Validation of Reportable Conditions Trigger Codes (RCTC) content and EHR implementation process Open Access

Abstract

Background: The electronic case reporting (eCR) project is a step towards achieving the vision of bidirectional information flow between public health and health care, it can help bridge the digital gap existing between healthcare and public health. The Reportable Conditions Trigger Codes (RCTC) is the appropriate first step for this initiative, as it can provide timely initiation of electronic initial case reports (eICR) from healthcare to public health when trigger codes are matched to information in a patient's encounter record.

Purpose: The purpose of this research is to validate both the RCTC content and the implementation of standard codes in the EHR processes.Through research and analysis, this thesis will explore discrepancies between LOINC® codes used within 4 national reference labs, one clinical lab, and the RCTC. The discrepancies will be categorized and reasons for the differences will be defined. In addition the study will evaluate the workflow and interactions between clinical lab Systems and EHRs and study the gaps in the use of LOINC® and SNOMED, and its impact of missing RCTC LOINC® and SNOMED codes on triggering eICR.

Methods: The LOINC® code data used by reference labs was collected, and quantitative analysis of LOINC® codes from selected data sources combined with visual inspection to categorize differences. The workflow process analysis was gathered by conducting a series of interviews with personnel's from an Atlanta hospital system.

Result: Descriptive analysis of validation of LOINC® codes used by four national reference labs for 4 piloted reportable conditions revealed that there were a total of 41 LOINC® codes missing in RCTC, with the highest number of missing codes coming from Quest laboratories, and the highest number of missing code coming from Salmonella. Through inferential analysis the study highlights the four discrepancies patterns in use of LOINC® codes. Additionally, the analysis of the validation of EHR process, revealed several discrepancies in the use of LOINC® codes and SNOMED-CT codes, and study recommended measurable next steps that can be taken to address the discrepancies.

Conclusion: The study highlighted the discrepancies in use of trigger codes (LOINC®) by reference labs, and suggested the validation of triggers codes against codes actually used by reporters. The study observed gaps through the EHR implementation process analysis and recommended that from a process standpoint the LOINC® codes should be an integral part of EHR, and clinical laboratories should map local codes for lab results reporting to SNOMED codes to facilitate trigger coding at the EHR.

Table of Contents

Chapter 1: Introduction. 7

Introduction and background. 7

Purpose: 10

Significance statement 11

Terms Definition: 13

Chapter 2: Review of Literature. 15

Introduction. 15

Work Flow analysis among EHR, lab, and outpatient's lab. 16

Role of electronic case reporting and ELR in public health surveillance. 21

Role of LOINC and SNOMED standardized coding support ELR and Case Reporting. 22

Chapter 3: Method and Analysis. 23

Process flow and interactions between Clinical and Lab(s). 24

Data Collection. 24

Data sources and data preparation. 24

Data preparation. 25

Framework used by study. 26

Chapter 4: Results. 31

Introduction. 31

Findings. 31

Inferential Analysis of result obtained from Descriptive analysis. 37

LOINC discrepancy and observation categories (Table 2). 37

Chapter 5: Discussion. 47

Introduction. 47

Summary of Study. 47

Limitations. 49

Conclusion. 49

Implications and Recommendations. 50

Appendix 1. 53

SQL queries used in study. 53

References:. 61

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	RCTC eCR Electronic health record trigger codes eICR LOINC
Committee Chair / Thesis Advisor	McGarvey, Sunanda R, Emory University Lipsky, Jon M, Emory University
Committee Members	Gaydos, Laurie, Emory University Conde, J Mark, Emory University
Partnering Agencies	CDC

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