Friends: And especially those who have a strong feeling how claims and EMR data should be treated, namely @jenniferduryea, @Gowtham_Rao, @bailey:
As part of the Themis 4 job, the vocab team and I went through the vocabularies Specialty (CMS Specialty, really), ABMS, NUCC and HES Specialty. We find a lot of different concepts tossed together, some of it because the CMS doesn't distinguish between individual providers and institutional providers. But we do: we have the PROVIDER and CARE_SITE tables. We therefore propose to clean things up and create four new Domains:
Specialty: These are medical specialties. The kind of thing you can specialize as a physician, or that institutions (wards, department) organize their work around. Such as "Surgery", "Internal Medicine", "Radiology". Everything else like Prosthetics, Accupuncture, Physical Therapy and all sorts of other Therapies would get the domain Service (see below). These specialties would be used in the PROVIDER and CARE_SITE (new field needed here, @bailey will be happy)
Provider: These are individual providers: Physicians, Nurses, Dentists. Therapists and all sorts of other personnel that charges the CMS for services are NOT providers according to this logic. We might add a new field in the PROVIDER table: provider_concept_id.
Care Site:: These are types of insitutions. Hospitals, clinics, offices, where healthcare is provided. Not agencies or ambulance services. In the CARE_SITE table, we'd have to rename the place_of_service_concept_id to care_site_id, making it consistent with everything else.
Service:: This is the "garbage can" for all sorts of things that are relevant to healthcare, but none of the other three domains above. They would go into the OBSERVATION table.
The domain "Place of Service" is ambiguous. It is now the domain "Care Site".
Again, the vocabularies are all over the place with mixing these things together. We are therefore proposing splitting them apart (like we do with HCPCS, CPT4, and to a lesser degree with the ICDs), and assigning our domains. We also want to remove duplicates and create a hierarchy, so you can rely on vocabulary to tell you that Hepatology is a kind of Gastroenterology is a kind of Internal Medicine. And we pull away the standard_concept='S' from the silly flavors of NULL.
Take a look and complain or agree: https://docs.google.com/spreadsheets/d/1A4OFGoJtRCz-G5qju-TrR5UDFX7coXwuRo7Yw5KSslo/edit#gid=0.