Stream: SANER-Connectathon
Topic: CARES MeasureReport
Abbie Watson (Jan 15 2021 at 17:01):
Hello,
So, over the past few weeks, I've been working with HHS (by way of a subcontractor) to implement a SANER implementation of the CARES ACT requirements.
Built out an entire data-collection pipeline for at-home testing data, starting with the ~33 data elements defined in Cares, which were mapped from CVS to HL7v2, and then to FHIR. End result is a MeasureReport that has a List of FHIR Patient/Observation resources, which then gets wrapped in a Bundle.
HHS-WATERS-SANER-MeasureReport.png
I'm attaching the produced Bundle containing a CaresAct MeasureReport, and would love to get some review or feedback. Would also like to schedule some time at the Working Group to bring this forward to the Public Health working group, for consideration of inclusion into the SANER Implementation Guide.
tl;dr - I think I've worked out the Cares Act requirements for SANER.
MeasureReport.CaresAct.0115202.json
@David Pyke @Keith Boone @AbdulMalik Shakir
Andrea Pitkus, PhD, MLS(ASCP)CM, CSM (Jan 16 2021 at 02:33):
Great to see this! Good timing as another home test looks like it's coming: https://ro.co/press/ro-and-gauss-partner-to-offer-rapid-at-home-covid-19-testing-nationwide
Andrea Pitkus, PhD, MLS(ASCP)CM, CSM (Jan 16 2021 at 02:44):
One thing caught my eye as a need as ONC pushes apps and interoperability, especially for consuming performed/reported testing. Normally, medical laboratory scientists create test names for the order and result(s) in their LIS build and test compendium/CLIA specimen collection manual, which is where providers order tests and names (although usually a bit different are created in EHR builds for the test order and results).
I remember a conversation on here a year or two ago with a app developer for a consumer device origination of a lab result. Apple also showed this is their Health kit developers conf with glucose result on iPhone screen. These non healthcare settings don't have a Lab Result Name!! I've seen them using the LOINC Long Name as that is the most pervasive description for a LOINC. I emailed Swapna at Regenstrief to see if they will expand their Display Names and/or Consumer Names to the COVID tests especially those performed in non traditional settings as we have been seeing expand. It might include the national guard tents, pharmacy/airport/university screening locations, and consumer/health IVD tests @Ralf Herzog @Ed Heierman @Riki Merrick Adding two of our LIVD IVD vendors participating in connectathon too and Riki.
@Ed Heierman Curious how your test(s) are named in your app for non traditional lab settings?
As tests are shared downstream, provider/EHR, Public Health, SANER, etc. assume folks want the same name for the same "test" in promoting semantic interoperability?
Andrea Pitkus, PhD, MLS(ASCP)CM, CSM (Jan 16 2021 at 03:56):
Quick question is "value string" the SANER field? In the lab (and updated USCDI) we often refer to it as the "test result value" or "result value"? (fyi, some of this info is in the LIVD FHIR connectathon tract too, from interoperability perspective.)
Andrea Pitkus, PhD, MLS(ASCP)CM, CSM (Jan 16 2021 at 04:10):
The laboratory would refer to the "Loinc Code Test" field as (Lab) or (Test) Result. If a physician were ordering would be Order or test order. as separate field. So the general laboratory data structures are Order (aka Service Request in FHIR), Result (aka Diagnostic Report) and Result Value (contained in DR). Also testing is performed on a specimen (type). For the LOINC code, the specimen type is likely "swab" (mapped to SCT code from Specimen hierarchy per ELR and v2 requirements in SPM 4 field) (It is What is collected). In most cases, "where the specimen is collected from is referred to as the (specimen) Source (in SPM 8 in v2.51 ELR mapped to SCT Anatomic Site hierarchy code) For a respiratory specimen (generic LOINC specimen source), for a home test it's likely a nasal source. For bonus points, laterality such as Right nares or Left nares can be indicated. Left and Right are in the SPM 9 field and mapped to SCT qualifier codes in (v2.51 ELR requirements such as MU). It's a post coordinated approach, but Specimen Cross Mapping table is in progress for all specimens and body sites used for lab specimens. (This is a significant problem with most LIS/EHR dictionary builds as specimen sources such as back or head or neck are often in the specimen type dictionaries mapped to SCT specimen type codes. These would be sent to pathology and if sent, usually from an autopsy specimen as one can only send their head once. More likely it is really a specimen source such as a "swab" submitted for a "wound culture" to microbiology or in this case, a swab of a respiratory specimen that is a nasal, oropharynx or nasopharangeal swab which is very common for COVID testing.) Specimen source is significant as sterile specimens sources for cultures (urine, CSF, etc.) are reportable by law, but not non sterile sources (skin) for things like MRSA. Also for COVID public health wants to know correct sources as there is different sensitivity and specificity from these different body sites that may or may not be clinically significant. (lots of info, I know, but congratulations, you have modeled some of the ELR fields in V2.51 for the same data now in FHIR)
Last updated: Apr 12 2022 at 19:14 UTC
