#90: Diagnoses Modifiers for data attribution
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Reporter: campbell | Owner: lv
Type: design-issue | Status: accepted
Priority: major | Milestone: data-domains2
Component: data-stds | Resolution:
Keywords: | Blocked By:
Blocking: 70, 91, 120 |
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Changes (by lv):
* status: assigned => accepted
Comment:
Are there are requests from researchers at other sites to use these
alternative types of diagnoses? MCRF use our main Diagnosis Table for the
majority of our research. Only in a rare case would we go after anything
else.
Notes:
1. Primary vs. Principle: after a quick, non-comprehensive check, Cattails
uses Primary.
2. Primary, Secondary: Currently we pull all diagnoses, without regard for
position. To fill Primary and Secondary, we'd need to adjust our ETL. How
would other diagnoses be handled? Are only two being loaded per encounter
for other sites?
3. Billing Diagnosis: Admit Diagnosis Principle, Admit Diagnosis
Secondary, Discharge Diagnosis Principle, Discharge Diagnosis Secondary,
Discharge Diagnosis Present on Admis..
- Do these modifiers only apply to inpatient diagnoses? What does
"Billing" mean for Epic? Is this what would be sent on an insurance claim?
We could fill some diagnoses for this categories from hospital or
insurance plan sources. It would take work.
4. Encounter Diagnosis: Admit Encounter Diagnosis, Discharge Encounter
Diagnosis, Primary Encounter Diagnosis, Secondary Encounter Diagnosis,
Medical History Diagnosis
- How does HSP_ADMIT_DIAGNOSIS differ from HSP_ACCT_ADMIT_DX? I'm not sure
how to differentiate between the first two modifiers in this category and
the Billing category above. This would be the majority of our diagnoses,
as clinical (outpatient). We would need to adjust our ETL as mentioned in
item 2 above. On a quick search, only .77% of our diagnoses include the
"History of" type.
5. Order Diagnoses: Order Medication Diagnosis, Order Procedure Diagnosis
- Cattails does not link diagnoses to medications. We couldn't accurately
fill this. There also isn't a direct association between a procedure and
diagnosis. We could do some work to try to fill this, but we'd have to
make a lot of assumptions.
6. Problem List Diagnosis: Active Problem, Deleted Problem, Resolved
Problem
- What does Deleted mean? Entered in error? What does this add for a
researcher? The Cattails Problem List table includes Problem Status,
Inactive Date, Last Problem Instance, etc. We don't get any requests to
pull diagnoses from the Problem List. It would take time to investigate
how to integrate this source.
7. Professional Diagnosis: Primary Professional Diagnosis, Secondary
Professional Diagnosis
- Are these also hospital-related codes? I don't know what ARPB means from
the Clarity Table.
It would take significant effort for MCRF to accurately implement this
series of modifiers. I'd like to hear feedback that the additional
elements add value for researchers, as we do not have a local use case.
Let me know if this makes sense or if you would like additional
clarification.
Thanks,
Laurel
________________________________________
From: Phillip Reeder [[email protected]]
Sent: Wednesday, November 12, 2014 2:13 PM
To: [email protected]; [email protected]; Dan Connolly
Cc: [email protected]
Subject: Re: [gpc-informatics] #90: Diagnoses Modifiers for data
attribution
Based on the emails I found, and what is on babel, this is what I think
the modifiers should be. The only difference from Babel is in the Billing
Diagnosis modifiers where I tried apply what was in the various emails.
Cerner had Inactive and Canceled modifiers for the Problem List Diagnosis
in one of the emails. I¹m unsure if they need to be added or if they
could be mapped to the three modifiers from Epic.
For consistency, is there a preference for Principle vs Primary? Does it
make a difference?
Modifier Modifier Code
Clarity Table
Billing Diagnosis
Admit Diagnosis Principle DX|BILL:ADMIT PRINCIPLE
HSP_ACCT_ADMIT_DX
Admit Diagnosis Secondary DX|BILL:ADMIT SECONDARY
HSP_ACCT_ADMIT_DX
Discharge Diagnosis Principle DX|BILL:PRINCIPAL
HSP_ACCT_DX_LIST
Discharge Diagnosis Secondary DX|BILL:SECONDARY
HSP_ACCT_DX_LIST
Discharge Diagnosis Present on Admis.. DX|BILL:POA
HSP_ACCT_DX_LIST
Encounter Diagnosis
Admit Encounter Diagnosis DX|ENC:ADMIT
HSP_ADMIT_DIAGNOSIS
Discharge Encounter Diagnosis DX|ENC:DISCHARGE
HSP_DISCH_DIAGNOSIS
Primary Encounter Diagnosis DX|ENC:PRIMARY
PAT_ENC_DX
Secondary Encounter Diagnosis DX|ENC:SECONDARY
PAT_ENC_DX
Medical History Diagnosis DX:HISTORY
MEDICAL_HX
Order Diagnosis
Order Medication Diagnosis DX|ORDER:MED
ORDER_DX_MED
Order Procedure Diagnosis DX|ORDER:PROC
ORDER_DX_PROC
Problem List Diagnosis
Active Problem DX|PROB:ACTIVE
PROBLEM_LIST
Deleted Problem DX|PROB:DELETED
PROBLEM_LIST
Resolved Problem DX|PROB:RESOLVED
PROBLEM_LIST
Professional Diagnosis
Primary Professional Diagnosis DX|PROF:PRIMARY
ARPB_TRANSACTIONS
Secondary Professional Diagnosis DX|PROF:SECONDARY
ARPB_TRANSACTIONS
--
Ticket URL:
<http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:10>
gpc-informatics <http://informatics.gpcnetwork.org/>
Greater Plains Network - Informatics
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