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Valueset for Y/N/U - Use PHINVADS valueset (Y/N from HL70136 and UNK from V3 Nullflavor) that is used for Case notifications: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888.  U is replaced with UNK below, except as noted in the implementation guidance.

Note that the following OBX fields are not usually expected for AOEs:

OBX-6 Units, except for Patient Age (and any other AOEs that might require units of measure)

OBX-7 Reference Range

OBX-8 Interpretation code

OBX-17 and -18 Method/Device

OBX-19 Analysis date/time

When populating OBX-23 Performing organization name, OBX-24 Performing organization address and OBX-25 Performing organization medical director should be valued with the appicable information for the provider organization that collected the data.

SeqNameOptionalityDefinitionAllowable AnswersImplementation GuidanceComments
1

First test

Suggest to HHS to change to: Whether this is the patient's first test for the condition of interest


RE-HHSPatient's first test for the condition of interest that is being ordered.Y/N/UNKOBX-2 = CWE
OBX-3 = 95417-2^First test for condition of interest^LN
OBX-5 OBX-5 can be one of:
Y^Yes^HL70136
N^No^HL70136
UNK^Unknown^NULLFL
OBX-11 = F
OBX-14 = Date question was answered
OBX-29 = QST

LOINC: 95417-2^Whether this is the patient's first test for the condition of interest^LN

Questions for HHS:

  • What is the intent of its use and does the patient have to answer it?
  • Is this for the exact test code ordered, or the type of order?  If the latter, what types do we need to consider like or different?  E.g. if a provider is ordering a COVID-19 serology test, but the patient has had a PCR test done in the past, would we say Y or N?  
  • Is this only for tests ordered within that organization, or ordered anywhere anytime?  E.g., since it’s possible that the patient has had other tests through other means (e.g. walk-up clinics, or at a separate ED, etc.)?
  • Is it relevant for previous test for diagnostic, screening, or research.
  • Is there clarification between first diagnostic test and first screening test?
2

Employed in healthcare?

Suggest to HHS to change to: Whether patient is employed in a healthcare setting


The main focus is on patients who work in a high-risk setting with patients who could be a super spreader. (first responders, front line clinicians, environmental staff, therapists, in direct contact with patients or in their location).

Y/N/UNK


OBX-2 = CWE
OBX-3 =  95418-0^Employed in a healthcare setting^LN
OBX-5 OBX-5 can be one of:
Y^Yes^HL70136
N^No^HL70136
UNK^Unknown^NULLFL
OBX-11 = F
OBX-14 = Date question was answered
OBX-29 = QST

LOINC: 95418-0^Whether patient is employed in a healthcare setting^LN


3

Symptomatic as defined by CDC?

Suggest to HHS to change to: Whether patient has symptoms related to condition of interest

RE-PHA, RE-HHSSymptomatic per current CDC guidance at time of order for the reportable condition/illnessY/N/UNKOBX-2 = CWE
OBX-3 = 95419-8^Has symptoms related to condition of interest^LN
OBX-5 OBX-5 can be one of:
Y^Yes^HL70136
N^No^HL70136
UNK^Unknown^NULLFL
OBX-11 = F
OBX-14 = Date question was answered
OBX-29 = QST

LOINC: 95419-8^Whether patient has symptoms related to condition of interest^LN


4

Date of Symptom Onset

Suggest to HHS to change to: Illness or injury onset date and time 

C-PHA, C-HHS

Condition: If Symptomatic is Y.mm/dd/yyOBX-2 = DT
OBX-3 = 11368-8^Illness or injury onset date and time^LN
OBX-5 = formatted as YYYYMMDD
OBX-11 = F
OBX-14 = Date question was answered
OBX-29 = QST

LOINC: 11368-8^llness or injury onset date and time^LN

5

Hospitalized?

Suggest to HHS to change to: Whether patient was hospitalized because of this condition


RE-PHA, RE-HHS

Patient has been hospitalized for the reportable illness/condition that this order has been placed for (suspected or diagnosed)

When ordered during ER duration, the answer would be N.


OBX-2 = CWE
OBX-3 =  77974-4^Patient was hospitalized because of this condition^LN
OBX-5 OBX-5 can be one of:
Y^Yes^HL70136
N^No^HL70136
UNK^Unknown^NULLFL
OBX-11 = F
OBX-14 = Date question was answered
OBX-29 = QST

LOINC: 77974-4^Whether patient was hospitalized because of this condition^LN


When interested in whether hospitalized at time of order, use PV1-2 (Patient Class).

6

ICU?

Suggest to HHS to change to: Whether patient was admitted to intensive care unit for condition of interest

RE-PHA, RE-HHS

Patient has been admitted/transferred to the ICU at any time during the encounter for the reportable illness/condition that the order has been placed for (suspected or diagnosed).

Y/N/UNKOBX-2 = CWE
OBX-3 =  95420-6^Admitted to intensive care unit for condition of interest^LN
OBX-5 OBX-5 can be one of:
Y^Yes^HL70136
N^No^HL70136
UNK^Unknown^NULLFL
OBX-11 = F
OBX-14 = Date question was answered
OBX-29 = QST

LOINC: 95420-6^Whether patient was admitted to intensive care unit for condition of interest^LN

When interested in whether in ICU at time of order, use PV1 location/organization providing care.

7

Resident in a congregate care setting (including nursing homes, residential care 
for people with intellectual and developmental disabilities, psychiatric treatment 
facilities, group homes, board and care homes, homeless shelter, foster care or other setting)

Suggest to HHS to change to:  Whether patient resides in a congregate care setting

RE-PHA, RE-HHS

This is at time of exposure where they normally live.Y/N/UNKOBX-2 = CWE
OBX-3 =  95421-4^Resides in a congregate care setting^LN
OBX-5 OBX-5 can be one of:
Y^Yes^HL70136
N^No^HL70136
UNK^Unknown^NULLFL
OBX-11 = F
OBX-14 = Date question was answered
OBX-29 = QST

LOINC: 95421-4^Whether patient resides in a congregate care setting^LN

8Pregnant?C-PHA, C-HHS

Condition: If patient is female

Current pregancy status of the patient

Pregnant, Not pregnant, UnknownOBX-2 = CWE
OBX-3 =   82810-3^Pregnancy status^LN
OBX-5 = can be one of:
77386006^Patient currently pregnant^SCT
102874004^Possible pregnancy^SCT
60001007^Not pregnant^SCT
UNK^Unknown^NULLFL
OBX-11 = F
OBX-14 = Date question was answered
OBX-29 = QST

LOINC: 82810-3 Pregnancy status

LOINC from https://loinc.org/sars-cov-2-and-covid-19/

9

Patient age



C-PHA, RE-HHS

For reporting from PHA to HHS (CDC), when DOB may not be included or in ELR, when DOB is not available.

Condition for PHA: If Patient Date of Birth is not available or cannot be calculated correctly to reflect the age at time of order, then include the age at time of specimen collection using the methodless LOINC (30525-0^Age^LN).


Send as AOE OBX:

OBX-2 = NM (can be SN)
OBX-3 = 30525-0^Age^LN
OBX-5 = numeric value
OBX-6 = age units in UCUM as applicable - expected as years => a^year^UCUM
other options:
months => mo^month^UCUM
days => d^day^UCUM
hours => h^hour^UCUM
OBX-29 = QST

Questions for HHS:

Can HHS accept DoB and figure out the age so we don't need to calculate? 

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