We did not have time to discuss diagnosis modifiers today. From Nathan's lastcomment, I offer the following in search of final agreement for diagnosis modifiers for attribution of source. green are those elements I have verified in Clarity Jim
PROPOSED Diagnoses Modifiers for data attribution (#70<http://informatics.gpcnetwork.org/trac/Project/ticket/70>): ● PROBLEM ○ ACTIVE (Epic) ○ RESOLVED ○ DELETED ○ INACTIVE (Cerner) ○ CANCELLED ● PMH ● ORDER DX ● ADMISSION DIAGNOSIS\PRINCIPAL \NONPRINCIPAL ● ENCOUNTER DX ○ PRIMARY DX ○ NONPRIMARY DX ● BILLING DX ○ DISCHARGE PRINCIPAL\PRESENT ON ADMISSION \NOT PRESENT ON ADMISSION| ○ DISCHARGE NONPRINCIPAL\PRESENT ON ADMISSION \NOT PRESENT ON ADMISSION ○ PROFESSIONAL DX PRIMARY ○ PROFESSIONAL DX NONPRIMARY ________________________________ From: Wilson Nathan [[email protected]] Sent: Monday, March 03, 2014 8:47 AM To: Campbell, James R; [email protected] Subject: RE: modifier proposal from hackathon Jim, Good catch. I wrote “ADMIT DIAGNOSIS PRESENT ON ADMISSION” when I should have wrote “DISCHARGE DIAGNOSIS PRESENT ON ADMISSION”. The concept of present on admission only applies to discharge diagnosis not admit diagnosis. I apparently wrote it correctly everywhere, but the email to the group. Looking at CLARITY data, there are 4 different ways to say that a diagnosis was not present on admission (I do not know what Marshfield or Cerner data looks like). It is simplest to identify the instances where the diagnosis is POA and use the built in i2b2 EXCLUDE filter to find those diagnosis not POA. If we are going to add a negative POA modifier, then we should determine how to include all the possible negative values for that modifier from each institution. Based on the NISO z39.19 Guidelines<http://www.niso.org/kst/reports/standards/kfile_download?id%3Austring%3Aiso-8859-1=Z39-19-2005.pdf&pt=RkGKiXzW643YeUaYUqZ1BFwDhIG4-24RJbcZBWg8uE4vWdpZsJDs4RjLz0t90_d5_ymGsj_IKVaGZww13HuDlYn5U74YdfA-3TffjxYQ25QrtR8PONuJLqxvo-l0NIr5> extending the POA modifier off of the Principal or Secondary Modifiers is not advisable as it does not meet one of the following criteria. Hierarchical relationships cover three logically different and mutually exclusive situations: a) the generic relationship (see section 8.3.1); b) the instance relationship (see section 8.3.2); and c) the whole-part relationship (see section 8.3.3). Additionally; if we do not include a negative POA modifier, then keeping the POA modifier as a sibling to principal and secondary modifier allows us greater flexibility in the queries we can create. Revised List: BILLING DIAGNOSIS ADMIT DIAGNOSIS PRINCIPAL ADMIT DIAGNOSIS SECONDARY DISCHARGE DIAGNOSIS PRESENT ON ADMISSION DISCHARGE DIAGNOSIS PRINCIPAL DISCHARGE DIAGNOSIS SECONDARY Nathan W From: Campbell, James R [mailto:[email protected]] Sent: Sunday, March 02, 2014 6:19 PM To: Wilson Nathan; [email protected] Subject: RE: modifier proposal from hackathon Looking over the data that is extracted to Clarity, it appears to me that any admitting or discharge diagnosis from the hospitalization may have flags indicating that it was present on admission. Therefore if we decide to track that additional source data, the modifier tree would need to look something like this: BILLING DIAGNOSIS ADMIT DIAGNOSIS PRINCIPAL\PRESENT ON ADMISSION \NOT PRESENT ON ADMISSION ADMIT DIAGNOSIS SECONDARY\PRESENT ON ADMISSION \NOT PRESENT ON ADMISSION DISCHARGE DIAGNOSIS PRINCIPAL\PRESENT ON ADMISSION \NOT PRESENT ON ADMISSION DISCHARGE DIAGNOSIS SECONDARY\PRESENT ON ADMISSION \NOT PRESENT ON ADMISSION or a variant..... Jim ________________________________ From: Greater Plains Collaborative Software Development [[email protected]] on behalf of Wilson Nathan [[email protected]] Sent: Wednesday, February 26, 2014 1:21 PM To: [email protected]<mailto:[email protected]> Subject: Re: modifier proposal from hackathon All, I talked over the billing section of the outline with one of our business planning folks who works with hospital account data and based on that conversation I would recommend the following adjustments to the billing diagnosis modifiers. Original: BILLING DX DISCHARGE DX PRINCIPAL DISCHARGE DX NONPRINCIPAL PROFESSIONAL DX PRIMARY PROFESSIONAL DX NONPRIMARY Suggested: BILLING DIAGNOSIS ADMIT DIAGNOSIS PRINCIPAL ADMIT DIAGNOSIS SECONDARY ADMIT DIAGNOSIS PRESENT ON ADMISSION DISCHARGE DIAGNOSIS PRINCIPAL DISCHARGE DIAGNOSIS SECONDARY Reasons: The main set of diagnosis found on the bill are discharge diagnosis (at least from a CLARITY perspective) Non-principal diagnosis are collectively referred to as secondary For admitting diagnosis it is important to know if it is/was present on admission Does the group have any thoughts and/or other suggestions? Nathan Wilson From: Greater Plains Collaborative Software Development [mailto:[email protected]] On Behalf Of Dan Connolly Sent: Tuesday, February 25, 2014 11:55 AM To: [email protected]<mailto:[email protected]> Subject: modifier proposal from hackathon This was on the presentation machine at the hackathon. I gather it's a proposed modifier hierarchy. -- Dan The information in this e-mail may be privileged and confidential, intended only for the use of the addressee(s) above. Any unauthorized use or disclosure of this information is prohibited. If you have received this e-mail by mistake, please delete it and immediately contact the sender.
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