✅ ELR for CP-CRE
As mentioned during the 8/21/2019 ELDR subcommittee call, I am interested in the experiences of other jurisdictions who have made CP-CRE lab reportable via ELR.
If CP-CRE is lab reportable in your state/jurisdiction, please come prepared to discuss the following questions:
- Have other states/jurisdictions implemented ELR reporting for CP-CRE only, but not other CREs? What has been your experience with implementation?
- If labs are required to ONLY report CP-CRE results via ELR, have other states/jurisdictions found that labs are able to specify transmission of ONLY those results, or do ALL CREs end up getting sent?
- Do labs tend the send the results for CP-CRE formatted like a “drug susceptibility test” result in the parent/child format and with multiple drugs tested from one sample?
- Other helpful suggestions/feedback/recommendations?
**Special thanks to MA (Scott) and NE (Tom) for sharing your insight and feedback with me on this topic already!
I added a few comments on the call from CT, but here they are in more detail.
We made CRE lab reportable in 2016 and CRAB lab reportable in 2017. There is some distinction to which specimen sources are wanted.
As we work with hospital labs to onboard them for ELR, they are required to report CRE/CRAB on "suspicion", i.e., any detection of possible resistance (translates to an intermediate finding in most cases). Isolates are also required to be sent to our State Lab for confirmation. For non-ELR reports, the labs are supposed to send antibiograms for each report.
Issues we've observed with ELR reporting.
1) what labs think are reportable in terms of timing and what our DPH HAI epis want is different, so we have to push to get that early reporting before results from our State Lab are done.
2) Suppression of antimicrobials - this is an existing story. We haven't encountered a lot of this yet, but we rely on the program epis to sort this out with hospital labs. As the ELR folks, we can't "make" a lab report an antimicrobial if this is not part of their internal algorithm. We support what is desired but our goal is to get reporting via ELR.
3) Child-parent to report susceptibilities -- this has taken a lot of work with labs, and even established labs with ELR (i.e., Quest) we have to circle back with on being sure they properly structure the message so we can capture the susceptibilities. We've added extra processing to be sure that reports that contain results for multiple organisms line up when the output is in a flat file format (HAI is not built into CTEDSS-Maven yet, it is in progress, so they are using ELR results in TSV format then uploading into their Access database).
4) Antibiograms results in ELR and on paper "look" different. We've had discussion with the HAI epis that if a lab sends a "0 (zero)" then that is exactly what they put into the ELR message and exactly what we capture. We do capture in the lab result section the numeric as well as interpretation of results.
5) What CDC wants "rolled up" from lab results is also on ongoing issue that
we are working on with the new HAI model.
Because of the complexity of demands for this reporting, we are trying not to end up spending our time being the HAI reporting police -- I have myself and one tech person to accomplish ELR and we have a ton of other work. So I'm trying to connect HAI folks with labs to get missing information directly. It's an ongoing process and we are still in the middle of the story until we onboard more labs this fall. :-)
Hope this helps!
I’m sorry I wasn’t able to join today’s call, so thank you for reaching out! And yes, I would love your notes on this subject, that would be awesome.
Best,
Tamara