Integrating the Healthcare Enterprise Japanese Activities

Transcription

1 Integrating the Healthcare Enterprise IHE LAB committee Face to Face meeting in Tokyo Japanese Activities October 15-17, 2013 IHE-Japan Laboratory Planning/Technical Committee

2 Self-Introduction Osaka Kimiko General Matsuoka Medical Center Osaka General Medical Center ICT Osaka NHK Staff and Me!! Tokyo ICMT(Infection Control Microbiological Technologist) Evaluator for ISO Medical Laboratory Standards (ISO : International Organization for Standardization)

3 Study on Standardization of Various Masters in Microbiology Kimiko Matsuoka 1), Shigeki Yokoyama 2), Takashi Noguchi 3), Genichi Kato 4), Kazuyuki Nakayasu 5) 1)Osaka General Medical Center, 2)KD-ICONS Co.Ltd., 3)Tokyo University, 4)Saiseikai Shigaken Hospital, 5)Ministry of Health, Labour and Welfare

4 Outline 1 st. Purpose of the Masters in Microbiology For Order and Result, furthermore, For Infection Treatment, Infection Control, Epidemiology, etc. 2nd. Classification Codes for Various Masters in Microbiology 3rd. Research LOINC, SNOMED, JLAC10, JANIS Codes

5 Study on Standardization of Various Masters in Microbiology 1st. Purpose of the Masters in Microbiology For Order and Result, furthermore, For Infection Treatment, Infection Control, Epidemiology, etc.

6 Usage of Microbial + Large Classification for 3years : Number of Positive Microbes =1,346/14,952 Blood Cultures (23.6%) Microbes : Code No. Detection Ratio (%) Anaerobes often detected by blood culture. 99% of Microbes in our intestinal tract Anaerobes

7 Miclobilogy Name microbial full code Micrlobial Classification Large Classificaation Middle Classificaation SmallClassificaati on 10 digits 2 digits 2 digits 3 digits 3 digits Staphylococci Bacteria Staphylococci - - Staphylococcus aureus Bacteria Staphylococci Staphylococcus aureus Staphylococcus epidermidis Bacteria Staphylococci Staphylococcus epidermidis Anaerobes Bacteria Anaerobes - - Bacteroides fragilis Bacteria Anaerobes Bacteroides fragilis Bacteroides thetaiotaomicron Bacteria Anaerobes Bacteroides thetaiotaomicron Enterobacteriaceae Bacteria Enterobacteriaceae - - Escherichia coli Bacteria Enterobacteriaceae Escherichia coli Klebsiella pneumoniae Bacteria Enterobacteriaceae Klebsiella pneumoniae

8 Middle Classification of Antimicrobial Agents: Yearly Change of Susceptibility on Enterobacteriaceae penicillins-2: agent 1st.year(n=477) 2nd.year(n=499) 3rd.year(n=447) 4th.year(n=348) tetracyclines: aminoglycosides-1: quinolones: % Antimicrobial Agent : Middle Code Number anti-βlact.penicillins: anti-pseud.penicillins-2 : cephems-1: carbapenems: From 2009 to 2012 cephamycins-5: anti-βlact.cephems: anti-pseud.cephems-4 : cephems-3:

9 Middle Classification: Microbial Substitution of Hospital-Acquired Pneumonia Microbes of Hospital - acquired pneumonia Late days Early days Streptococcus spp.: Haemophilus spp : Middle days Staphlococcus spp.: Enterobacter spp.: Microbes: Middle Code No. Serratia spp.: , Proteus spp.: Pseudomonas spp.: Acinetobacter spp.: Days in Hospital

10 Infrequent Changes : Microbes Name, Antibiotic Substance etc.

11 Study on Standardization of Various Masters in Microbiology 2nd. Classification Codes for Various Masters in Microbiology

12 Microbiology Name 50 characters Bacterial code 10 digits Microbial 2digits Large 2digits Middle 3digits Small 3digits Microbial Large Middle Small Staphylococcus aureus Bacteria Staphylococci Staphylococcus aureus Staphylococcus capitis Bacteria Staphylococci Staphylococcus capitis Staphylococcus intermedius Bacteria Staphylococci Staphylococcus intermedius Salmonella typhi Bacteria Enterobacteriaceae Salmonella typhi Salmonella typhimurium Bacteria Enterobacteriaceae Salmonella typhimurium Serratia marcescens Bacteria Enterobacteriaceae Serratia marcescens Morganella morganii Bacteria Enterobacteriaceae Morganella morganii Shigella boydii Bacteria Enterobacteriaceae Shigella boydii Shigella dysenteriae Bacteria Enterobacteriaceae Shigella dysenteriae Alcaligenes xylosoxidans ssp. xylosoxidans Bacteria Glucose nonfermentans GNR Alcaligenes xylosoxidans ssp. xylosoxidans Burkholderia cepacia Bacteria Glucose nonfermentans GNR Burkholderia cepacia Comamonas testosteroni Bacteria Glucose nonfermentans GNR Comamonas testosteroni Blastoschizomyces species Fungi Yeast Blastoschizomyces species Candida albicans Fungi Yeast Candida albicans Geotrichum penicillatum Fungi Yeast Geotrichum penicillatum Cryptococcus neoformans Fungi Yeast Cryptococcus neoformans Entamoeba histolytica negative Parasite Protozoa Entamoeba histolytica Giardia lamblia positive Parasite Protozoa Giardia lamblia Cytomegalo virus negative Virus Virus Cytomegalo virus negative Adeno virus negative Virus Virus Adeno virus negative

13 Microbiology Name 50 characters Bacterial code 10 digits Microbial 2digits Large 2digits Middle 3digits Small 3digits Microbial Large Middle Small Staphylococcus aureus Bacteria Staphylococci Staphylococcus aureus Staphylococcus capitis Bacteria Staphylococci Staphylococcus capitis Staphylococcus intermedius Bacteria Staphylococci Staphylococcus intermedius Salmonella typhi Bacteria Enterobacteriaceae Salmonella typhi Salmonella typhimurium Bacteria Enterobacteriaceae Salmonella typhimurium Serratia marcescens Bacteria Enterobacteriaceae Serratia marcescens Morganella morganii Bacteria Enterobacteriaceae Morganella morganii Shigella boydii Bacteria Enterobacteriaceae Shigella boydii Shigella dysenteriae Bacteria Enterobacteriaceae Shigella dysenteriae Alcaligenes xylosoxidans ssp. xylosoxidans Bacteria Glucose nonfermentans GNR Alcaligenes xylosoxidans ssp. xylosoxidans Burkholderia cepacia Bacteria Glucose nonfermentans GNR Burkholderia cepacia Comamonas testosteroni Bacteria Glucose nonfermentans GNR Comamonas testosteroni Blastoschizomyces species Fungi Yeast Blastoschizomyces species Candida albicans Fungi Yeast Candida albicans Geotrichum penicillatum Fungi Yeast Geotrichum penicillatum Cryptococcus neoformans Fungi Yeast Cryptococcus neoformans Entamoeba histolytica negative Microbiology Name 50 characters Bacterial code 10 digits Microbial 2digits Large 2digits Middle 3digits Small 3digits Staphylococcus aureus Bacteria Staphylococci Staphylococcus aureus Salmonella typhi Burkholderia cepacia Bacteria Enterobacteriaceae Salmonella typhi Bacteria Glucose non-fermentans GNR Burkholderia cepacia Candida albicans Fungi Yeast Candida albicans Parasite Protozoa Entamoeba histolytica Giardia lamblia positive Parasite Protozoa Giardia lamblia Entamoeba histolytica Parasite Protozoa Entamoeba histolytica Cytomegalo virus negative Virus Virus Cytomegalo virus negative Adeno virus negative Virus Virus Adeno virus negative

14 4 Classification Levels on Master of Anti-Microbial Agents Microbial / Large / Middle / Small Classification Medical Agent name Medical Agent codes 10 digits Anti-Microbial codes 2 digits Large codes 2 digits Middle classigication codes 3 digits Small codes 3 digits anti-microbial Sultamicillin anti-bacteria Tazobactam/piperacillin anti-bacteria Large βlact.inhib. Penicillins βlact.inhib. Penicillins Middle compound drug compound drug Small Sultamicillin Tazobactam/piperacillin Amikacin anti-bacteria Aminoglycosides Aminoglycosides-1 Amikacin Arbekacin anti-bacteria Aminoglycosides Aminoglycosides-2 Arbekacin Panipenem/Betamipron anti-bacteria Carbapenems Carbapenems Panipenem/Betamipron Ritipenem/acoxil anti-bacteria Carbapenems Carbapenems Ritipenem/acoxil Vancomycin anti-bacteria Glycopeptides Glycopeptides Vancomycin Chloramphenicol anti-bacteria Chloramphenicols chloramphenicols Chloramphenicol Aciclovir anti-virus anti-virus Purine derivative Aciclovir Ganciclovir anti-virus anti-virus anti-virus Ganciclovir Interfelon alfa anti-virus anti-virus anti-virus Interfelon alfa Ethambutol anti-tuberculous anti-tuberculous anti-tuberculous Ethambutol Ethinamide anti-tuberculous anti-tuberculous anti-tuberculous Ethinamide p-aminosalicylic acid anti-tuberculous anti-tuberculous anti-tuberculous p-aminosalicylic acid Amphotericin B anti-fungi anti-fungi Polyene macrolides Amphotericin B Fluconazole anti-fungi anti-fungi Triazoles Fluconazole Flucytosine anti-fungi anti-fungi Pyrimidines Flucytosine Itraconazole anti-fungi anti-fungi Triazoles Itraconazole

15 Medical Agent name Medical Agent codes 10 digits Anti-Microbial codes 2 digits Large codes 2 digits Middle classigication codes 3 digits Small codes 3 digits anti-microbial Sultamicillin anti-bacteria Tazobactam/piperacillin anti-bacteria Large βlact.inhib. Penicillins βlact.inhib. Penicillins Middle compound drug compound drug Small Sultamicillin Amikacin anti-bacteria Aminoglycosides Aminoglycosides-1 Amikacin Arbekacin anti-bacteria Aminoglycosides Aminoglycosides-2 Arbekacin Tazobactam/piperacilli n Medical Anti- Large Middle Small Medical Agent Microbial classigication Agent name codes codes codes 2 digits codes 3 digits codes 3 digits 10 digits 2 digits Sultamicillin βlact.inhib. anti-bacteria compound drug Sultamicillin Penicillins Vancomycin anti-bacteria Glycopeptides Glycopeptides Vancomycin Chloramphenicol anti-bacteria Chloramphenicol Chloramphenicol Chloramphenicol Amikacin anti-bacteria Aminoglycosides Aminoglycosides-1 Amikacin Amphotericin B anti-fungi anti-fungi Polyene macrolides Amphotericin B Aciclovir Panipenem/Betamipron anti-bacteria Carbapenems Carbapenems Panipenem/Betamipron Ritipenem/acoxil anti-bacteria Carbapenems Carbapenems Ritipenem/acoxil Vancomycin anti-bacteria Glycopeptides Glycopeptides Vancomycin Chloramphenicol anti-bacteria Chloramphenicols chloramphenicols Chloramphenicol Aciclovir anti-virus anti-virus anti-virus Aciclovir Ganciclovir anti-virus anti-virus anti-virus Ganciclovir Interfelon alfa anti-virus anti-virus anti-virus Interfelon alfa Ethambutol anti-tuberculous anti-tuberculous anti-tuberculous Ethambutol Ethinamide anti-tuberculous anti-tuberculous anti-tuberculous Ethinamide p-aminosalicylic acid anti-tuberculous anti-tuberculous anti-tuberculous p-aminosalicylic acid Amphotericin B anti-fungi anti-fungi Polyene macrolides Amphotericin B Fluconazole anti-fungi anti-fungi Triazoles Fluconazole anti-virus anti-virus Purine derivative Aciclovir Flucytosine anti-fungi anti-fungi Pyrimidines Flucytosine Itraconazole anti-fungi anti-fungi Triazoles Itraconazole

16 Intermission ANAEROBE 2000 in Manchester, England

17 Study on Standardization of Various Masters in Microbiology 3rd. Research LOINC, SNOMED, JLAC10, JANIS Codes

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19 LOINC Test Codes Subset in Microbiology Microbiology Component, System, Class, Method, etc.

20 SNOMED Codes ( Systematized Nomenclature of Medicine, College of American Pathologists ) NOS:not otherwise specified spp. SNOMED Codes seem to be classified by Non-Microbiologist??

21 SNOMED Codes ( Systematized Nomenclature of Medicine, College of American Pathologists ) NOS:not otherwise specified spp. Microbes with Clinical Similarities have Similar Classification Codes??

22 4 Classification Levels on Master of Microbes Name Microbial / Large / Middle / Small Classification Microbial Full Name Full Microbial code Microbial Classification Large Classification Middle Classification Small Classification 10 digits 2 digits 2 digits 3 digits 3 digits Campylobacter spp Campylobacter fetus Campylobacter jejuni/ coli Brucella spp Brucella abortus Brucella canis

23 Structure of JLAC10 Masters of JLAC10 Classification of Clinical Test Out of Medical Treatment Insurance Test of Hematology, Biochemistry and Pathology Biopsy Test Microbiology Test Medical Treatment Fees Medical Treatment Masters of Clinical Test JLAC10 Unsupported by JLAC10

24 Bacterial Codes:JANIS ( Japan Nosocomial Infections Surveillance ) JANIS Codes Infectious agent code_ver4.0_ xls

25 Bacterial Codes Master for B Company Bacterial code Bacterial name

26 Our Microbial Classification Codes ( ) Bacterial code 3 digits Classification Staphylococci Enterobacteriaceae GNF-GNR Anaerobes Streptococci Other GN Other GN Fungi Comment atc.

27 Our Anti-Microbial Agents Classification Codes ( ) 89

28 Summary 1 st. Purpose of the Masters in Microbiology For Order and Result, furthermore, For Infection Treatment, Infection Control, Epidemiology, etc. 2 nd. Classification Codes for Various Masters in Microbiology 3 rd. Research LOINC, SNOMED, JLAC10, JANIS Codes

29 Suggestion?? Comments??

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31 Appendix : Problem Solutions Problem Solutions for Microbiology Tests (Order / Result) Kimiko Matsuoka 1), Shigeki Yokoyama 2), Takashi Noguchi 3), Genichi Kato 4), Kazuyuki Nakayasu 5) 1)Osaka General Medical Center, 2)KD-ICONS Co.Ltd., 3)Tokyo University, 4)Saiseikai Shigaken Hospital, 5)Ministry of Health, Labour and Welfare

32 Appendix 1: Problems for Microbiology Tests Comparison between Normal Clinical Tests and Microbiology Tests Clinical Test Order / Result One to One : One Order One Result. Microbiology Test Order / Result One to Multi (Combination) : One Order Multi Results (Combination)

33 Appendix 2: Features of Microbiology Tests Identification Test Results : Microbes Names : 1~5, No Growth. Susceptibility Test Results : Combinations S.I.R Category : S(Susceptible), of these results! I(Intermediate), R(Resistant) MIC (Minimum Inhibitory Concentration) E-Test Disk Diffusion Microscopic Test Results : Stained Microorganisms, Quality of Specimen. Culture Test Results : Bacterial Volume (++, +, etc.)

34 Appendix 3: Problem Solutions for Microbiology Tests As Consultants and Developers of Microbiology Information System, we believe that we can contribute actively to solutions in these problem for Microbiology tests (Order /Result).

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36 Question & Answer Q1: 日本では JANIS のコードは使っているのか? A1: 厚生労働省に報告するときに使っている しかし 施設で使っているコードと異なっている 各施設は 独自のコードを作って 運用している

37 Question & Answer Q2: 詳細分類で集計するとどのような支障があるのか? A2: 母集団の数が少なくなるので 傾向がつかみにくい 似かよった性質の持ったものは グループにまとめて統計解析した方が 感染制御や感染管理に役立つ

38 Question & Answer Q3: グループにまとめて分析したらどういう意味があるのか? A3: その母集団 例えば 菌の病原的意義や 抗菌薬の耐性傾向をすることが出来る

39 Question & Answer Q4: 菌名や耐性菌定義が変わったとき その情報をどのように把握し 発信すれば良いか? A4: 菌命名委員会や CLSI などとの強力や連携を取ることが出来ればいいですね

40 Question & Answer Q5:10 桁のコードはどのようにして作っているのか? A5: エクセル関数を利用している