ISDS Annual Conference Proceedings 2017. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution,  
and reproduction in any medium, provided the original work is properly cited.

ISDS 2016 Conference Abstracts

Mapping Laboratory Reports to Illinois’ Extensively 
Drug-Resistant Organism Registry
Emily Augustini*1, William Trick2 and Stacey Hoferka1
1Office of Health Protection, Division of Infectious Diseases, Illinois Department of Public Health, Chicago, IL, USA; 2Cook County 
Health & Hospitals System, CDC Prevention Epicenters Program, Chicago, IL, USA

Objective
To streamline carbapenem-resistant enterobacteriaceae (CRE) 

surveillance by integrating electronic laboratory reporting (ELR) 
data and electronic case reports (eCR) automatically into Illinois’ 
extensively drug-resistant organism (XDRO) registry.

Introduction
CRE are drug-resistant bacteria that have a mortality rate of up to 

50% in those infected1. Several clusters of CRE have been detected in 
Illinois, often in long-term acute care hospitals2. In response Illinois 
created the XDRO registry, a mandatory reporting system designed 
to aid inter-facility communication concerning CRE.

Despite being a high priority for control in the US, the case 
definition for CRE has been the subject of debate3. There are over 
70 Enterobacteriaceae which can have different mechanisms of 
carbapenem resistance3. Criteria for carbapenem resistance include 
susceptibility results, and phenotypic or genotypic detection. The 
case definition for the XDRO registry is intentionally more exclusive 
(specific) than that used by CSTE (Table 1). CSTE utilizes a 
definition designed to maximize sensitivity. Illinois’ XDRO registry’s 
definition is more specific, meant to reduce unnecessary adoption of 
contact precautions and the negative consequences some patients may 
experience.

Currently, case reporting to the XDRO registry is a manual data 
entry process, which has important advantages. However, transitioning 
to automatic ELR integration will streamline the reporting process 
and minimize data entry effort. Unfortunately, the clinical information 
needed to investigate XDROs is often not captured by ELR. The eCR 
is a new message type being piloted in Illinois that contains many 
clinical data elements. We examined the feasibility of combining ELR 
and eCR into reports for the XDRO registry. In the construction of 
these reports we examined the impact of using CRE definitions from 
CSTE and the XDRO registry.

Methods
We obtained sample HL7 CRE messages from Illinois’ ELR 

database. Using these messages and the HL7 Implementation Guide 
for Electronic Laboratory Reporting, we mapped ELR fields to those 
in the XDRO registry. Specific codes corresponding to the registry 
fields were found though a systematic keyword search of LOINC, 
SNOMED, and sample messages. When there was no match for an 
XDRO field in ELR, we referred to the HL7 CDA Implementation 
Guide for the Electronic Initial Case Report and sample eCR 
messages. A collection of fields and codes was created to correspond 
to both the CSTE and Illinois CRE case definition.

Results
The XDRO registry has 37 unique fields. Twenty-six can be 

populated from ELR, four can be found in the eCR, and seven are 
generated within the system. In sample ELR and eCR messages all of 
the necessary fields were populated with appropriate text and codes. 
The mapping process was straightforward for demographic and 
facility information, but more complicated for culture and organism 
information. Some XDRO tests do not have corresponding LOINC 

or SNOMED codes, so we will develop a logic statement to fill these 
based on free-text. Addition of the eCR adds important information 
to the registry report, notably encounter type and encounter/admission 
date. We were able to create separate mapping schemas for the 
CSTE and XDRO registry definitions for CRE. Using each of these 
definitions, we will quantify how many ELR messages would be 
committed to the XDRO registry.

Conclusions
By combining the data captured in ELR and eCR, it is possible to 

populate the fields of the Illinois XDRO registry. When this merge is 
completed it should result in more complete and better quality data 
on CRE in Illinois. As intended, the definition of CRE used by the 
registry is less inclusive than that used by CSTE. Future work will 
show the number of CRE lab results captured by each definition.

Table 1: CRE Definition

Keywords
CRE; Data Mapping; ELR; eCR

Acknowledgments
Project SHINE

References
1. Centers for Disease Control and Prevention (CDC). (2015). CRE

Toolkit: Facility Guidance for Control of Carbapenem-resistant
Enterobacteriaceae. Atlanta, Georgia: CDC.

2. Trick, W. E., Lin, M. Y., Cheng-Leidig, R., Driscoll, M., Tang, A. S.,
Gao, W., Weinstein, R. A. (2015). Electronic Public Health Registry 
of Extensively Drug-Resistant Organisms, Illinois, USA. Emerging 
Infectious Diseases. 21(10):1725-1732.

3. Council of State and Territorial Epidemiologists (CSTE). (2015).
Standardized definition for Carbapenem-resistant Enterobacteriaceae
(CRE) and recommendation for sub-classification and stratified
reporting. 15-ID-05.

*Emily Augustini
E-mail: emily.augustini@illinois.gov

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 9(1):e44, 2017