtering the output of clinical labs

RCMT tables can identify tests and results of public health interest.

Clinical LabHospitalsMedical groupsetc.

RCMTfilter

Public health agency

Test results

Within a public health agency

Test results

Public health agency

STD

Foodborne

Tb

Hepatitis

etc...

RCMT

Routing test results within an agency

The problem of non-comparable lab data

ARUP labs

LabCorp

Mayo labs

etc....

Quest labs

Each lab has its own codes and names for lab tests. There is no consistency across labs.

It isn’t possible to map the test catalog of each lab to reportable conditions.

The problem of non-comparable lab data

In order to solve this problem the Regenstrief Institute in Indianapolis created a universal code system for clinical lab tests called LOINC. The first edition of LOINC was released in 1995.

Mayo lab sends a lab report to Dr. Jones John Smith 41370 Serum creatinine 1.2

One month later ARUP lab sends Dr. Jones a report on the same patient John Smith 120025 Creatinine, Ser 1.2 mg/dl

It is easy for Dr. Jones to look at these two test results and see that the patient’s creatinine level has not changed over the past month.

But Dr. Jones’s computer cannot tell that the tests or the results were the same.

LOINC

Clinical labs do not replace their own test names and codes with LOINC. Labs continue to use their own names and codes. When their computers send out lab report messages the test results contain the lab’s own test names and codes, along with the equivalent LOINC names and codes.

• LOINC now contains over 45,000 lab tests.• It is freely available and has been widely adopted.• Federal agencies that exchange lab data must use LOINC to code the tests.

LOINC

• LOINC now contains over 40,000 lab tests.• It is freely available and has been widely adopted.• Federal agencies that exchange lab data must use LOINC to code the tests.

LOINC makes it possible to aggregate and compare lab test data.

Clinical labs do not replace their own test names and codes with LOINC. Labs continue to use their own names and codes. When their computers send out lab report messages the test results contain the lab’s own test names and codes, along with the equivalent LOINC names and codes.

The problem of non-comparable lab data

ARUP labs

LabCorp

Mayo labs

etc....

Quest labs

Each lab has its own codes and names for lab tests. There is no consistency across labs.

It isn’t possible to map the test catalog of each lab to reportable conditions.

LOINC enables data aggregation across labs

ARUP labs

LabCorp

Mayo labs

etc....

Quest labs

This problem disappears when labs send LOINC codes along with their own codes.

It is possible to map LOINC tests to reportable conditions.

RCMTs map LOINC tests to reportable conditions

Simplified example of RCMT content

How does it work?

HospitalLab HL7message

How does it work?

Patient #

101

102

103

104

105

106

LOINC LOINC test name

2160-0 Creatinine : MCnc : Pt : Ser/Plas : Qn :

20570-8 Hematocrit : VFr : Pt : Bld : Qn :

2823-3 Potassium : SCnc : Pt : Ser/Plas : Qn :

33688-3 Yersinia pestis Ag : ACnc : Pt : Isolate : Ord : IF

16533-2 Helicobacter pylori Ab : Titr : Pt : Ser : Qn :

31955-8 Rubella virus Ag : ACnc : Pt : CSF : Ord :

Lab test results in the HL7 message

HospitalLab HL7message

How does it work?

Patient #

101

102

103

104

105

106

LOINC LOINC test name

2160-0 Creatinine : MCnc : Pt : Ser/Plas : Qn :

20570-8 Hematocrit : VFr : Pt : Bld : Qn :

2823-3 Potassium : SCnc : Pt : Ser/Plas : Qn :

33688-3 Yersinia pestis Ag : ACnc : Pt : Isolate : Ord : IF

16533-2 Helicobacter pylori Ab : Titr : Pt : Ser : Qn :

31955-8 Rubella virus Ag : ACnc : Pt : CSF : Ord :

Code Condition

10440 Plague

10200 Rubella

Lab test results after processing with RCMT

RCMT

HospitalLab HL7message

Does this LOINC map to a reportable condition?

Many LOINCs are non-specific and cannot be mapped to conditions.

Does this LOINC map to a reportable condition?

For these non-specific LOINCs the RCMTs contain lists of organisms that cause reportable conditions.

These lists contain SNOMED organism codes and names.

RCMT virus list

What they are and what they aren’t

Applications – The RCMTs are not applications or software. They are repositories of facts that are used to identify lab tests and results of public health importance.

Breakable – The RCMTs contain many thousands of rows. The tables can be subsetted to create program-specific filters. For example an STD program can create an STD subset of the RCMTs.

Case definitions – The RCMTs are not laboratory criteria for diagnosing notifiable conditions and they cannot be used to confirm cases. Some tests, like blood cultures, are diagnostic of current infections. Others, like IgG antibody tests, can only be evaluated in conjunction with other tests because they may indicate past infection.

Decision support – The information in these tables can be used in decision support systems. But since the tables do not contain rules or criteria, they are not sufficient for decision support.

ELR – The RCMTs are for electronic lab reporting (ELR). They should be used to filter the output of clinical labs for test results that need to be routed to public health programs.

Finished – These tables are not finished or complete. New diseases emerge unpredictably, new lab tests are developed, organism taxonomies are revised, medical knowledge expands, and coding systems like LOINC and SNOMED try to keep up. This is an ongoing project.

Reviewing RCMT content

The scope of the RCMTs is all reportable conditions in all jurisdictions. This means the content of the tables needs to be reviewed with many CDC programs.

• Is the list of lab tests for each condition correct?• Are there other tests that we should add to LOINC?• Are there other organisms (or toxins) that should be added to SNOMED?• How will we find out about new tests for each condition?

Interacting with Public Health Programs

Based on past experience with many state public health labs....

Point of contact

One person from each program should be in charge of interactions between the program and the RCMT team. This person will be able to answer many questions without wasting the time of lab and epi SMEs.

Pre-review intro

Prior to reviewing the RCMTs with each program there should be an introductory meeting with the RCMT team and appropriate people from the program. This will be a high-level overview of the RCMTs and what we need from the program.

Follow-through

After reviewing the RCMTs with a program new questions will arise and information on the program web site will change. So there will be some ongoing communication between the RCMT and the program’s point of contact.

Questions and comments about the RCMTs are always welcome.

RCMT contact information

RCMT Planning Team E-mail: PHINVS@CDC.GOV

RCMT Website (phConnect) : http://www.phconnect.org/group/rcmt