Even a cursory review of the antimicrobial resistant content in the organism hierarchy suggests that it could be used to facilitate flagging of antimicrobial resistant organism isolates for antimicrobials of specific, even dire, concern. Some editing is in order as described in documents posted for the November 2018 - OIDM Meeting. What is less clear is how this content might be logically (and automatically) associated with clinical laboratory reports of actual isolates. Without a use case or two, it's very difficult to determine what content should or shouldn't be present and how it should be organized. Any "applications" lurking out there that we should be thinking about? Does this content actually get used?
5 Comments
Sheila Abner
Below are organisms used in CDC’s National Healthcare Safety Network surveillance system for reporting healthcare-associated infections:
Jeff Wilcke
What's the use case for these? Who selects them, sends them, receives them, uses them... ?
Matt Cordell
The immediate use case would be so that concepts such as |Infection caused by resistant organism (disorder)| and subtypes could be defined. (Though not many are).
Though I agree it's not clear what the clinical use for organism codes might be. When I was in micro (pre snomed), we just reported the organism identified e.g. "Staph. Aureus". And if the resistance pattern matched, our CDC would be notified. We may have made a comment that the "Staph isolated was MRSA" - for which the above codes could be used. These comments may have triggered the notification. It's LIS dependent. Though arguably, a finding code could also be appropriate.
There's an antimicrobial stewardship program here, that I think leverages organism codes for its triggers and advice.
Jeff Wilcke
The immediate use case is likely what established this group of concept classes, I suspect the general "antimicrobial resistant organism, antimicrobial resistant bacteria + many of the methicillin resistance concepts were created to support the disorder hierarchy. I suspect that the newer vancomycin and carbapenem concept classes came from the outside (fewer of these used in defining other content I think).
I'm hoping to find use cases that motivate the "Member Forum" - changing, enhancing etc. requires resources we are not afforded.
Your "comments may have triggered the notification" statement comports with a reporting requirement. Sheila's email confirms that public health organizations like CDC are "using" the one-drug-one-bug content. In order to describe the use-case adequately, I need details. Do laboratories transmit these? Are these transmitted internally? An of this in response to mandate? What are they used for?
For me, the clinical question is about automation. Is anyone "translating" actual lab reports of susceptibility into organism - drug pairs? Could be serving the "reporting" use case above, could be something entirely different. Do we need to anticipate a model to support an automation use case?
Sheila Abner
For the NHSN use case, users (healthcare facilities) reporting healthcare-associated infections requested selected drug resistant organisms to be made available in the pathogens Value Set / pick list. For analysis and reporting purposes, the 3 drug resistant Klebsiella pneumoniae organisms displayed below are aggregated in the same bucket of data based on the root 'NHSN Code' without the *#.