Newly Proposed Variables for the

National Notifiable Diseases Surveillance System

July11, 2012

Introduction:

This document includes two sections describing newly proposed variables for the National Notifiable Diseases Surveillance System (NNDSS). Section one includes descriptions for seven newly proposed Generic variables. Section twoincludes a description of a newly proposed disease-specific variable for measles, mumps, rubella, and congenital rubella syndrome,related to the sub-classification of US-acquired cases, as per the national surveillance case definition for the specified conditions. This document also demonstrates modeling of vocabulary and message construct using HL7 Case Notification for Nationally Notifiable Conditions specifications.

Section 1: Newly Proposed Generic Variables

The newly proposed generic variables we want your comments on include: Birth Country (DEM126); Country of Usual Residence (INV501), Binational reporting criteria (INV515), and four location of potential exposure questions which are included in a repeating block (INV502, INV503, INV504, INV505). Descriptions of these variables are as follows:

Birth Country:

PHIN UID / Label/Short Name / Description / Data
type / Value Set Name and Notes
DEM126
(cannot repeat) / Birth Country / Patient’s country of Birth / CWE / PHVS_CountryOfBirth_CDC
(will include all current and former countries and U.S. territories)

Country of Usual Residence:

This variable replaces the Foreign Resident variable mentioned in CSTE Position Statement 11-SI-04 titled “Revised Guidelines for Determining Residency for Disease Reporting” located at:

PHIN UID / Label/Short Name / Description / Data
type / Value Set Name
INV501
(cannot repeat) / Country of UsualResidence / Where does the personusually* live (defined as their residence)
*For the definition of ‘usual residence’ refer to CSTE position statement # 11-SI-04 titled “Revised Guidelines for Determining Residency for Disease Reporting” at . / CWE / PHVS_CountryOfBirth_CDC
(will include all current countries, US territories, and an Unknown value )

NOTE: The following algorithm will be used to identify the cases to be included in state-specific counts and rates in the MMWR: Cases with country of usual residence equal to the US, Puerto Rico, and U.S. Virgin Islands as well as unknown and null responses will be included in the state-specific counts and rates. In the MMWR, the US total for the condition will include all cases, including those excluded because they were non-US residents (in other words, they resided in any Country outside of the US, Puerto Rico and U.S. Virgin Islands, which collectively represent the US).

Binational Reporting Criteria (single PHIN UID with repeating observation value)

NOTE: The binational reporting criteria field (INV515) has not been approved by CSTE and won’t be implemented until CSTE approves it. We would, however, like to receive local and state comments about this field, in preparation for submission of a revised CSTE position statement about binational reporting.”

PHIN UID / Label/Short Name / Description / Data
type / Value Set Name and Notes
INV515 / Binational Reporting Criteria / For cases meeting the binational criteria, select all the criteria which are met / CWE / PHVS_BinationalReportingCriteria_CDC New value set with the following:
  • Potential exposure in Mexico or Canadaanother country
  • Resident of Mexico or Canada another country
  • Has case contacts from Mexico or Canada another country
  • Exposure to a suspected product from Mexico or Canada another country
  • Other reason (all criteria not fitting into the categories listed above)

Example HL7 message using this implementation.

Example HL7 message usingBinational Reporting Criteria: single observation value; new value set

OBX|1|CWE|INV515^Binational Reporting Criteria^2.16.840.1.114222.4.5.232||xxx^Potential exposure in another country^xxxOID^4^5^L^7^8^9||||||F

Example HL7 message usingBinational Reporting Criteria: single observation value; new value set; use of the 9th component

OBX|1|CWE|INV515^Binational Reporting Criteria^2.16.840.1.114222.4.5.232||xxx^Other Reason^xxxOID^4^5^L^7^8^Other reason free text goes here||||||F

Example HL7 message using Binational Reporting Criteria: repeating observation value denoted by ~; new value set

OBX|1|CWE|INV515^Binational Reporting Criteria^2.16.840.1.114222.4.5.232||xxx^Potential exposure in another country^xxxOID~xxx^ Resident of another country ^xxxOID ||||||F

Exposure Questions (where was disease acquired)

For the question regarding exposure, the below summarizes the recommendation at this point. The information would be presented as a repeating block in the generic guide. This series of questions about location of potential exposure would NOT replace the imported fields currently in the Generic guide.

Note: A repeating block is more desirable in this situation than a repeating observation because the only way to tie the specific variables together would be manual, if it could be done at all (and subject to human error). In addition, it is better to do a more generic question with a specific answer as a repeating block instead of asking specific questionwith generic responses. An example of a specific question and a generic response is as follows: Was the patient exposed in the US? Y/N, Was the patient exposed in Canada? Y/N, was the patient exposed in Mexico? Y/N, etc.). With the number of countries in existence, asking specific questions would be very tedious.

Repeating Block (uses OBX -4 Observation Sub-ID)to relate the observations to one another – see sample message below
PHIN UID / Label/Short Name / Description / Data
type / Value Set Name and Notes
INV502
New PHIN UID / Country of Exposure or Country Where Disease was Acquired
Note: use exposure or acquired consistently across variables / Indicates the country in which the disease was potentially acquired. / CWE / PHVS_CountryOfBirth_CDC
Note: US Territories are treated as countries for the purpose of this question.
INV503
new PHIN UID / State or Province of Exposure / Indicates the state in which the disease was potentially acquired.
Business Rule: If Country of exposure was US, populate with US State. If Country of exposure was Mexico, populate with Mexican State. If country of exposure was Canada, populated with Canadian Province. For all other countries, leave null. / CWE / PHVS_State_FIPS_5-2
Note: Need to expand value set to include Mexican States and Canadian Provinces
INV504
new PHIN UID / City of Exposure / Indicates the city in which the disease was potentially acquired.
Business Rule: If country of exposure is US, populate with US city. For all other cities, can be populated but not required.
Note: Since value set only includes US cities, would allow states to populate the CWE 9th component with another city. / Text / Free text field
INV505
new PHIN UID / County of Exposure / Indicates the county in which the disease was potentially acquired.
Business Rule: If country of exposure is US, populate with US county. Otherwise, leave null. / Text / Free text field

Example HL7 message using this implementation.

A patient waspotentially exposed in the following locations:

In Ontario, Canada

OBX|30|CWE|INV502^Country of Exposure or Country Where Disease was Acquired

^2.16.840.1.114222.4.5.232||CAN^Canada^2.16.840.1.113883.12.136^4^5^L^7^8^9||||||F

OBX|31|CWE|INV503^State or Province of Exposure^2.16.840.1.114222.4.5.232||224020003^Ontario^SNOMED-CT^4^5^L^7^8^9||||||F

OBX|32|ST|INV504^City of Exposure^2.16.840.1.114222.4.5.232||City of ExposureFree text field||||||F

OBX|33|ST|INV505^County of Exposure^2.16.840.1.114222.4.5.232||County of ExposureFree text field||||||F

In US, Georgia, Macon, Bibb

In US, Georgia, Warner Robbins, Houston

OBX|30|CWE|INV502^Country of Exposure or Country Where Disease was Acquired

^2.16.840.1.114222.4.5.232|1|USA^UnitedStates^2.16.840.1.113883.12.136^4^5^L^7^8^9||||||F

OBX|31|CWE|INV503^State or Province of Exposure^2.16.840.1.114222.4.5.232|1|13^Georgia^2.16.840.1.113883.6.92^4^5^L^7^8^9||||||F

OBX|32|ST|INV504^City of Exposure^2.16.840.1.114222.4.5.232|1|Macon||||||F

OBX|33|ST|INV505^County of Exposure^2.16.840.1.114222.4.5.232|1|Bibb||||||F

OBX|34|CWE|INV502^Country of Exposure or Country Where Disease was Acquired

2.16.840.1.114222.4.5.232|2|USA^United States^2.16.840.1.113883.12.136^4^5^L^7^8^9||||||F

OBX|35|CWE|INV503^State or Province of Exposure^2.16.840.1.114222.4.5.232|2|13^Georgia^2.16.840.1.113883.6.92^4^5^L^7^8^9||||||F

OBX|36|ST|INV504^City of Exposure^2.16.840.1.114222.4.5.232|2|Warner Robins||||||F

OBX|37|ST|INV505^County of Exposure^2.16.840.1.114222.4.5.232|2|Houston||||||F

In Some Mexican State, Mexico (shows use of the 9th component)

OBX|26|CWE|INV502^Country of Exposure or Country Where Disease was Acquired

^2.16.840.1.114222.4.5.232||MEX^Mexico^2.16.840.1.114222.4.11.828^4^5^L^7^8^9||||||F

OBX|27|CWE|INV503^State or Province of Exposure^2.16.840.1.114222.4.5.232||MX-Col^Colima^ 2.16.840.1.114222.4.11.3286^4^5^L^7^8^9||||||F

OBX|28|ST|INV504^City of Exposure^2.16.840.1.114222.4.5.232||A small town near Mexico City||||||F

OBX|29|ST|INV505^County of Exposure^2.16.840.1.114222.4.5.232||County of Exposure Free text field||||||F

Section 2: Newly Proposed Variable for the Sub-classification of US Acquired Cases, as per the National Surveillance Case Definitions for Measles, Mumps, Rubella, and Congenital Rubella Syndrome

PHIN UID / Label/Short Name / Description / Data
type / Value Set Name and Notes
INV516
New PHIN UID / US Acquired / Sub-classification of disease or condition acquired in the US
Business Rule: this variable should only appear if the answer to INV152
(Case Disease Imported Code) is one of the following:
PHC244 (Indigenous, within jurisdiction),
PHC245 (out of jurisdiction, from another jurisdiction within state), or
PHC246 (out of state), or
The NETSS imported variable is
Coded 1 (Indigenous – acquired in the USA in reporting jurisdiction) or
Coded 3 (Out of State – but in the USA and outside the reporting state). / CWE / PHVS_CaseClassification
ExposureSource_NND:
Import-linked case,
Imported-virus case,
Endemic case,
Unknown source case

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