Provider Specialty code set clean up

[MPhilofsky (Melanie Philofsky)]

I am working with THEMIS focus group #1 on Provider Specialty code set clean up. I’d like community input on the follow suggestions regarding issues with the Provider table and the standard concepts for Provider Specialty:

1. The Provider Specialty code sets (NUCC, ABMS, HES Specialty, Specialty-CMS) have not been updated in

Athena vocabulary update dates

Probably 3 years ago.

2. There are the same/similar provider specialties with standard_concept = S in different vocabularies. An example:

Athena vocabulary update dates

Cardiology exists as standard in both Specialty and HES Specialty

3. Clinician title/cerfification/level (i.e. MD, PA, NP, EMT, etc.) is not represented in the Provider table.

I suggest the following:

1. Update the vocabularies. @Christian_Reich said that is possible.

2. Create a trump order for standard codes based on the vocabulary. The trump order for vocabularies should start with NUCC. If NUCC doesn’t not have a needed Provider Specialty code, then we could look to one of the other Provider Specialty code sets for the necessary code. The NUCC code set has the most granular codes.

Athena vocabulary update dates

I would also like to add “clinician title or provider level or provider certification” (open to other naming conventions) to the Provider table. Values would be the concept_ids for MD, RN, CNM, EMT-I, etc. which are found in the NUCC code set.

[aostropolets (Anna Ostropolets)]

If you want NUCC to be the first let it be

[Gowtham_Rao]

If NUCC doesn’t not have a needed Provider Specialty code, then we could look to one of the other Provider Specialty code sets for the necessary code.

We need to make sure we have a comprehensive set of specialty codes for sure that is ‘Standard’. But NUCC will need a hierarchy to be useful, example NUCC https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/TaxonomyCrosswalk.pdf . This may be useful for a ‘hierarchy’ mapping

Also important I think is, it needs to support specialties of providers and care_sites.

Potential for non-individuals in the provider table

It is a common practice to have specialty codes referring to care sites. @bailey I think it is an important information to bring up.

Specialties may apply to care-sites. E.g. ‘Short Term Acute Care Hospital’, ‘Long Term Acute Care Hospital’, ‘Urgent Care’ - so we need to ensure that is covered when we update vocabularies. @Tom_Galia @bailey do we need to add ‘Specialty’ to care_site table?

Regarding

Clinician title/cerfification/level (i.e. MD, PA, NP, EMT, etc.)

Is the idea to enhance the provider table thru CDM WG to add a new concept to represent provider’s certification? i.e. create a level_source_value and level_source_concept_id and level_concept_id fields? With concept_id being used to represent the highest level license e.g. MD > mid-level providers like PharmD, RPH, Nurse Practionner, PA > next-level RN, BSN > next-level Patient care technician > next-level non-clinical care givers including family care givers?

[Christian_Reich]

@Gowtham_Rao

Specialties may apply to care-sites

Ouch!!! This is the insurance guy talking, who treats providers as a mixture of institutions and individuals.

I would propose that specialties are something that belong to the (flesh and blood) provider. They actually went to school and passed final examinations and board examinations. Your remember those, @Gowtham_Rao!!

A institutional “specialty” is just a marketing gag. They are not even bound to them.

@MPhilofsky

I suggest the following:

Above. I like these.

[Christian_Reich]

Friends:

Just talked with the THEMIS 1 folks, and @razzaghih said she may have a solution. So, I retract all I said.

[MPhilofsky (Melanie Philofsky)]

NUCC will need a hierarchy to be useful

I do think adding the hierarchies found here would be useful. Also, the crosswalk you linked should be used for mapping to the standard concept_id.

Specialties may apply to care-sites.

I want to focus on the Provider table here. That is an issue for the appropriate THEMIS WG.

Is the idea to enhance the provider table thru CDM WG to add a new concept to represent provider’s certification? i.e. create a level_source_value and level_source_concept_id and level_concept_id fields? With concept_id being used to represent the highest level license e.g. MD > mid-level providers like PharmD, RPH, Nurse Practionner, PA > next-level RN, BSN > next-level Patient care technician > next-level non-clinical care givers including family care givers?

Yes. A “certification/license/title/level” *_source_value, *_source_concept_id and *_concept_id would be added to the Provider table. I think many of these values are represented in the NUCC code set (very American representation). Community members with non-US data @Rijnbeek @rwpark @MaximMoinat @nicolepratt @leenad @SCYou and others I missed, should review the NUCC code set for comprehensiveness. We may need to utilize another code set for these values.

[Christian_Reich]

Friends:

Could we sit down, take all the NUCC, ABMS, HES Specialty and Specialty-CMS and make a definitive list with a hierarchy and no duplicates?

[ericaVoss]

All,

This was tied to this Vocabulary issue:

Issue: Duplicate provider specialties

I know I’m part of THEMIS but I haven’t heard much on this topic. Was there some resolution here?

[aostropolets (Anna Ostropolets)]

Yes, we’re removing all the duplicates. And are creating a hierarchy, which is even cooler

[Christian_Reich]

Please go here: Care sites and specialty, specialty code clean-up

Let’s close this one.

[ericaVoss]

@aostropolets, @Christian_Reich, @Dymshyts,

This has come up in THEMIS. However based on this thread it looks like this might already be covered. Do we need to remove duplicates as part of this work?

Could you provide an update?

Specialty & Add Clinical Title

[Christian_Reich]

Sorry. Tried to find all places where we discussed this. So, yes, thanks.

And no, NUCC doesn’t trump everything. It is OMOP>Specialty>Place of Service>NUCC>ABMS>HES Specialty>UB04. But it really doesn’t matter. The other ones will be mapped over in case of duplicates.

[ericaVoss]

@Christian_Reich. @aostropolets, & @Dymshyts,

But has the integration into the Vocabulary been completed or is it still work in progress? Or do people need to still discuss how this needs to be done.

[aostropolets (Anna Ostropolets)]

Seems like Christian is done with showing how the approach is better than any other. If so, we need to put it into the vocabularies in January after the holidays are over.

[ericaVoss]

@aostropolets

Is there a Vocabulary ticket that I can reference so I can close out the THEMIS ticket?

I just want to connect all the dots.

[aostropolets (Anna Ostropolets)]

Sure it is!
(Ok, just created it; probably we’re too spoiled by Erica keeping an eye on the vocabularies issue page :))
Here

[Christian_Reich]

Thanks. I was looking for that ticket as well.

Christian I think is done. Folks don’t seem to have objections. I will send over to the vocab team. We can always improve. And add.

[Gowtham_Rao]

Team - is there an interest in providing longer descriptive synonyms to some/all of these concepts? I am imagining populating the concept_synonym table for each of the concept_id being worked on.

Because we will populate a vocabulary table - standardized softwares like ATLAS can now use these fields and show the results as part of the vocabulary search (making the guess work lesser).

[MPhilofsky (Melanie Philofsky)]

is there an interest in providing longer descriptive synonyms to some/all of these concepts?

Yes. EHR data has many custom codes. A description of each would make it easier for those mapping source to concept.

[Christian_Reich]

providing longer descriptive synonyms

Do you have them?