We are a NHS teaching hospital in the UK and is using SNOMED CT as the clinical data standard throughout our EHR system. it is also a standard mandated to be used by NHS England. I wonder which acceptable SNOMED CT concept to use if for the “discharge_to” field in the Visit domain if patient is deceased, given SNOMED CT is the non-standardised terminology for this?
“Deceased” isn’t a place someone gets discharged to. This fact should be recorded in the Death table. And the discharge_to_concept_id = 0
You are right from an American standard perspective, but according to the UK standard, this is one of our choices for Discharge Destination. It means patient has been sent to the Mortuary. So in many ways, Mortuary is a valid discharge destination but not on your acceptable concept list. As we are using SNOMED CT, so all discharge_to_concept_id is 0 regardless what choice.
Thanks for bringing this up, and I know you have done so repeatedly in the different locations. And we have to make sure we find a solution for your problem.
But: This is not an American standard, but a global. And by that standard the patient doesn’t “go” to a morgue. In fact, “morgue” is not a Visit where a patient interacts with the healthcare system. So, you will have to take the way the NHS handles it and convert it to the way the OMOP CDM handles it. It doesn’t change what happened, it only changes the way it is represented, and one standard is as good as another one.
Let’s relook at your definition of discharge_to: “Use this field to determine where the patient was discharged to after a visit.” so patient was discharged to Mortuary after their visit. therefore I dont agree with your comments. However, you also noted that there are other elements we can’t come to terms but I dont wish to have a debate here. Let’s use this as an example and make sure we do it to your existing standard given I dont this is going to be resolved.
so we submit:
discharge_to_concept_id is 0
discharged_to_source_value (we left blank?)
If a person is discharged to home, we also use concept id = 0, that is correct yes?
actually as SNOMED CT is non-standard concept, discharge_to_concept-id is always 0.
Yes, discharge_to_concept_id=0. That indicates no healthcare interaction is following the visit, the patient is no longer a patient at this point.