Friends,
Per our discussion today, I want to make sure our written discussion decouples two parallel things:
- “Long COVID as a condition” aka the need to phenotype Long COVID – this is a systematic way to qualify patients as “Long COVID syndrome” based on the clinical attributes that are present at that point in time in their health records. This is being done by @Gowtham_Rao @Evan_Minty @annika_joedicke and team in the Phenotype WG Long COVID subgroup.
- Ontological representations of terms that are associated to Long COVID related clinical attributes that are not currently picked up in our CONCEPT table but are in terminologies we support OR can be incorporated in the OMOP Extension structure temporarily while we “wait”.
To clarify, the table above represents 2 - where Stephanie is creating a CONCEPT record to record Patients who are seen at a Long COVID Clinic. It is not the same as rubberstamping someone as “having had long COVID”.
This is a bit of a meandering thought as the title of this thread is related to ICD10 codes. The ICD10 codes that came out are different. (My impression is that these ICD10 should be treated as local clinical codes entered in an EHR by someone who is indicating that person is in their office for a Long COVID encounter – whether they are in a long COVID clinic or not.)
The Long COVID clinic visit is the confirmed presence of a clinical encounter that is specific to specialty care for those who are suspected to have long COVID. It, in itself, may have clinical noise in that there are different protocols for how people show in long COVID clinics depending on the clinical practice patterns of that specific medical center. The RECOVER program is working with a subset of sites to identify if they have a long COVID clinic that qualifies patients for the presence of this encounter type and then is providing ETL guidance by data model as to how to send that information so it gets standardized to this particular concept.
Why this is important to delineate: @DaveraG presented a use case about the ambiguity of coding related to HIV/AIDS in the 1980s before we knew what HIV/AIDS was. This use case may have eventually congealed around clinical definitions for what constituted HIV/AIDS. However, the period of time when we did not know the clinical attributes that fed into HIV/AIDS is not a clinical coding issue where we have no ontological representation of the terms from the clinical encounter. Instead, the period of time when we did not have clinical consensus on what constitutes an HIV/AIDS diagnosis (because we also may have not understood or seen all of its manifestations in a way that we could code it accurately) is a phenotyping problem.
I would caution that we keep this in mind as we continue to tackle this issue. There are 25 symptoms in the WHO Delphi Consensus on Long COVID. If people are interested in ensuring we have robust concept sets for these specific concepts, you may join the Phenotype WG tomorrow from 12:30-5:30PM EST as we do a hackathon to do design diagnostics in PHOEBE and ATLAS. You can participate via MS Teams in the Phenotype WG group or directly connect via this MS Teams Invite Link. Note if you are not in the Phenotype WG group of OHDSI MS Teams, you may have issues in accessing the collaboration sheet. Please use the onboarding form at OHDSI.org to be added to this area.
Best,
Kristin