NC LEAD. Clinical Case Management and NC LEAD NC LEAD 12/5/2012. Statewide web-based system. Clinical and environmental case management

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1 Clinical Case Management and NC LEAD Tena Ward (919) NC Childhood Lead Poisoning Prevention Program NC LEAD Statewide web-based system Clinical and environmental case management 130A Laboratory Reports. Point of Care (POC) (a) All laboratories doing business in Lead Analyzers this State shall report to the Department all environmental lead test results and blood lead test results for Clinical Laboratory Improvement Amendments (CLIA) designates children less than six years of age and facilities using a POC lead analyzer for individuals whose ages are as a laboratory. unknown at the time of testing. Reports shall be made by electronic submission within five working days after test completion. POC Lead Analyzers Have diagnostic tests analyzed at a reference laboratory. Same day test results obtained using the POC lead analyzer cannot be accepted as diagnostic testing. Note: Test results are rounded to a whole number. For example, test results between 4.5 to 4.9 µg/dl are rounded off to 5 µg/dl. State Lab LabCorp Mayo Direct Feed NC LEAD Other Commercial Labs POC Labs NC LEAD Reformat Recode 1

2 Clinical Workflow Overview Workflow Queues Blood lead test results Case Processor Workflows Workflow Queues Workflow Details Workflow Details 2

3 Lab Results Tab Surveillance Reports Surveillance Reports 3

4 Surveillance Report Review children in need of diagnostic or follow-up testing, environmental referral Make sure all results have been reported FAX a copy of missing lab reports to confidential FAX (919) Environmental Referral Definitions Elevated blood level a blood lead concentration of 10 micrograms per deciliter or greater determined by the lower of two consecutive blood tests within a six-month period. (10 µg/dl 19 µg/dl) Confirmed lead poisoning a blood lead concentration of 20 micrograms per deciliter or greater determined by the lower of two consecutive blood tests within a six-month period. ( 20 µg/dl) Missing results? Delay in processing files Name, date of birth didn t match Laboratory reporting issue that needs to be handled Missing results? Name Birth Date Doe, Jane 05/01/ /05/ Doe, Jane 05/01/ /18/ Doe Smith, 05/01/ /01/ Jane Smithdoe, 05/10/ /08/ Jane Doe, Jone 05/01/ /14/

5 Clinical Workflow Overview Workflow for new action level Blood lead test results Case Processor Workflows Clinical Follow-up Needed for >=5 Update needed Administrative Gotta Gonow New Action Level Gotta Gonow New Action Level View Question Package Yes DO NOT answer Yes to the question Clinical follow-up completed? 5

6 UNLESS there is a diagnostic test result less than 5. If the child is confirmed at 5 or greater DO NOT answer Yes until there are TWO consecutive test results less than 5 after the date of confirmation. Yes Are you sure diagnostic test is less than 5 OR there are TWO test results less than 5 if confirmed? What should happen next? If you marked clinical follow-up completed and it s back in the workflow it means another test result >=5 has come in. 08/21/ /18/ Follow-up Schedule Environmental Referral 08/21/ /18/ When there are two consecutive test results 10 within 6 months Form 3651: Evaluation of Child with Elevated Blood Lead Level 6

7 Follow-up Testing 08/21/ /18/ Follow-up testing every 1-3 months until two consecutive tests < 5 What should happen next? 07/05/ /18/ /18/ Diagnostic test needed 07/05/ /18/ /18/ Diagnostic test needed based on higher risk category Confirmed Lead Poisoning 07/05/ /18/ V 09/18/ /20/ V Refer to local health department for required environmental investigation. What should happen next? 08/21/ /28/ V If age 1, retest at age 2 08/21/ /28/ V unless there is reason to believe the child faces increased risk for lead exposure 7

8 Tricky question 02/21/ /23/ Tricky question 02/21/ /23/ Diagnostic test needed Does not meet state definition of confirmed because test results are not within six months of each other 8