A few concerns:
With the new structure, how do we determine what visits are Urgent Care Visits? In the current structure, we rely heavily on the place_of_service_concept_id (8782 - Urgent Care) in the care_site table to do this. According to the hierarchy, this is being folded in as an outpatient visit (9202). For most of our researchers, because this type of visit is associated with some level of acuity we consider it to be more of an emergency (9203) visit. From a provider perspective, there is no distinct specialty for Urgent Care. The provider may have general pediatrics or emergency care as their speciality designation. We would like to avoid using the visit_source_value to determine these things.
Overall, the idea of eliminating the care site specialty is troubling form a practical standpoint of how the data is stored in our EHR and the governance tied to care sites at our insitutions (for example to attribute the “Oncology Clinic” or “Hematology Clinic” to a visit), with no way of telling what specialty the provider was “acting” in at the time besides looking at the department and the potentially the service at the visit.
As it relates to the vist designations:
For the “Home” visit type does this include Social Work Visits? If so, will there be conventions to clearly state this?
For the “Case Management” At our organization we consider case management to be opened by a discharge planner with the intent of organizing the transition from inpatient to home care for our patients. However, it was stated on a call that this is supposed to represent administrative visits as well. Do we put Emails/Telephones encounters in this category? These are true encounters in our EHR which have providers and information pertaining to the clinical care.
As it relates to the EHR structure, consults are procedures as opposed to actual visits. We would have to manufacture a visit that represents a “consult” type becase these are included in the inpatient visit and occur as outpatient visits.
@bailey Please feel free to elaborate