Hi Jim, Thanks for the good discussion on gpc-dev yesterday on the medication modifiers for pcornet and the potential to load procedure orders in the procedure table.
1. Procedures and procedure orders I am very interested in orders as the driver of activity and so having them in alongside the billing representations could be very nice for informatics research proposals that want to generalize across several sites. I did some investigation this morning after talking with Michael, Matt and Dan. Now that we are using Epic for charge capture, it's possible to get coverage on especially lab orders by linking to the hospital billing transaction log in Epic and seeing where the hsp_transactions match to the order_proc and vice versa on the specific order transaction (order_id or order_proc_id); note that for some things like a Basic Metabolic Panel, the proc_id (concept of the order) is Epic's ordering table (678 for us) doesn't match the transaction table (has 10233657 as the proc_id) because I think our preforming lab is using Sunquest so there may be an intermediary relationship somewhere. Both are in the CLARITY_EAP table. /* this looks at the order and finds matching transactions */ select cht.tx_id, cht.cpt_code, cht.order_id, cht.pat_enc_csn_id, cht.procedure_desc, cht.proc_id, cht.service_date, cht.tx_filed_time, cop.order_time, cop.description, cop.order_proc_id, cop.result_time, cop.ordering_date, cop.proc_code from CLARITY.ORDER_PROC cop left join clarity.hsp_transactions cht on cop.pat_enc_csn_id=cht.PAT_ENC_CSN_ID and cop.ORDER_PROC_ID= cht.ORDER_ID where cop.pat_enc_csn_id =---put in a csn id here--- order by cop.order_time ; /* this looks at the transactions and finds matching orders */ select cht.tx_id, cht.cpt_code, cht.order_id, cht.pat_enc_csn_id, cht.procedure_desc, cht.proc_id, cht.service_date, cht.tx_filed_time, cop.order_time, cop.description, cop.order_proc_id, cop.result_time, cop.ordering_date, cop.proc_code from clarity.hsp_transactions cht left join CLARITY.ORDER_PROC cop on cop.pat_enc_csn_id=cht.PAT_ENC_CSN_ID and cop.ORDER_PROC_ID= cht.ORDER_ID where cht.pat_enc_csn_id =---put in a csn id here--- order by cop.order_time ; In our environment we get pretty good hits to CPTs for the labs and occasional hits for ECG But lots of other good stuff like nursing activities don't to a CPT (which is why I suppose Michael Prittie's work is research). But it's possible someone might make a order to flowsheet measure to LOINC mapper and then crosswalk those to the orders for things like "Vital Signs". Question to Jim: was your bias to build an interoperable ontology based on CPT hierarchies like we pull out of the UMLS? Or, did you have one developed based on LOINC by linking to the reported results related to the parent order? - I think having someone prototype this on real data is going to be key to see how usable it will be. - My bias would be to support some things as interoperable like a BMP by exploiting this billing link but also allow sites to load other procedure orders with their local terminology to at least expose the magnitude of the problem (as we've done at KUMC on babel in our procedure orders ontology). We built our local procedure orders hierarchy off native trees in Epic and there are probably pros and cons here. Could do a CPT tree with added branches for stuff like nursing and consults not in CPT and base those branches off perhaps something Dan Vreeman and the LOINC team might be creating. Question to SCILHS but also Charles with Pedsnet and Data committee members: is anyone else creating an interoperable procedure order ontology and bringing into the CDM along with OHDSI or i2b2? Did you go down the road of CPT/billing based or LOINC/observables based? 2. Medications. I updated ticked 280 https://informatics.gpcnetwork.org/trac/Project/ticket/280 with my thoughts and would like to hold off until we see the thinking emerging from the cancer CRG and the recommendations of the team doing the antibiotic study interfacing with the DRNOC. Russ Waitman, PhD Director of Medical Informatics Associate Vice Chancellor for Enterprise Analytics Professor, Department of Internal Medicine University of Kansas Medical Center, Kansas City, Kansas 913-945-7087 (office) [email protected]<mailto:[email protected]> http://www.kumc.edu/ea-mi/ http://informatics.kumc.edu<http://informatics.kumc.edu/> http://informatics.gpcnetwork.org<http://informatics.gpcnetwork.org/> - a PCORnet collaborative
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