#90: Diagnoses Modifiers for data attribution
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Reporter: campbell | Owner: nateapathy
Type: design-issue | Status: assigned
Priority: major | Milestone: data-domains2
Component: data-stds | Resolution:
Keywords: | Blocked By:
Blocking: 70, 91, 120 |
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Comment (by nateapathy):
Replying to [comment:10 lv]:
> 3. Billing Diagnosis: Admit Diagnosis Principle, Admit Diagnosis
Secondary, Discharge Diagnosis Principle, Discharge Diagnosis Secondary,
Discharge Diagnosis Present on Admis..
> - Do these modifiers only apply to inpatient diagnoses? What does
"Billing" mean for Epic? Is this what would be sent on an insurance claim?
We could fill some diagnoses for this categories from hospital or
insurance plan sources. It would take work.
>> CMH is currently working on setting up their billing system feed into
the i2b2 database, which will distinguish source of diagnosis (EMR vs.
Billing). This will include primary and non-primary as discussed above, as
well as a Present on Admit flag. We don't distinguish admit vs. discharge
diagnosis in the billing feed data, since it is based on the UB04 and
CMS1500 standards that don't specify admit/discharge diagnoses.
> 4. Encounter Diagnosis: Admit Encounter Diagnosis, Discharge Encounter
Diagnosis, Primary Encounter Diagnosis, Secondary Encounter Diagnosis,
Medical History Diagnosis
> - How does HSP_ADMIT_DIAGNOSIS differ from HSP_ACCT_ADMIT_DX? I'm not
sure how to differentiate between the first two modifiers in this category
and the Billing category above. This would be the majority of our
diagnoses, as clinical (outpatient). We would need to adjust our ETL as
mentioned in item 2 above. On a quick search, only .77% of our diagnoses
include the "History of" type.
>> I'm also not clear how "encounter diagnoses" are distinguished. All
diagnoses are associated in Cerner at the encounter level, and we do not
have a distinction of historical diagnoses in the i2b2 database. We would
need to do some work to incorporate this into our ETL as well, if it
exists in our extracts.
> 5. Order Diagnoses: Order Medication Diagnosis, Order Procedure
Diagnosis
> - Cattails does not link diagnoses to medications. We couldn't
accurately fill this. There also isn't a direct association between a
procedure and diagnosis. We could do some work to try to fill this, but
we'd have to make a lot of assumptions.
>> I echo this - we do not link orders to diagnoses either. Is this
intended to record medical necessity checking or ABNs? i.e. "this is the
diagnosis that justifies this medication or procedure"?
> 6. Problem List Diagnosis: Active Problem, Deleted Problem, Resolved
Problem
> - What does Deleted mean? Entered in error? What does this add for a
researcher? The Cattails Problem List table includes Problem Status,
Inactive Date, Last Problem Instance, etc. We don't get any requests to
pull diagnoses from the Problem List. It would take time to investigate
how to integrate this source.
>> Per my comment above: Is this problems that were once problems and have
been promoted to official diagnoses, or is it entries on the problem list
documented with diagnosis codes? It appears from Laurel's comments that
it's the latter, which makes sense to me and would be the most
straightforward to fulfill.
> 7. Professional Diagnosis: Primary Professional Diagnosis, Secondary
Professional Diagnosis
> - Are these also hospital-related codes? I don't know what ARPB means
from the Clarity Table.
> > +1; I'm not sure how this is different from billing diagnoses.
> It would take significant effort for MCRF to accurately implement this
series of modifiers. I'd like to hear feedback that the additional
elements add value for researchers, as we do not have a local use case.
> > This level of granularity would also take a significant amount of
effort on the Cerner/CMH side to implement this proposed structure of
modifiers.
--
Ticket URL:
<http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:18>
gpc-informatics <http://informatics.gpcnetwork.org/>
Greater Plains Network - Informatics
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