To those of us who do ETL, “use cases” are theoretical. What is concrete is the number of errors we produce. And often there are competing errors.
For instance, in this situation, if I tie the drug to the original visit (even if it is ordered later in the day), I get a Visit Date Disparity error. If I tie it to the pseudo-visit (Orders Only), then I get a Zero-Concept ID error. If I don’t tie it to a visit at all, the orphaned drug record results in a Null Foreign Key error.
I know, I know, visit_occurrence_id is not required, but bosses often don’t care about why a measure might be yellow or red. They just want to see green.
I’ve noticed that these types of problems most often occur in the Ambulatory setting, rather than the Hospital setting… OMOP seems to me to be fitted mostly to hospital type visits.
In the hospital, when a patient is admitted, the attending may order a test, wait for the results, examine the patient, order a medication and then administer it, all in one “visit”.
In the ambulatory setting, a doctor may order a blood test prior to the visit, go over the results during the examination, order another test, and then order a medication the next day. It’s essentially the same process. However, in the hospital, it’s considered a single visit. In the ambulatory setting, the tests and drugs are not part of the “visit”.
Why should an ambulatory visit be only “face-to-face”? Most of the time in a hospital visit, the patient doesn’t actually see the attending. Most of the work is done by surrogates or outside of the patient’s room. What difference if they’re sitting in a hospital bed or their own bed at home?