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Multiple Addresses per Provider, Provider Address differs from Care Site

Recently a THEMIS issue that has come up is what to do when a provider has multiple addresses. For example, provider works at multiple facilities. Additionally, mixed with this question is what happens if there are multiple locations associated with care (e.g. provider address and provider location).

THEMIS #48 - under review for THEMIS V2.0.0.

Here is our initial recommendation:

The CDM allows us to capture location of visits, so knowing where a patient was treated is quantified in the CDM. If a provider has multiple addresses the ETL should just choose one as it is unknown what the analytical use case for storing multiple addresses per provider.

The question of how to handle a situation where the billing address differs from where the patient received care is already handled in the CDM. The VISIT_OCCURRENCE table has a separate PROVIDER_ID and CARE_SITE_ID for expressly this purpose. This is already handled with Convention #8 on the VISIT_OCCURRENCE page (https://github.com/OHDSI/CommonDataModel/wiki/VISIT_OCCURRENCE).

Update Convention #3 under PROVIDER.
A single Provider cannot be listed twice (be duplicated) in the table. In situations where a provider has multiple addresses the ETL should choose the best one. If a Provider has more than one Specialty, the main or most often exerted specialty should be recorded.

Update Conventions #8 under VISIT_OCCURRENCE:
One visit may involve multiple care sites, in which case the ETL must specify how a single CARE_SITE_ID is selected or leave the CARE_SITE_ID field null. When the address of the provider and site of care differ you can use the CARE_SITE_ID to capture location of care and PROVIDER_ID to capture provider office.


Based on the CDM, provider is at a care_site_id (provider table does not have location_id), care_site_id is at a location_id. So, I think this must be re-worded as ‘providers with multiple care_sites, the ETL should choose the best one’.

Although, I think this convention is inherently limiting – because majority of the time a provider_id will have more than one care_site_id.

This probably needs to be updated with more specifics - considering the updates to specialty that @Christian_Reich is introducing - along with hierarchy.

This is where I would advocate for visit_detail. We probably can capture the multiple care_sites within the same visit_occurrence_id as a separate record in visit_detail. I made a similar argument here in favor of using the visit_detail.

I think we are converging at the convention that the provider are not linked to the Care Site directly, but through the visit. And then you can have as many to as many as you want.

Will do.

I agree. Does it make sense to create a Themis convention that a Visit Detail belongs to just one Care Site?

Great! Because one visit_occurrence_id can have multiple visit_detail_id; in effect we can say

  • the care_site_id of the visit_occurrence_id is the MAIN or PARENT care_site
  • the care_site_id of each of the visit_detail_id are the different care_site’s in the same visit_occurrence_id

This way, we can support multiple care_site_id’s for the same visit. This allows for the construct of nested care_sites (e.g. ICU within a hospital - where the hospital is the MAIN care_site)

This was our intent when we proposed the need for the Visit Detail a couple years ago. We need to identify the different care sites within the inpatient Visit Occurrence.

A more thorough description on the specifications for the Visit Detail would be helpful for those writing the ETL. I don’t think there needs to be a convention, just guidance. Honestly, all the documentation needs more detail.