Reporting Positive Toxicology Screens
Statutory and Regulatory Requirements
The following statutory and regulatory requirements mandate that Kentucky hospitals are required to electronically report positive toxicology screen results to the Cabinet for Health and Family Services via the Kentucky Health Information Exchange (KHIE).
KRS218A.202 (4) requires "a Kentucky-licensed acute care hospital or critical access hospital shall report to the Cabinet all positive toxicology screens that were performed by the hospital's emergency department to evaluate the patient's suspected drug overdose."
902 KAR 55:110 Section 1 (9) defines Suspected drug overdose as: "acute condition that:
- (a) May include physical illness, coma, mania, or hysteria that is the result of consumption or use of a controlled substance, or another substance with which a controlled substance was combined; and
- (b) Relates to injury, poisoning by, or other adverse effect of any substance corresponding to the following International Classification of Disease (ICD) version 10 (ICD-10) codes, or equivalent codes in the most recent version of the International Statistical Classification of Diseases and Related Health Problems:
2. T42; or
902 KAR 55:110 Section 2 (9) further requires that "a hospital shall report to the Cabinet all positive toxicology screens ordered by the hospital's emergency department to evaluate a patient's suspected drug overdose via the Kentucky Health Information Exchange."
What is Reported?
Diagnosis Codes Related to Overdose
Hospitals should report patient demographics including the patient identifiers and the ICD-10 codes associated with 'poisoning by' under the categories of T40, T42, and T43. This information is reported to KHIE as part of an ADT (Admit, Discharge, Transfer) feed.
Hospitals should report all positive laboratory and urine drug screens for patients with a T40, T42, or T43 ICD-10 code. These results must be appropriately LOINC coded when submitted to KHIE. LOINC codes for reporting to meet legislative requirements can be found here.
Please Note: The KHIE Onboarding Analyst will work with each KHIE Participant organization's IT/EMR/EHR vendor team to ensure the appropriate information is included in the messages in the data feed.
How Do I Report?
Kentucky licensed acute care and critical access hospitals shall participate in KHIE to report non-fatal or suspected non-fatal drug overdose information via interface connections established with KHIE. If you are not currently reporting this information, contact the KHIE Outreach Coordinator in your area.
Instructions for Reporting
KHIE Onboarding Analysts will work with your hospital's IT/EMR vendor team to ensure that the appropriate interface connections are established to receive the required suspected non-fatal drug overdose information into the health information exchange.
The exact process and specifications will be provided to you during project discovery. Generally speaking, one of the required connections is a data feed that contains ADT (Admit, Discharge, Transfer) information which includes patient encounters and diagnoses; another required connection is a Laboratory data feed that contains suspected non-fatal drug overdose laboratory and toxicology screen details.
How do I find out if my patient has had a suspected non-fatal drug overdose?
Kentucky licensed acute care and critical access hospitals are required to send demographic information containing patient encounters and diagnoses. Additionally, they are required to send laboratory results containing toxicology screen information . KHIE displays this information and notifies Kentucky All Schedule Prescription Electronic Reporting (KASPER) users when this information is available in KHIE.
When you are in the KASPER system, you may see a message that indicates the KHIE patient record may contain additional information on this patient.
When you are in the KHIE patient record, you may see encounters, laboratory information, and toxicology screen details indicating the patient has had a suspected non-fatal drug overdose.
KASPER now includes the capability for users to request information from KHIE to determine whether a patient has been seen in the emergency department of a licensed acute care hospital or critical access hospital for a non-fatal or suspected non-fatal drug overdose.
To receive the indicator message, users of the KASPER system must opt-in to request this information from KHIE.
While in KASPER, Opt-in to request information from KHIE:
- Enter full patient demographic data in the KASPER Request Report Screen.
- Select the checkbox for the 'Check the Kentucky Health Information Exchange for suspected drug overdose information for this patient'.
If the patient record in KHIE contains an ICD-10 diagnosis code and a corresponding positive toxicology screen, a flag will appear at the top of the patient's PDMP report. For more information on using and interpreting the response in KASPER, please see KASPER Tips: Identifying Patients Who May Have Experienced a Drug Overdose.
Reviewing a Patient Record in KHIE:
Authorized users can search KHIE's web-based portal, the ePartnerViewer, to view demographic and toxicology information, in addition to other clinically relevant patient information.
- To search for a patient, enter the first name, last name, and date of birth.
- When you locate the patient record, review the Encounters section of the patient record to identify encounters that include the required ICD-10 codes. Please note the encounter date and location.
- Next, review the Laboratory & Pathology sections of the patient record to locate and view the appropriate laboratory and toxicology screens.
Please Note: The PDMP report doesn't include non-fatal or suspected non-fatal drug overdose information; to find that information, you must review the patient's medical record in KHIE. When KASPER data is available on a patient, users with existing KASPER access can view the KASPER report in the PDMP Portlet and in the Clinical Documents Portlet in the ePartnerViewer. Users must use the same KOG ID linked to their KASPER account to view KASPER data in the ePartnerViewer. KOG authenticates when an ePartnerViewer user is also an authorized KASPER user.
If your EMR/EHR System is integrated with KHIE
Some EMR/EHR systems have the capability to pull KHIE information directly into their system. Navigate to the location where KHIE data is displayed within your system and review the patient record for non-fatal or suspected non-fatal drug overdose related information. Diagnosis information will be available in the Encounters section of the KHIE Summary CCD. Toxicology and Laboratory information will be available in the Results section of the KHIE Summary CCD.
Please Note: When your EMR/EHR system is integrated with KHIE, the PDMP report can be retrieved when the appropriate configuration and validation has occurred. The KHIE Onboarding Analyst and KASPER team will work with each KHIE Participant organization's IT/EMR/EHR vendor team to ensure the configuration is set to include the PDMP report and the appropriate testing and validation has occurred.