RCMT Mapping Overview

Jeremiah SableConsultant, The St. John Group

Contractor to APHL

What problem do the RCMTs solve?

Which test results are of public health interest?

Lab Test results

Consumer of lab data

Filtering the output of clinical labs

RCMT tables can identify tests and results of public health interest.

RCMTfilter

Lab Test results Reportable

Non reportable

Consumer of lab data

Within a public health agency

Test results

Public health agency

TB

STD

Foodborne

Hepatitis

etc.

RCMT

Routing test results within an agency

The problem of non-comparable lab data

It isn’t possible to map the test catalog of each lab to reportable conditions.

Each lab has its own codes and names for lab tests. There is

no consistency across labs.

ARUP labs

LabCorp

Mayo labs

etc....

Quest labs

LOINC enables data aggregation across labs

It is possible to map LOINC tests to reportable conditions.

ARUP labs

LabCorp

Mayo labs

etc....

Quest labs

This problem disappears when labs send LOINC codes along

with their own codes.

LOINC

LOINC

LOINC

LOINC

LOINC

RCMT mappings for LOINC and SNOMED

The RCMT contains mappings of LOINC lab tests and SNOMED organism codes to reportable conditions. The following slides describe the RCMT mappings for two types of LOINC codes:

•Specific lab tests •Nonspecific lab tests

Specific LOINC mappings

These four LOINCs are examples of condition-specific tests.• Rabies and Giardiasis are reportable conditions and these LOINCs are in the RCMT• Aspergillosis and Filariasis are not reportable and these LOINCs are not in the RCMT

loinc_num component property system scale method This is a test for6524-3 Rabies virus Ab ACnc Ser Qn Neut Rabies6412-1 Giardia lamblia Ag ACnc Stool Ord EIA Giardiasis10645-0 Aspergillus fumigatus Ag ACnc Tiss Ord IF Aspergillosis59850-8 Wuchereria bancrofti Ag ACnc Ser Qn EIA Filariasis

Condition-specific LOINCs

Specific LOINC mappings

loinc_num component property system scale method This is a test for6524-3 Rabies virus Ab ACnc Ser Qn Neut Rabies6412-1 Giardia lamblia Ag ACnc Stool Ord EIA Giardiasis10645-0 Aspergillus fumigatus Ag ACnc Tiss Ord IF Aspergillosis59850-8 Wuchereria bancrofti Ag ACnc Ser Qn EIA Filariasis

All LOINCs that are specific tests for reportable conditions are in the RCMT.

Lab RCMTfilter

not reportable

6524-3 6412-1

reportable

10645-0 59850-8

Condition-specific LOINCs

These four LOINCs are examples of condition-specific tests.• Rabies and Giardiasis are reportable conditions and these LOINCs are in the RCMT• Aspergillosis and Filariasis are not reportable and these LOINCs are not in the RCMT

Specific LOINC mappings

Examples of RCMT rows for condition-specific LOINCs

loinc_num component system scale_typ method_typ Condition name6412-1 Giardia lamblia Ag Stool Ord EIA Giardiasis14210-9 Giardia lamblia Ag Stool Ord IF Giardiasis60544-4 Giardia lamblia DNA XXX Ord Probe.amp.tar Giardiasis... 47260-5 Plasmodium sp DNA Bld Nom Probe.amp.tar Malaria56968-1 Plasmodium sp Ab Ser Ord IF Malaria10711-0 Plasmodium vivax Ag Bld Qn IF Malaria... 6523-5 Rabies virus Ab CSF Qn Neut Rabies23390-8 Rabies virus Ag Brain Ord Immune stain Rabies51647-6 Rabies virus RNA XXX Ord Probe Rabies... 57320-4 Trypanosoma cruzi Ab Ser Ord EIA Chagas disease51827-4 Trypanosoma cruzi Ab.IgM Ser Qn EIA Chagas disease49801-4 Trypanosoma cruzi DNA Bld Ord Probe.amp.tar Chagas disease...

The RCMT maps these tests to reportable conditions, regardless of the test results• The RCMT does not include reporting criteria for condition-specific LOINCs• The RCMT has many tests that are not in the case definitions (e.g., Plasmodium sp Ab)

Nonspecific LOINC mappings

loinc_num component property system scale method Reportable?600-7 Bacteria identified Prid Bld Nom Culture ?14489-9 Virus identified Prid Bld Nom IF ?10701-1 Ova+Parasites identified Prid Stool Nom Concentration ?

These nonspecific LOINCs are are too general to be associated with specific conditions. • The results of these tests can indicate many different conditions (or no condition)• For these LOINCs the RCMT maps the test results (organisms) to reportable conditions• This is why the RCMT contains SNOMED organism codes for each reportable conditions

Some nonspecific LOINCs

Nonspecific LOINC mappings

loinc_num component property system scale method Reportable?600-7 Bacteria identified Prid Bld Nom Culture ?14489-9 Virus identified Prid Bld Nom IF ?10701-1 Ova+Parasites identified Prid Stool Nom Concentration ?

Some nonspecific LOINCs

Lab RCMT filter

Nonspecific LOINCs

Look at result

reportable

not reportable

These nonspecific LOINCs are are too general to be associated with specific conditions. • The results of these tests can indicate many different conditions (or no condition)• For these LOINCs the RCMT maps the test results (organisms) to reportable conditions• This is why the RCMT contains SNOMED organism codes for each reportable conditions

Nonspecific LOINC mappings

RCMT value set LOINCs for...PHVS_LabTestName_Bacteria Bacteria nonspecificsPHVS_LabTestName_Fungus Fungus nonspecificsPHVS_LabTestName_Parasite Parasite nonspecificsPHVS_LabTestName_Virus Virus nonspecificsPHVS_LabTestName_AcidFastStain Acid fast bacillus nonspecifics

RCMT value sets of nonspecific LOINCs

loinc_num component system scale method RCMT value set Reportable?600-7 Bacteria identified Bld Nom Culture Bacteria look at result17928-3 Bacteria identified Bld Nom Aerobic culture Bacteria look at result...10701-1 Ova+Parasites identified Stool Nom Concentration Parasites look at result43227-8 Ova+Parasites identified Stool Nom Trichrome stain Parasites look at result...14489-9 Virus identified Bld Nom IF Virus look at result14488-1 Virus identified CSF Nom IF Virus look at result...

The RCMT includes more than 400 nonspecific LOINCs

Nonspecific LOINC mappings

Examples of RCMT rows for nonspecific LOINCs

Concept Code Concept Name Reportable condition4716008 Entamoeba histolytica Amebiasis110390006 Entamoeba histolytica cysts Amebiasis110389002 Entamoeba histolytica trophozoites Amebiasis ... 420364006 Anaplasma phagocytophilum Anaplasma phagocytophilum131419006 Anaplasma species Anaplasma phagocytophilum ... 9194001 Jamestown Canyon virus Arbovirus infection61399004 Keystone virus Arbovirus infection30434006 La Crosse virus Arbovirus infection57311007 West Nile virus Arbovirus infection ... 76828008 Babesia microti Babesiosis86432002 Babesia divergens Babesiosis ...

For nonspecific LOINCs the RCMT has SNOMED organism lookup tables for the test results

Summary of RCMT mappings to reportable conditions

Lab RCMT filter

Nonspecific LOINCs

Look at result

reportable

not reportable

Specific LOINCs

reportable

not reportable

This diagram summarizes how the RCMT can be used to filter data coming out of a lab

RCMT contact information

RCMT Planning Team E-mail: PHINVS@CDC.GOV

RCMT Website (phConnect) : http://www.phconnect.org/group/rcmt