Electronic Message Staging Area (EMSA) provides extensive configurability to determine the outcome of incoming electronic laboratory (ELR) test data and electronic case reporting (eCR) on several levels. By customizing the intake of the ELR or eCR, the EpiTrax surveillance system is positioned to meet investigational and reporting needs. All of these configurations are controlled by the jurisdiction and do not require vendor intervention.
EMSA standardizes the data being sent by the reporting entity.
At the condition level, the system can be configured to:
- Always or never accept messages for the condition
- Always create a new case, never create a new case, or set a date range for when a new case is created
- Add the information to a contact case or never add to the contact case
Cross-reference rules allow a message to be entered into either case that the patient has in EpiTrax rather than creating a new case for the cross-referenced condition.
At the test level, LOINC codes and SNOMED codes are configured at both the EMSA master level and the individual reporter level.
Master Level LOINC Configuration
Master LOINC codes for the test performed are configured to identify the condition and organism or, in the case of a culture test, to examine the SNOMED or organism code to determine the condition.
List indicators also determine the workflow for the LOINC code:
- White list — The message should follow through for processing.
- Gray list — The report message should be held without creating a case until another report message is processed with case creating configurations. Once the case is created, the held report would also be imported into the case. (That is, if a hepatitis report is received which doesn’t indicate the disease, the test would be held until the hepatitis confirmatory report is received.)
EMSA allows you to decide whether to create a new case, update an existing case, close the case on creation, or set the state case status (e.g. positive, negative, indeterminate, specimen not suitable for evaluation, etc.) based on the incoming master LOINC code.
Reporter (Child) Level Configuration
- At the reporter LOINC level, each LOINC has its own rules to interpret the result sent in the message.
- Both qualitative and quantitative results are handled at the reporter level.
- LOINCs at the reporter (child) level are interpreted to determine the positivity and are linked back to the master LOINC. This gives the jurisdiction flexibility to receive non-LOINC codes to identify the test for those reporters which have not been able to convert their systems to LOINC code-based reporting.
- Each LOINC can have their own workflow to accommodate reporters where the jurisdiction feels that the particular test needs to be examined by staff before importing. Others can be automatically processed.
- Qualitative results look to the master LOINC to determine the rule for case creations. Quantitative results first interpret the numeric value in the result to link the positivity in the master LOINC.
SNOMED Level Configuration
- Master SNOMED codes store both organism and test SNOMED codes. A LOINC culture test cannot determine the condition and case creation rules until the organism is examined. The master SNOMED can store both the SCT and previously used SNM to allow those reporters who may have not updated their codes and multiple SNOMED codes can be stored for an organism.
- The condition is identified at the master SNOMED level as well as the list and test result.
- Case creation rules are also at the master SNOMED level.
- Stored ICD codes determine the disease reported by the physician/provider.
- ICD codes can determine the pregnancy of the patient.
- Create or update existing events are determined by ICD codes.