We have come across an issue regarding “released orders” in Epic EHR and their inclusion in the visit occurrence table. Specifically, there are cases where released orders create “results-only” encounters, but these encounters are not currently being pulled into the visit occurrence table. This means that measurements (labs) tied to these encounters are excluded, which we would like to address.
I have a couple of questions for the group:
Should we consider including “released orders” as a visit type, such as under case management or laboratory visits?
Is it reasonable to include these “results-only” encounters in the visit occurrence table, even if the patient does not physically visit the institution on the same day?
Are there any best practices or recommendations from other institutions (e.g., Athena or other sites) that we should consider for handling these released orders?
Per the CDM rules, you do not need a Visit record to have any other clinical event record. The Visit is not required. So, bring the Measurements into the OMOP CDM.
Regarding your questions:
What exactly is a “released order”? Is it always a lab? Or could it be imaging or an order for a drug? Does this happen during a patient-provider interaction? Or could this be a standing order for a person to always do X before they do Y?
Telehealth Visits are also Visits and should be put into the Visit Occurrence table. The easiest way to define a Visit is it is a patient-provider interaction. This could be your typical inpatient or clinic visit. And it can also be a person receiving their influenza immunization at the pharmacy. The key is the person is having an interaction with a provider. And the ‘provider’ is a fairly loose term. Medical professional is more accurate.
Bring in all real, true clinical events to your OMOP CDM. You don’t need a Visit to bring in the data.
Regarding best practices for Visits in general. It is extraordinary difficult to identify a true patient-provider interaction in the EHR. You can’t rely on the type of encounter. At the University of Colorado, we have gone through many iterations of our Visit Occurrence table. We have completed countless chart reviews. And even something as innocuous as a “canceled” visit, isn’t always canceled. At this point in time, we exclude very few encounters. We know these aren’t all patient-provider interactions. We are working on identifying the ‘transactional encounters’, Once we get a solid definition, we will share on one of the Health Systems calls.
Thank you for the thoughts on how to handle encounters and measurements.
Regarding the released orders, I wanted to clarify a point:
How do you account for orders that are never completed, particularly lab orders? Do you track or flag these incomplete orders within the system? And if so, what’s the best way to handle this in the context of the CDM, especially if those orders are initiated but not processed? Looking forward to your thoughts on this!
Was it ordered? Or was it canceled before it even reached the lab? If it was canceled before it reached the lab, then don’t bring it in. Most likely the order was a mistake.
Use type concept_id = 32833 to identify the orders.