VA-NATIONAL EPI LAB EXTRACT (41)    REMINDER DEFINITION (811.9)

Name Value
NAME VA-NATIONAL EPI LAB EXTRACT
PRINT NAME National Hepatitis Lab Extract
CLASS NATIONAL
USAGE C
DESCRIPTION
This reminder is used to identify and extract data to send to the
The reminder will extract laboratory data for patients who have any of the
such, surveillance for both acute and chronic diseases is important.  In
order for the VHA to do surveillance for these diseases, we are looking
for laboratory evidence of  infection with Hepatitis B.  This laboratory
evidence of infection includes the following standard serological markers:
        Presence of the Hepatitis B surface antigen
        Presence of antibodies against the Hepatitis B core antigen (in
           particular, the IgM antibody)
        Presence of antibodies against the Hepatitis B surface antigen
        Presence of the Hepatitis B e antigen.
 
findings listed in the patient cohort logic.  There are 9 laboratory
These are not all of the tests that can be done for Hepatitis B, but they
are the ones likely to pick up acute cases (new) or those chronic cases
that are likely to be infectious to other persons.  Please list only those
tests at your facility that are in keeping with what addresses the EPI
Hepatitis B target data-acute cases, or those cases likely to be
infectious to others.  
 
Note:  There are advanced polymerase chain reaction (PCR) based tests that
can measure the amount of virus in the bloodstream.  These are not done at
all sites and have not yet been FDA approved.  As such, these PCR tests
reminder terms in the patient cohort logic:
will not be used for case determination.
 
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Hepatitis C laboratory tests:
 
Data collected for Hepatitis C is based on the following national reminder
terms:
         HEP C VIRUS ANTIBODY NEGATIVE    
         HEP C VIRUS ANTIBODY POSITIVE    
                
     HEP C VIRUS ANTIBODY POSITIVE
Background: 
It is important to identify what differences there are in those
people who are positive for Hepatitis C antibody as opposed to those who
do not have Hepatitis C antibody present.  Therefore, please review those
results that you have designated to be placed into the Hepatitis C
Antibody Positive portion of the EPI.  Be sure that they truly meet the
definition, as noted in this Reminder definition and the related Reminder
Term definitions.
 
All the results of Hepatitis C antibody testing that are not considered
     HEP C VIRUS ANTIBODY NEGATIVE
"positive" need to be mapped as "negative". Therefore, all of the
Hepatitis C antibody results that your facility reports will be mapped to
either the HEP C VIRUS ANTIBODY POSITIVE reminder term or the HEP C VIRUS
ANTIBODY NEGATIVE reminder term. reminder term.  Not positive terms may
include "negative," "indeterminant," "indeterminate," "undetectable."  As
with the Hepatitis C Antibody Positive component, be sure phrases that
truly differentiate results are used (e.g. the results of "present" and
"not present" are not truly differentiated by computer retrieval as both
contain the word "present").
 
     HAV Ab positive
TIP on Positive and Negative Conditions to define for laboratory tests:
When defining the condition for the negative results, you could use the
same text that was used for the positive results, but add '= (not equal)
or '[ (not contain), instead of the = or [.
     HAV IgM Ab positive
     HAV IgG positive
     HBs Ag positive
     HBc Ab IgM positive
national EPI database.  The data extracted includes Hepatitis A, B, and C
     HBs Ab positive
     HBe Ag positive
 
 
If the patient data had one of these lab tests in the extract month, the
lab test data will go to Austin. When one of the labs above is found, the
most recent test for the following lab tests will be sent to Austin:
         TRANSFERASE (AST) (SGOT)
         ALANINE AMINO (ALT) (SGPT)
         BILIRUBIN 
laboratory tests.  This reminder is not for daily clinical care.  It is
 
What resolves this reminder?
This reminder does not have any resolution findings so it will always be
due.  This allows sites to use the reminder to report on patients who
have data updating the EPI national database. 
 
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Hepatitis A Laboratory Tests:
 
Data collected for Hepatitis A is based on the following national reminder
used by an EPI patch, LR*5.2*260, to identify new data to send to the AAC
terms which are patient cohort findings in the reminder:
        HAV Ab positive         Hepatitis A virus antibody total positive
        HAV IgM Ab positive     Hepatitis A virus antibody immunoglobulin
                                        M positive
        HAV IgG positive        Hepatitis A virus antibody immunoglobulin
                                        G positive
 
Background:
One of the goals of the Healthy People 2000 and 2010 initiatives of the
Department of Health and Human Services is to decrease certain infectious
EPI national database. Sites may use this reminder in the reminder reports
diseases, especially those that are vaccine preventable.  Acute infection
with Hepatitis A is one such disease that has specific objectives present
in the Healthy People objectives.
 
The purpose of surveillance for this disease is to record all cases as
diagnosed by the laboratory.  A positive laboratory test for the presence
of Hepatitis A virus is needed.  Usually this criterion is met by presence
of antibodies to the Hepatitis A virus.  In particular, the IgM antibody
against hepatitis A is the test most commonly used for determining acute
Hepatitis A infection.  There are other antibody tests available for
to get a list of patients with laboratory data that the EPI is interested
Hepatitis A.  These tests usually indicate past infection with hepatitis A
(or in some circumstances may indicate evidence of previous vaccination).
Usually the IgG antibody against Hepatitis A, OR the Total antibody
against Hepatitis A (a test that does not discriminate between IgM or IgG,
but can show evidence of exposure) are the tests done for this purpose.
 
The Infectious Disease Program Office, VAHQ, is looking for the presence
of any positive antibody to Hepatitis A, whether it be recorded as "weakly
positive," "strongly positive," "positive," or "present."  If other
phrases are used to describe a test result, you can differentiate
in.
responses upon entry in the term findings via the CONDITION field. As an
example, the words "present" and "not present" might be used to designate
"positive" vs. "negative";  however, they would not allow retrieval of
only the positive cases as both phrases contain the word, "present." Also,
numerical values of results are not readily useable.  All of the lab tests
related to the Hepatitis A terms above need to be defined as findings for
the national reminder terms with the conditions that identify the positive
laboratory test results.
 
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Hepatitis B laboratory tests:
 
Data collected for Hepatitis B is based on the following national reminder
terms which define the patient cohort:
        HBs Ag positive         Hepatitis B surface antigen positive
        HBc Ab IgM positive     Hepatitis B core antibody immunoglobulin  
                                                M positive
        HBs Ab positive         Hepatitis B surface antibody positive
        HBe Ag positive         Hepatitis B e antigen positive 
 
What determines whether this reminder applies to a patient? 
Background:
One of the goals of the Healthy People 2000 and 2010 initiatives of the
Department of Health and Human Services is to decrease certain infectious
diseases, especially those that are vaccine preventable.  Acute and
chronic infection with Hepatitis B is one such disease that has specific
objectives present in the Healthy People objectives.
 
Both acute and chronic diseases have significant morbidity and can
contribute to mortality.  Further, infection with Hepatitis B can
complicate the medical course of people with other liver ailments.  As
FINDINGS
  1. FINDING ITEM:   VA-HEP C VIRUS ANTIBODY POSITIVE
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   OR
  2. FINDING ITEM:   VA-HAV Ab positive
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   OR
  3. FINDING ITEM:   VA-HAV IgM Ab positive
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   OR
  4. FINDING ITEM:   VA-HAV IgG positive
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   OR
  5. FINDING ITEM:   VA-BILIRUBIN
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  6. FINDING ITEM:   VA-HBs Ab positive
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   OR
  7. FINDING ITEM:   VA-HBs Ag positive
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   OR
  8. FINDING ITEM:   VA-HBc Ab IgM positive
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   OR
  9. FINDING ITEM:   VA-HEP C VIRUS ANTIBODY NEGATIVE
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   OR
  10. FINDING ITEM:   VA-HBe Ag positive
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   OR
  11. FINDING ITEM:   VA-TRANSFERASE (AST) (SGOT)
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  12. FINDING ITEM:   VA-ALANINE AMINO (ALT) (SGPT)
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
INTERNAL PATIENT COHORT LOGIC (SEX)&(AGE)!FI(1)!FI(2)!FI(13)!FI(14)!FI(15)!FI(17)!FI(18)!FI(19)!FI(20)
PATIENT COHORT FINDINGS COUNT 11
PATIENT COHORT FINDINGS LIST SEX;AGE;1;2;13;14;15;17;18;19;20
RESOLUTION FINDINGS COUNT 0
AGE FINDINGS COUNT 0
INFORMATION FINDINGS COUNT 3
INFORMATION FINDINGS LIST 3;4;16
GENERAL COHORT FOUND TEXT
This patient has Hepatitis laboratory data that will be rolled up to the
national EPI data base.
GENERAL COHORT NOT FOUND TEXT
This patient has no Hepatitis laboratory data to send to the national EPI
data base.
# OF GEN. COHORT FOUND LINES 2
# GEN. COHORT NOT FOUND LINES 2
# GEN. RES. FOUND LINES 0
# GEN. RES. NOT FOUND LINES 0
BASELINE AGE FINDINGS
  1. REMINDER FREQUENCY:   1M
    NO. OF AGE MATCH LINES:   0
    NO. OF AGE NO MATCH LINES:   0
# SUM. COHORT FOUND LINES 0
# SUM. COHORT NOT FOUND LINES 0
# SUM. RES. FOUND LINES 0
# SUM. RES. NOT FOUND LINES 0