[covid19] ETL help for converting your data into OMOP

[Vojtech_Huser]

Just some notes when I tried to get the concepts for results of COVID19 RNA test.

The definition on official server - you must first login (see uper right corner) and after that, you still only see the text view of definition.

See here:
https://atlas.ohdsi.org/#/cohortdefinition/108

To see it in the usual way, I used the JSON export from atlas server and imported it into atlas-demo.
Then you see it with the codes
http://atlas-demo.ohdsi.org/#/cohortdefinition/1773844

I was after how to see the actual coded value: (there is detected via SNOMED and detected via LOINC).
This can be seen here in the JSON from here
https://raw.githubusercontent.com/edward-burn/OHDSI-COVID19-HopitalisationsCharacterisation/master/COVID%20Cohort%20Diagnostics/inst/cohorts/COVID%20ID2%20v1.json

and via picture

[Vojtech_Huser]

If you are a site with COVID data, consider representing properly the result of the test. For covid-tested-characterization study and for prediction study, detecting properly patients tested with negative results is important. In measurement table, you may have this test represented

https://loinc.org/94500-6/

The guidance is to put into value_as_concept_id the following SNOMED CT codes (for positive and negative)

in OHDSI concept id world that means
http://athena.ohdsi.org/search-terms/terms/9191 for positive
http://athena.ohdsi.org/search-terms/terms/9189 for negative

If you think this guidance is wrong, please post an opposing view and justification.

Note that the current definition (PhenoID 30) is working with MANY positive codes:
see a list here (in italic and in picture)

PhenoID 30 on final server it is https://atlas.ohdsi.org/#/cohortdefinition/139
_to see all values better, use this corresponding definition on covid19 dev server _
_h_ttp://atlas-covid19.ohdsi.org/#/cohortdefinition/451

[aostropolets]

Vojtech, this is a good point. LOINC says how it should be, but it cannot force users to use these values in their ETL. So what we did was creating a comprehensive list of positive results. It will catch whatever was used in a ETL and will not hurt anybody.

[Vojtech_Huser]

Perhaps we can use a scenario (or patient story) and a preferred way to represent it in OMOP. Let me offer one scenario

John Doe had dry cough starting on March 1. (at home)
He had fever 37.9C on March 2nd. (at home)
He had outpatient visit on March 4th.
On March 4th, he got tested using RNA test (nasal swab) (date of specimen collection)
On March 5th, the result came back and it was positive.
To facilitate return the work, he was tested again (same approach, RNA test, nasal swab) on March 16th and the result was negative.

His EHR record had covid19 added to problem list as a result of positive test on March 5th.

Some notes on OMOP (open for debate)

CONDITION_OCCURRENCE

March 4, condition_concept_id http://athena.ohdsi.org/search-terms/terms/37311061

MEASUREMENT

March 4
Measurement_concept_id : https://loinc.org/94500-6/

Value_as_concept_id = http://athena.ohdsi.org/search-terms/terms/9191 or for March 16 http://athena.ohdsi.org/search-terms/terms/9189

LINKS
https://github.com/OHDSI/Covid-19/issues
https://github.com/OHDSI/Covid-19/wiki

Similar approach for Lauren with endometriosis
https://github.com/OHDSI/Tutorial-ETL/tree/master/data/laurenCDM

[Vojtech_Huser]

Thinking about this further - in Condition_occurrence table, it would be good to distinguish covid19 asymptomatic patient from a severe covid19. One trial used a covid severity scale. I also found this mdcalc site (https://www.mdcalc.com/brescia-covid-respiratory-severity-scale-bcrss-algorithm#evidence)

Per snomed page https://confluence.ihtsdotools.org/display/snomed/SNOMED%2BCT%2BCoronavirus%2BContent

There are pre-release codes (not found in Athena) for covid-pneumonia and covid-ARDS. Maybe we should embrace those. (will be released in July 2020) (looks like SNOMED now embraced pre-release notion (like LOINC) (Yay!)

However, still no luck with asymptomatic covid19. Patient with positive PCR test but super mild or asymptomatic disease.

One option is to “record an observation about covid” and use OBSERVATION table https://github.com/OHDSI/CommonDataModel/wiki/OBSERVATION
that offers

And term like
http://athena.ohdsi.org/search-terms/terms/4309345

How sites doing NLP sites (in OMOP model) are dealing with a note indicating fever 39C three days prior outpatient visit start date. Do you populate measurement table (with some special value in measurement_type_concept_id indicating “inferred from NLP”. and using the measurement_date of [visitDate-3days] ?

[Alexdavv]

in Condition_occurrence table, it would be good to distinguish covid19 asymptomatic patient from a severe covid19.

Currently, we have a rich hierarchy of COVID forms (under this concept). It includes pneumonia, ARDS and asymptomatic. I’d not add SNOMED pre-release concepts since they may change the identifiers. Once SNOMED released them, we will remap temporary OMOP Extension concepts to SNOMED. Sounds good?

a covid severity scale

SNOMED UK added the following. Should than be enough?

concept_code	concept_name	symantic_tag
1300671000000104	COVID-19 severity scale	(assessment scale)
1300631000000101	COVID-19 severity score	(observable entity)
1300681000000102	Assessment using COVID-19 severity scale	(procedure)
1300591000000101	Low risk category for developing complication from COVID-19 infection	(finding)
1300571000000100	Moderate risk category for developing complication from COVID-19 infection	(finding)
1300561000000107	High risk category for developing complication from COVID-19 infection	(finding)

[Vojtech_Huser]

There is a good question about PROCEDURE vs DEVICE_EXPOSURE for representing many care steps in the care for covid19. Korea notes are on the github. If there are US sites that adopted certain approach, posting you design choices here would help other sites.
This initiative will use OMOP (among others): https://covid.cd2h.org/N3C

[krfeeney]

This initiative will use OMOP (among others): https://covid.cd2h.org/N3C

@Vojtech_Huser, yes! We know this initiative well. @hripcsa @cukarthik @Christian_Reich @clairblacketer @Andrew myself and others are all part of WGs on this initiative to make sure we take advantage of the community’s guidance and best practices.

[schillil]

@krfeeney @cukarthik @andrew @clairblacketer @Christian_Reich Have you listed out common data elements for N3C-- it doesn’t seem OHDSI’s typical working style, but it seems that it is one of the requirments for this project. THanks! Lisa

[Vojtech_Huser]

In case we want to analyze use of antibody tests - I looked at the temp LOINC codes for that
See
https://rpubs.com/vojtech_huser/temp-loinc

Also - there is now SARS-COV2 Viral Load (just like HIV viral load).
See SARS coronavirus 2 RNA [Log #/volume] (viral load) in Unspecified specimen