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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 Abhilasha Saxena ·

Parent-child messages in 2.5.1 - lessons learned?

Can any of the jurisdictions here share information on how parent-child relationships for antibiotic susceptibility tests or reflex tests are handled in 2.5.1? What has been your experience with partners reporting parent-child relationships? Is it a relatively common practice or can we expect some pushback from partners during onboarding? Any experiences/guidance/advice on best practices for parent-child messages reporting? Thank you.

Context – we are currently onboarding a partner for HL7 2.5.1 and experiencing some resistance/pushback in getting them to conform to the minimum reporting requirements for parent-child messages despite numerous attempts.

Comments & Events

Alan May, Hepatitis C Epidemiologist Alan May, Hepatitis C Epidemiologist
Arkansas would be interested in hearing about this also. We have struggled with this because we do not have a good process to

(1) identify when to expect these linkages (culture and susceptibility messages only, or also other types of messages with reflex testing?); 
(2) validate that the linkages are right (how strict should the rule be about the match between OBR-26/OBR-29 and the parent segments?); and 
(3) parse the messages to determine which condition has been sent and put them in a format where the surveillance system will consume them.

We are trying to follow along with section 6 of the 2.5.1 implementation guide (May 2014 version) and the CRE best practices document https://cste.confex.com/cste/2017/webprogram/Handout/Session4615/CRE_ELR_Best_Practices_FINALv1.1_20170601.pdf.

I know of the following state guidance:

Arizona, https://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/pi/az-emr-implementation-guide.pdf (page 43)
California, https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Title17_2505_Changes_ELRGuidance.pdf (pages 2-4, 11-13) and https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CalREDIE-ELR2PH-CompanionGuide2012.pdf (pages 178-181)
Georgia, https://dph.georgia.gov/document/publication/cre-letter-laboratories10-5-2018pdf/download
Kansas, https://www.kdhe.ks.gov/DocumentCenter/View/13365/Implementation-Guide-PDF (pages 65-67)
Minnesota, https://www.health.state.mn.us/diseases/reportable/medss/elrappb.pdf (pages 49-50)
Oregon, https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/COMMUNICABLEDISEASE/REPORTINGCOMMUNICABLEDISEASE/ELECTRONICLABREPORTING/Documents/OR%20ELR%20HL7%20251%20Implementation%20Guide.pdf (pages 32-34)
Tennessee, https://www.tn.gov/content/dam/tn/health/documents/meaningful-use/MU_ELR_ONBOARDING.pdf (page 22)
Virginia, https://www.vdh.virginia.gov/content/uploads/sites/19/2018/08/VDH_ELR_ImplementationGuide_Final_Aug2018-2.pdf (pages 44-45)

This is from non-systematic internet searching, so I may be looking at guidance that is outdated and probably missing some other guidance. Sorry for any mistakes or omissions -- I will edit or correct if any of the above isn't right. Would definitely be happy to know if there is additional or more recent documentation.
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Nancy Barrett, Epi 4/PH Informatics Specialist Nancy Barrett, Epi 4/PH Informatics Specialist
Hi - my tech person has just done some coding revisions in our electronic data exchange platform to better capture susceptibilities esp for HAI related reports. He did mention changes to accommodate labs not following the full standard. He is not on this basecamp but I can get details.

Do folks think this may be a good topic for the Aug ELR workgroup call?
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Alan May, Hepatitis C Epidemiologist Alan May, Hepatitis C Epidemiologist
Thanks Nancy! If y'all are willing, I think that would be a helpful topic (at least for our state).
Nancy Barrett, Epi 4/PH Informatics Specialist 👍
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John Satre, Informatician at Iowa Department of Public Health John Satre, Informatician
Yes, absolutely.
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Annie Fine, CSTE Annie Fine
Agree this is a great topic
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Jonathan Johnson, Informatics and Data Science Lead (HI - DOH) Jonathan Johnson, Informatics and Data Science Lead (HI - DOH)
Yes, would be very helpful. Thank you!
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Becky Lampkins, Manager, Surveillance/Informatics Program at CSTE Becky Lampkins, Manager, Surveillance/Informatics Program
Thank you all - we've added this topic to tomorrow's National ELR Workgroup Call agenda (August 2nd, 1 pm ET).
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