PHA feedback for RCKMS Timeboxing

Hi-

I missed the call, so can you please post whatever presentation was delivered on the 1/10/2023 call as some of us need a little more clarity on the timeboxing definition as well as the bullet points regarding fixed vs. variable.

Thanks.

~P

Hello everyone,

I have attached the RCKMS Timeboxing presentation from the January 10 Public Health eCR Data Quality Subgroup call (please see slides 6-19).

Also, a friendly reminder to please provide your feedback by Tuesday, January 31, 2023 by responding to this post. Thank you!

Data Quality Subgroup meeting Slides - January 2023.pdf 867 KB • Download

1. These three are top priority for KY: Campylobacter, Salmonella, Gonorrhea. Lower priority: Hepatitis A, Perinatal Hepatitis C, Histoplasmosis, Legionella, Shigella, RMSF, Ehrlichiosis.
2. Option 2.
3. The five proposed conditions for initial rollout vary significantly. Some are acute, some are chronic. There isn't a suitable time period for these five conditions.
4. COVID-19: 3 weeks is suitable. COVID-19 (diagnosis or active problem) is not a sufficient criteria, so timeboxing will not affect our jurisdiction. HBV, HCV, and TB: longer time periods, but would need to confirm a specific timeframe with subject matter experts. HIV in KY will not be onboarded for eCR.
5. We would prefer to have separate variable durations for each condition. 
6. Would timeboxing be applicable in the latest version of any condition, or would it be applied to whichever version the PHA has published? Will timeboxing be available in AIMS onboard environment for testing purposes? How will timeboxing work if the versions published in staging and AIMS onboard environment are different? Is the proposed go live date of March still expected for timeboxing? How will the timeboxing options show up in the reportability response? Can we test timeboxing before we move into production? 

California's top 5 conditions for initial timeboxing rollout in RCKMS:

1.       COVID

2.       Gonorrhea

3.       Syphilis (adult)

4.       Coccidioidomycosis

5.       Hepatitis C 

*CDPH is interested in seeing high burden conditions that may serve PHAs more at this time, meeting PH at the stage we're currently at with eCR, than HIV/TB which have a larger scope of privacy challenges and programmatic differences than the diseases I've noted above.

2. Option 2 – variable

 

3. No accurate fixed time duration would really be appropriate across conditions.

 

4. COVID-19: 3 weeks is ok. HepC chronic & Syphilis: 12 months. Gonorrhea & Coccidioidomycosis

: 30 days

 

5. If we have to implement a fixed timeframe, then we’d prefer to have separate variable durations for each condition. 

 

6. CA will not be working on TB & HIV anytime soon for eCR due to the scope of these conditions  around privacy issues and the fact that the majority of case work for these conditions are done outside of CalREDIE.  We are interested in pulling out HIV status from the eICR as it relates to other reportable conditions. 

For Syphilis (or any conditions with Meds): would the timeboxing occur around the possible Medications that are on the RCTC as well?

I agree and appreciate KY’s questions, so +1 to Amanda Ward!

Arizona's top 5 conditions for initial timeboxing rollout in RCKMS:

1.       COVID

2.       Gonorrhea

3.       Syphilis (adult)

4.       Salmonellosis

5.       Hepatitis C 

1. It might be more helpful for acute conditions. STIs (?) However, medication often gets updated long after the encounter. 

2. Prefer Option 2. variable by jurisdiction, variable by conditions, and variable by data elements. Have the ability to customize the duration date but still can use the default time. Will there be another pilot to test this? 

3. No accurate fixed duration should be appropriate, especially because the other 4 conditions are chronic. Without knowing the impact of chronic disease.

4. We prefer "variable" and we don’t feel confident coming up with a duration without seeing the possible impact at this time. 

5. We prefer "variable" but if it has to be fixed, we would prefer each condition to have a separate duration.

6. Other comments or questions

Thank you for the opportunity to share our feedback. 

 

Question 1: WI is flexible with what conditions are chosen to go first.  We do plan on pulling in eCRs for all the mentioned conditions. Another Condition we thought of is Lyme disease & EM rash.  We are hoping to get these reports and fill in the reporting gap with eCR.  And Lyme is very common in WI so we do not want to get multiple reports.  Another helpful condition to add would be syphilis.

 

Question 2: WI would prefer variable.  I think that there will be a lot of variation in how many reports and how strict or not strict each PHA will want to be.  

 

Question 3: WI would prefer variable, conditions are so different from one another. 

Question 4: Spoke to our epi’s and did not have consensus at this time on a duration that makes sense.  Hard to say when we only have the COVID data to look at. If PHAs could determine their timeframes and it could be variable, that would help us make adjustments in both the short and long term.  

Question 5: If it had to be fixed, I think we would prefer being able to have different durations for each disease.  

 

Question 6: I do think that there will likely be advantages to have a timebox option for all conditions.  Once the above is figured out for a small group of diseases.  And for all other diseases, like the rarer ones, I think at that time there could be a fixed standard that is applied to all of them. I would also like to put in a vote for timeboxing pregnancy triggers, especially for Hep B and also for Syphilis.  I see many times old pregnancies on active problem lists.  And additionally, timeboxing hospitalization if possible for flu (and covid).

Thank you for the opportunity to give feedback

Question 1: IA is flexible on conditions.

 

Question 2: IA prefers variable.

 

Question 3: The variable option is important and preferred. 

Question 4: Don't really have any recommendations on this.  

Question 5: Definitely different durations by disease. 

 

Question 6: N/A

Thank you for the opportunity to provide feedback.
1. CT agrees with COVID but would suggest other diseases of high volume and acute duration for initial rollout such as the STIs, foodborne or vectorborne diseases that have been suggested by other states.  
2. CT would prefer variable durations defined by the PHA. 
3. Don't believe one fixed duration could be applied uniformly due the variablity across conditions.
4. If we had to go with fixed durations for each condition initially proposed then at least a year for HCV, HBV, HIV, TB and 3 weeks or 30 days for COVID.
5. Separate fixed durations if we had to go with fixed but prefer variable durations.
6. As mentioned by WI, we are also seeing issues regarding previous hospitalizations and pregnancies related to disease reporting so would like to see these issues also addressed through timeboxing vs filtering at the PHA level.
Thank you.

Question 1: IN suggests possibly Chlamydia and Gonorrhea as well as Lyme disease for inclusion in addition to the initially included conditions.

Question 2: IN would prefer either variable durations or a hybrid approach that may provide easier programming where a specific set of options are available for all conditions. For example a choice of 3 weeks, 3 months, 6 months, 9 months,  or 12 months for each condition. This would allow for some flexibility, but the full variable duration approach which could prove more difficult could be avoided or delayed.

Question 3: IN does not feel that one duration for all conditions would be a feasible approach.

Question 4: For COVID Indiana is not planning on using timeboxing at this time.  For Hepatitis B and Hepatitis C 12 months. For HIV and TB no recommendation at this time

Question 5: Separate fixed durations but a choice of durations (see answer 2) would be preferable.

Question 6: Not at this time.

Michigan's answers -
Question 1: 
When we met and shared the potential for using the Time-boxing feature, the Program Epidemiologists say they want it for All Conditions eventually but would like to start with these three conditions.

Preferred conditions to start:
1.   COVID-19 

2.   Gonorrhea 

3.   Chlamydia 

 

Question 2: 
Option 2: “variable” duration defined by the PHA.

 

Question 3:  
We do not have a consensus for these 5 but we are interested in testing the following conditions with this duration.

1.  COVID-19 – 3 weeks duration

2.  Gonorrhea - 3 weeks duration

3.  Chlamydia - 3 weeks duration

 

Question 4: 
Not for the 5 proposed conditions.

 

Question 5:  
We prefer variable durations for most conditions but are interested in starting with the 3 conditions mentioned in Q3. In the event the 3-week Time-boxing is not beneficial then we would like to have the option to set a new duration by condition.

1.  COVID-19 – 3 weeks duration

2.  Gonorrhea - 3 weeks duration

3.  Chlamydia - 3 weeks duration
 
Question 6: 
When will we know what the RCKMS team is going to offer in respect to Time-boxing for conditions and their respective duration?

 

Question 1:  CO would like to add RSV, Flu, Hospitalization, and Ventilator event if possible

Question 2:  Option 2: “variable” duration will be defined by the PHA Jurisdictional user in the reporting specification. 

Question 3: CO would prefer the variable duration.

Question 4: No recommendation.

Question 5: separate fixed durations for each condition.

Question 6: When will timeboxing be available for other diseases?  Will it be a roll-out by disease or all at once?

Q1: Giardiasis, measles, m-pox, and pertussis. The natural history of disease of such conditions may be well suited for timeboxing. They would all be impacted based on the authoring specifications published to production by Washington State Department of Health.   

Q2: Option 2 is preferred. This would allow us flexibility to update the Timeboxing duration as we learn about the data we receive. 

Q3: No, this would not be appropriate given the difference in natural history of disease for the proposed conditions.  

Q4: COVID will not be impacted by timeboxing based on Washington States’ authoring; diagnosis is not currently sufficient for WA State DOH’s RCKMS specification. All other conditions in question would be affected by timeboxing selection.  

As for the additional conditions we have suggested; a duration of 6 weeks may be considered for m-pox pertussis. This would only be necessary if option 1 was followed (which we do not prefer). 

Q5: Each condition should have a unique duration, though some may overlap.  

Q6: Is there a means to which the checkbox for timeboxing could be automated under a set of emergency preparedness calculations? Might there be an additional review period following the initial rollout, prior to additional implementation, to support further feedback from SME’s.