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New Comprehensive Hierarchy for Providers, Visits (and Place of Service, Specialty, Care Site)

(Christian Reich) #43

All good now. Check it out.

NOOOOOO!!! They are all there, standard and happy. But:

  • They now roll up in the hierarchy to the top 12
  • They are deduped, so if CMS Place of Service and NUCC have the same concept one of them became standard, and the other one become source, with a Maps to relationship. Like everywhere else.

All there. I think it works, but you guys need to make it fly.

Place of service, no standard concept equal S
(Adam Black) #44

Thanks for everyone’s work on this. It is very helpful. In using this hierarchy I have a couple questions. It looks like the “Telehealth” place of service code (concept_id = 5083) does not roll up into a visit type. Is this because telehealth encounters are not considered visits since they do not involve a patient going to a care site?

Another issue is the “Other Place of Service” code (concept_id = 8844) which seems to be used heavily. It has no standard concept. Maybe this is an ETL question but I’m wondering how people handle this code when creating visits.

(Christian Reich) #45

Correct. It’s a “top dog”. Like Inpatient and Outpatient.

It does. It’s concept_id=0. So-called Flavor of Null. We don’t know what it is.

(Adam Black) #46

Thanks @Christian_Reich. So would you create a record for a telehealth encounter in the visit_occurrence table and if so what would the visit_concept_id be? According to the CDM documentation the visit_concept_id must be in the visit vocabulary. Would it be incorrect to put the Telehealth concept_id (5083) in the visit_concept_id field?

(Christian Reich) #47

Almost. It must be in the Visit Domain. So, 5083 “Telehealth” is just fine.

(Christian Reich) #48

And fixed the documentation.

(Adam Black) #49

I have another question and I think it belongs on this thread. Suppose I am creating a CARE_SITE record for a hospital with an associated taxonomy code from the NUCC vocabulary of 282N00000X (General Acute Care Hospital). What should go in the place_of_service_concept_id field? Does place_of_service_concept_id need to be a standard concept in the place_of_service domain?

General Acute Care Hospital is a standard concept which rolls up to Inpatient Hospital but both are in the visit domain so I’m not sure if it they belong in the CARE_SITE.place_of_service_concept_id field.

(Christian Reich) #50

Oh. You found an lapse. The VISIT_OCCURRENCE table defines the care constellation, not the CARE_SITE table. In other words - a Care Site is not limited to a single way the care is provided. The same Care Site can have an office and an ambulatory surgery in the same instance. Put an issue in. Thanks, @Adam_Black

(Adam Black) #51

I’m not sure removing place of service from the care site table makes sense. Without it the table is just a name tied to a location. It seems natural that we would want some classification of care sites that would differentiate between an acute care hospital, a walk in clinic, a private practice, and a long term care facility for example. I guess you are saying that information should be represented in the visit_occurance table. Don’t we want some classification of different types of care_sites?

(Christian Reich) #52

Correct. You can use it as a covariate for all sorts of purposes, but in itself it has no meaning.

You are absolutely right. It does feel natural, and that is why people inevitably gravitate to trying modeling it, over and over again. But after some lengthy debate we realized it is impossible, or very hard. Look: The way those sites organize themselves is completely local. An outpatient clinic might have a surgery attached. But not every patient is a surgical patient. It can also have a lab. Now what? Is it an outpatient office, surgery or lab? All three? What if the lab only consists of a couple urine sticks and a microscope on the desk of the doctor. Still a lab?

This is impossible to nail. The only chance to nail it is in the Visit. Each visit is pretty clear what happened. If you really really need that place_of_service (which outside the US is a crazy term anyway) then take all the Visits that happen in that Care Site and infer it from the visit_concept_id.

Makes sense?

(Adam Black) #53

Yes that makes sense. Thanks for the explanation.