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CSTE National ELR Workgroup

Welcome to the CSTE National ELR Workgroup Basecamp! We hope you will utilize the space to share resources with colleagues, start discussion threads, and identify topics for the workgroup to tackle on future calls. All workgroup members will have the opportunity to join. Please note that you may edit your notification preferences to suit your needs (and your email inbox). If you are not already on the ELR distribution list and would like to receive call communications, please enroll using this subscription form (copy and paste in browser): https://app.smartsheet.com/b/form/5a91a4579952496682084796b82112e6
Becky Lampkins, Manager, Surveillance/Informatics Program at CSTEMegan Toe, CSTEScott Troppy, Surveillance Epidemiologist at MA DPHMeredith Lichtenstein, CSTEAmy Drake, NMJohn RobertsNancy Barrett, Epi 4/PH Informatics SpecialistErin Holt, TDHRita Altamore, EpidemiologistDavid DiCesareJason HallWalter Kemper, ELR Coordinator, NC DHHS Div of Public HealthJulie LuepkeCarmen Pugh, Labcorp Manager State Reporting at LabCorpTom Safranek +399 others
Posted by Sarah Boneske ·

CDC ELIMS TB Susceptibility Message Assistance

Has anyone had success with CDC ELIMS TB Susceptibility messages? The MDH PHL identifies the organism and then passes it onto to CDC for the susceptibility testing. When the HL7 comes back to us, there is no organism/parent OBR to link it to and we cannot get the message into our surveillance system without failure. Message example with PID removed below. 

OBR|1|2200191^SPHL-000034^2.16.840.1.114222.4.1.3661^ISO|29_30038336_47007_782^STARLIMS.CDC.Prod^2.16.840.1.114222.4.3.3.2.1.1^ISO|29579-0^Mycobacterial Susc Pnl Islt^LN^782^MTBC Agar Proportion Susceptibility^L^2.69^v unknown^^^^^^2.16.840.1.113883.6.1|||20000326|||||||||SPHL-000034^MN PHL Division, Minnesota Department of Health^^^^^^^STARLIMS.CDC.Prod&2.16.840.1.114222.4.3.3.2.1.1&ISO^^^^XX|^WPN^PH^^1^651^2015200|||||200008091858-0404|||F

NTE|1|L|Susceptibility testing method: Indirect agar proportion, 7H10 medium. Resistance is defined as >1% (growth on drug-containing medium compared to drug-free medium).|RE^Remark^HL70364^^^^2.5.1^^^^^^^2.16.840.1.113883.12.364

NTE|2|L|<p>Molecular Detection of Drug Resistance (MDDR) report was issued 10/08/2022.<p>  <p>These growth-based DST results agree with the MDDR results.<p>|RE^Remark^HL70364^^^^2.5.1^^^^^^^2.16.840.1.113883.12.364

OBX|1|SN|25180-1^Ciprofloxacin 2 ug/mL Islt SlowMyco^LN^2763^Ciprofloxacin 2.0 ?g/mL^L^2.69^v_unknown^Ciprofloxacin 2.0 ?g/mL|N8KGZKT5-1|=^0|%^%^UCUM^^^^2.1|<1 = Susceptible, >= 1 = Resistant|S^Susceptible^HL70078^131196009^Susceptible^SCT^2.7^09012017^0 Susceptible^^^^^2.16.840.1.113883.12.78|||F|||20000326|11D2030855^Centers for Disease Control and Prevention (OTHER)^CLIA||||20000809185700||||Centers for Disease Control and Prevention (OTHER)^L^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^11D2030855|1600 Cliffton Rd^^Atlanta^GA^30329^USA^B

OBX|2|SN|25182-7^Kanamycin 5 ug/mL Islt SlowMyco^LN^2770^Kanamycin 5.0 ?g/mL^L^2.69^v_unknown^Kanamycin 5.0 ?g/mL|N8KGZKT5-1|=^0|%^%^UCUM^^^^2.1|<1 = Susceptible, >= 1 = Resistant|S^Susceptible^HL70078^131196009^Susceptible^SCT^2.7^09012017^0 Susceptible^^^^^2.16.840.1.113883.12.78|||F|||20000326|11D2030855^Centers for Disease Control and Prevention (OTHER)^CLIA||||20000809185700||||Centers for Disease Control and Prevention (OTHER)^L^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^11D2030855|1600 Cliffton Rd^^Atlanta^GA^30329^USA^B

OBX|3|SN|25194-2^Ethambutol 5 ug/mL Islt SlowMyco^LN^2765^Ethambutol 5.0 ?g/mL^L^2.69^v_unknown^Ethambutol 5.0 ?g/mL|N8KGZKT5-1|=^0|%^%^UCUM^^^^2.1|<1 = Susceptible, >= 1 = Resistant|S^Susceptible^HL70078^131196009^Susceptible^SCT^2.7^09012017^0 Susceptible^^^^^2.16.840.1.113883.12.78|||F|||20000326|11D2030855^Centers for Disease Control and Prevention (OTHER)^CLIA||||20000809185700||||Centers for Disease Control and Prevention (OTHER)^L^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^11D2030855|1600 Cliffton Rd^^Atlanta^GA^30329^USA^B

SPM|1|2200191&SPHL-000034&2.16.840.1.114222.4.1.3661&ISO^3003598336&STARLIMS.CDC.Prod&2.16.840.1.114222.4.3.3.2.1.1&ISO||119334006^Sputum^SCT^^^^09012017^^Sputum|||||||||||||20000326|20000705082500||||||ROOM^Room temperature^HL70493




Comments & Events

Riki Merrick, Terminologist at APHL Riki Merrick, Terminologist at APHL
So you cannot currently link to the ELR from the PHL that submitted the culture to CDC based on the PHL specimen ID - is that what you said on the Open ELR call?
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Sita Smith Sita Smith
That's what we are seeing in MA, Riki. We are triaging these for manual review at the moment, because I don't think volume is very high.
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Sarah Boneske Sarah Boneske
Riki, that is correct! Sita, we are also manually reviewing them at this time, volume is low. 
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Sarah Boneske Sarah Boneske
Hello all,

Any further thoughts on this?

Thank you,
Sarah
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Riki Merrick, Terminologist at APHL Riki Merrick, Terminologist at APHL
Sorry - I have no good idea on how to make it dable for CDC to add another OBR for a test they did not perform to build the parent-child linkage (unless they actually do some form of confirmatory testing on the isolate you submit). Who produced the "Molecular Detection of Drug Resistance (MDDR) report was issued 10/08/2022" mentioned in NTE|2|?
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Sarah Boneske Sarah Boneske
Riki, what do you mean by who produced it? 
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Riki Merrick, Terminologist at APHL Riki Merrick, Terminologist at APHL
Who made that Molecular Detection of Drug Resistance (MDDR) report - CDC or the PHL?
If CDC then they should be able to create a parent child linkage, if the PHL, then that is harder for them to do.
Riki
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Sarah Boneske Sarah Boneske
CDC did the MDDR report. But that's in the NTE, is that different?
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Riki Merrick, Terminologist at APHL Riki Merrick, Terminologist at APHL
So if the CDC created that report that is different, becasue they have the organism ID in their system. 
Creating the full parent-child linkage might be problematic because the MDDR report is pbobly NOT built in a micro module, that is used to parent-child linkages, so getting that added will be much more complicated or not possible at all.
BUT at mimimum they should be able to at least add an OBX segment with the species identification - not sure if that will help you on your end though. 
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