I would like to join . EST .
@mgkahn I think there is a very substantive issue here that might be better decided by empirical criteria than by established convention. The issue is that EHRs capture clinical events that are not billed for. The empirical question is: Are important attributes of patients’ clinical experience lost if we only capture billed services? If the answer is “yes”, then one goal of the EHR data holding community might be to develop mappings from EHR’s internal codes for unbilled services to standard OMOP vocabs. If it’s “no” then the effort to do that mapping might not be worth it. If it’s “no one knows” then we might want to get a plan together to find out. I suspect that the answer is “yes” and that there is significant addressable incompleteness in our data as a result. If so, this could be a major distinguishing advantage of EHR over claims data sources.
We are going to issue a new and improved Visit hierarchy. Should be good for EHRs.
Please don’t. We introduced the VISIT_DETAIL so you don’t have to have a flat world.
OMOP is not a model around billing. Go and play with the claims databases, if you need to do that. It is about the patient experience. So, we absolutely need the EHR-derived concepts, and if something is missing please please point it out.
Glad to hear it. I am happy to share the types we have in our data with whoever is building this out, if it’s of any use - just point me in the right direction.
Oh, could you please?
Colorado is re-visiting this as we speak. I’ll send along the visit types that are not part of an “Inpatient”, “ER”, or “Outpatient” Visit, but do result in an OMOP event.
Our next EHR WG meeting is Friday, November 16th at 10am EST/8am MST/
Agenda:
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Discuss the different ways to map proprietary (not OMOP supported) reference terminology to OMOP supported concepts when the reference terminology maps directly to two code systems.
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Maxim to share the issues he posted on the Issues & Assumptions Google doc re: Visits & Deaths
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Byum to discuss Observation Period questions & concerns
Here’s the Zoom Meeting Lin:k
Very good points to bring up, @esholle!
Do the above encounters result in a clinical event record? i.e. measurement, drug exposure, etc. If not, I don’t think it belongs in the the CDM. But you probably also have telephone encounters that do result in clinical events such as an order for a Measurement or Drug Exposure. Maybe even a Condition Occurrence for the tele-health patient. And I think those do belong in the CDM. How do you decide which encounters/visits to keep?
In Colorado this week we discussed the @mgkahn example below:
during an inpatient hospitalization, the angiogram or operating room encounter should be a Visit Detail of the parent inpatient Visit.
In the Colorado EHR data, we have solo radiology, lab, etc. I view these events as “visits” because they result in a record in the CDM table. But I would NOT say a lab draw or chest x-ray is an outpatient “Visit”. An outpatient Visit is with a Provider So, we will need more visit types to cover the solo events like imaging procedures.
I would like to create/develop a standard way to map source encounters to the Visit Occurrence table. We need conventions for the EHR data holding community. Otherwise clinical events or lost or Visit records are seriously inflated.
We keep them all. The real reason is because I haven’t given it too much thought, although I hear your point. That said, let me play devil’s advocate for a bit. Not only can I envision potential use cases built around frequency of telephone encounters as one component of a proxy score for healthcare utilization, but also, if our CDM instance is ever going to serve the purposes of a data warehouse, we need to keep the notes that correspond to these visits - and as far as I know all the telephone encounters have an associated note, even if it’s 'tried to leave vm with pt - wrong #." I don’t want to get into the business of determining what notes are and aren’t useful later on down the line.
In yesterday’s EHR WG meeting we discovered the expansion of the Visit vocabulary. There are now 123 standard concepts of 421 total Visit concepts.
Colorado is working on this. I call it “improper OMOP”. Most of our requestors want custom datasets, so we’ve created extension tables to hold multiple races & procedure modifiers, added extra columns for traceability and source FKs, and created our own vocabulary with relationships and hierarchies to serve the needs of our local community. However, as we have developed our CDM word is starting to get out and more people want the data in proper CDM format.
We’re building a proper OMOP view on top of the improper CDM. This will also allow us to deliver proper CDM datasets to our community and to participate in more OHDSI activities without generating the longest Achilles list ever!
We, @mgkahn and I, are always open to discuss any of the above.
This is a fantastic idea, and we’ve been kicking around something similar, in part by offering adjunct tables to the CDM standard. For example, we include a “MEASUREMENT_LOOKUP” table that offers the equivalencies between how our EHR displays labs and how they are mapped to LOINC codes and thus to CONCEPT on the backend. As I have also mentioned in the past, per @mgkahn we have been putting JSON in the source_value columns and found it invaluable as well. I was hoping to discuss this with you at the symposium but ended up unable to make it - perhaps we can try to find a time at some point.
Hi all,
Our presenter for tomorrow, Steve Lyman, will be traveling. Therefore, I am cancelling the meeting. We will reconvene on Friday, December 14. If anyone has any topics they would like to discuss on 12/14, please email so we can discuss.
The Google Doc with a very short list of issues and goals is here https://docs.google.com/document/d/12ELmThYhw6TJ_FoQpMWVDJ3rMlB5_6BkjPye1W20yUU/edit
Melanie
Friends. I started a new Forum post on this issue. Please discuss there. Haven’t looked your expansion, yet.
The EHR WG will meet tomorrow at 8am PST/11am EST (note the time change). @Christian_Reich will be presenting proposed changes to the Visit, Care Site and Provider domains.
Here’s the Zoom meeting link
EHR WG meeting is tomorrow, Friday, January 11th at 10am EST. Steve Lyman will lead the discussion on incomplete data and the impact of analytics. The Zoom meeting details remain the same as above.
EHR WG meeting is tomorrow, Friday, January 25th at 10am EST. Don Torok will lead the discussion on the different approaches of ETLing from source EHR to the CDM.
Zoom meeting details:
Join from PC, Mac, Linux, iOS or Android: https://ucdenver.zoom.us/j/4984831362
Or iPhone one-tap :
US: +16468769923,4984831362# or +16699006833,4984831362#
Or Telephone:
Dial(for higher quality, dial a number based on your current location):
US: +1 646 876 9923 or +1 669 900 6833
Meeting ID: 498 483 1362
International numbers available: https://zoom.us/u/9hXjQ
Friends:
Our meeting is cancelled this week. Our next meeting is Feb. 22nd at 10am.
Please get in touch with me if you want to present a topic or lead a discussion!
Our next EHR WG meeting is Friday, February 22nd at 10am EST. Sam Martin and Roger Carlson will “share some of our effort to better document and measure our OMOP ETL and general validation work…Our goal is to receive general feedback before we offer this for internal implementation at other sites and possible incorporation via OHDSI.”
Zoom meeting details:
Join from PC, Mac, Linux, iOS or Android: https://ucdenver.zoom.us/j/4984831362
Or iPhone one-tap :
US: +16468769923,4984831362# or +16699006833,4984831362#
Or Telephone:
Dial(for higher quality, dial a number based on your current location):
US: +1 646 876 9923 or +1 669 900 6833
Meeting ID: 498 483 1362
International numbers available: https://zoom.us/u/9hXjQ