RE: And what about the mods for medications? (was: Re: current diagnosis)

[Dan Connolly]

"Cumulative Daily Dose" and such are HERON-isms, not Epic-isms.

https://informatics.kumc.edu/work/blog/heron-walnut-update
https://informatics.kumc.edu/work/browser/heron_load/epic_meds_transform.sql#L157
https://informatics.kumc.edu/work/wiki/MedMapping

--
Dan


From: gpc-dev-boun...@listserv.kumc.edu [gpc-dev-boun...@listserv.kumc.edu] on 
behalf of Alex Bokov [bo...@uthscsa.edu]
Sent: Wednesday, September 24, 2014 5:33 PM
To: gpc-dev@listserv.kumc.edu
Subject: And what about the mods for medications? (was: Re: current diagnosis)

And, given how much of a difference mods make for diagnoses, should we be 
expecting analogous gotchas for modifiers on medications?

Does anybody know what PRN means?
Does anybody know under what circumstances "Cumulative Daily Dose" is used and 
under what circumstances "Medication Administration Record" is used? Are those 
two mutually exclusive?
Why is it that medications with a CONCEPT_CD like 'RXCUI:%' never have 
modifiers, only the '%MEDICATION_ID:%' ones do?

Further thanks to any Epic experts willing and able to sound off on this.

On 09/24/2014 01:10 PM, Dan Connolly wrote:
I have a note from the six month evaluation: "4.c currently have a diagnosis." 
i.e. distinguishing between historical/resolved diagnoses and current diagnoses.

I can imagine some somewhat manual approaches to this, but I don't know of a 
crisp, generalizable technique for it. Is it clear to you (or anybody else in 
gpc-dev) how to do it?

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And what about the mods for medications? (was: Re: current diagnosis)

[Alex Bokov]

And, given how much of a difference mods make for diagnoses, should we 
be expecting analogous gotchas for modifiers on medications?


Does anybody know what PRN means?
Does anybody know under what circumstances "Cumulative Daily Dose" is 
used and under what circumstances "Medication Administration Record" is 
used? Are those two mutually exclusive?
Why is it that medications with a CONCEPT_CD like 'RXCUI:%' never have 
modifiers, only the '%MEDICATION_ID:%' ones do?


Further thanks to any Epic experts willing and able to sound off on this.

On 09/24/2014 01:10 PM, Dan Connolly wrote:
I have a note from the six month evaluation: "4.c currently have a 
diagnosis." i.e. distinguishing between historical/resolved diagnoses 
and current diagnoses.


I can imagine some somewhat manual approaches to this, but I don't 
know of a crisp, generalizable technique for it. Is it clear to you 
(or anybody else in gpc-dev) how to do it?


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Re: current diagnosis

[Alex Bokov]

This is a very important question-- I can't imagine doing a meaningful 
retrospective study without addressing it.


I noticed that whenever an encounter has a diagnosis with MODIFIER_CD = 
'DiagObs:PROBLEM_LIST' that encounter will also contain the same 
diagnosis but with MODIFIER_CD = 'PROBLEM_STATUS_C:X' where X is 1,2, or 
3. And in these cases I've been filtering so that there are only 
'PROBLEM_STATUS_C:1' if I want the active diagnoses.


I also filter out anything that has MODIFIER_CD = 'DiagObs:MEDICAL_HX'.

There is a second pattern for what I suspect are also active diagnoses. 
These have MODIFIER_CD = 'DiagObs:PAT_ENC_DX'. Some of these have a 
second copy of the diagnosis in the same encounter with MODIFIER_CD = 
'DiagObs:PRIMARY_DX_YN' and some do not. I have been assuming that the 
'PAT_ENC_DX' ones are current if they exist at all and have been 
ignoring 'PRIMARY_DX_YN' because I'm interested in active diagnoses 
regardless of whether or not they are primary for their respective visits.


So, together this means that through the I2B2 interface, every single 
diagnosis term in my query I would include twice in the same pane: once 
with the 'DiagObs:PAT_ENC_DX' modifier and once with the 
'PROBLEM_STATUS_C:1' modifier (and never just a bare diagnosis).


BUT, that's just my current best guess. I'm just as uncertain as you, 
Dan. How do the rest of y'all do?


Something I've been meaning to do is actually pull consecutive visits 
for patients and see if 'PAT_ENC_DX' for something you would expect to 
go away (fracture, laceration) actually goes away in subsequent visits. 
But the opinion of any Epic experts on the list will save us all a lot 
of trial and error.


PS: KUMC also has diagnoses where MODIFIER_CD is one of 
'DiagObs:UHC_DIAGNOSIS', 'DiagObs:Clinic', or 'DiagObs:Primary'. My site 
doesn't have those, so I have no idea how to distinguish active 
diagnoses from among the ones with those modifiers.


On 09/24/2014 01:10 PM, Dan Connolly wrote:

Russ,

I have a note from the six month evaluation: "4.c currently have a 
diagnosis." i.e. distinguishing between historical/resolved diagnoses 
and current diagnoses.


I can imagine some somewhat manual approaches to this, but I don't 
know of a crisp, generalizable technique for it. Is it clear to you 
(or anybody else in gpc-dev) how to do it?


In any case, is this something I/we can leave in the someday pile?

--
Dan



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Re: [gpc-informatics] #157: CMD 2.x review: outpatient medication dispense etc.

[GPC Informatics]

#157: CMD 2.x review: outpatient medication dispense etc.
---+
 Reporter:  dconnolly  |   Owner:  jcampbell
 Type:  task   |  Status:  assigned
 Priority:  major  |   Milestone:
Component:  data-stds  |  Resolution:
 Keywords: |  Blocked By:
 Blocking: |
---+
Changes (by huhickman):

 * owner:  huhickman => jcampbell
 * status:  accepted => assigned


Comment:

 Email sent to Jim Campbell.  Reassigning ticket.

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Re: [gpc-informatics] #157: CMD 2.x review: outpatient medication dispense etc.

[GPC Informatics]

#157: CMD 2.x review: outpatient medication dispense etc.
---+
 Reporter:  dconnolly  |   Owner:  huhickman
 Type:  task   |  Status:  accepted
 Priority:  major  |   Milestone:
Component:  data-stds  |  Resolution:
 Keywords: |  Blocked By:
 Blocking: |
---+
Changes (by huhickman):

 * status:  assigned => accepted


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Re: current diagnosis

[Russ Waitman]

Active versus resolved dx on problem list


Park in someday right now

Russ Waitman


On Sep 24, 2014, at 1:10 PM, "Dan Connolly" 
mailto:dconno...@kumc.edu>> wrote:

Russ,

I have a note from the six month evaluation: "4.c currently have a diagnosis." 
i.e. distinguishing between historical/resolved diagnoses and current diagnoses.

I can imagine some somewhat manual approaches to this, but I don't know of a 
crisp, generalizable technique for it. Is it clear to you (or anybody else in 
gpc-dev) how to do it?

In any case, is this something I/we can leave in the someday pile?

--
Dan

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Re: [gpc-informatics] #144: ETL Annotated Data Dictionary form required by PCORI

[GPC Informatics]

#144: ETL Annotated Data Dictionary form required by PCORI
-+---
 Reporter:  campbell |   Owner:  campbell
 Type:  task |  Status:  assigned
 Priority:  major|   Milestone:  initial-data-domains
Component:  data-stds|  Resolution:
 Keywords:  ETL Data Dictionary  |  Blocked By:
 Blocking:   |
-+---
Changes (by dconnolly):

 * blockedby:  145, 146 =>


Comment:

 I think there are a few details left in #145 and #146, but they're no
 longer blocking this work.

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current diagnosis

[Dan Connolly]

Russ,

I have a note from the six month evaluation: "4.c currently have a diagnosis." 
i.e. distinguishing between historical/resolved diagnoses and current diagnoses.

I can imagine some somewhat manual approaches to this, but I don't know of a 
crisp, generalizable technique for it. Is it clear to you (or anybody else in 
gpc-dev) how to do it?

In any case, is this something I/we can leave in the someday pile?

--
Dan

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Re: [gpc-informatics] #157: CMD 2.x review: outpatient medication dispense etc.

[GPC Informatics]

#157: CMD 2.x review: outpatient medication dispense etc.
---+
 Reporter:  dconnolly  |   Owner:  huhickman
 Type:  task   |  Status:  assigned
 Priority:  major  |   Milestone:
Component:  data-stds  |  Resolution:
 Keywords: |  Blocked By:
 Blocking: |
---+
Changes (by dconnolly):

 * cc: ngraham, jcampbell (removed)
 * cc: gpc-dev@… (added)
 * owner:  dconnolly => huhickman
 * status:  new => assigned


Comment:

 Hubert, would you please go over the notes of our discussion with Jim C.
 and re-assign this to him?

 ref:
   - [http://listserv.kumc.edu/pipermail/gpc-dev/2014q3/000517.html gpc-dev
 23 Sep meeting notes for review]

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Re: [gpc-informatics] #56: shareable synthetic test data sets: Epic clarity, i2b2, NAACCR, ...

[GPC Informatics]

#56: shareable synthetic test data sets: Epic clarity, i2b2, NAACCR, ...
--+
 Reporter:  dconnolly |   Owner:  bokov
 Type:  enhancement   |  Status:  assigned
 Priority:  major |   Milestone:  data-quality-plan
Component:  data-sharing  |  Resolution:
 Keywords:|  Blocked By:
 Blocking:|
--+

Comment (by dconnolly):

 At the PCORINet steering committee meeting, R. Kaushal of the NY-CDRN
 spoke of exchanging dummy data files.

 Anybody interested to reach out and get details on whether they can share
 their dummy data?

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RE: gpc-dev 30 Sept call - PopMedNet participants?

[Mudgapalli, Ashok]

I vote for engaging Lincoln Peak. Thanks.

Ashok

From: gpc-dev-boun...@listserv.kumc.edu 
[mailto:gpc-dev-boun...@listserv.kumc.edu] On Behalf Of Apathy,Nate
Sent: Wednesday, September 24, 2014 10:13 AM
To: gpc-dev@listserv.kumc.edu
Subject: gpc-dev 30 Sept call - PopMedNet participants?

Hi everyone,

I've been in discussions with Mike Sullivan at PopMedNet and we've engaged his 
team and engineers to have a meeting with Cerner to discuss our questions 
specific to our i2b2 database design and how we might best enable PopMedNet. As 
a part of that discussion, we asked if Mike and Bruce Swan, the lead PMN 
architect at Lincoln Peak, would be willing to join the GPC-Dev call next 
Tuesday (9/30) to answer questions from the group. Would their participation be 
valuable to the group? I'm happy to forward the meeting on; the only ask would 
be to discuss our PopMedNet questions at the top of the hour so they can drop 
off when we get into non-PMN discussions later on in the agenda.

Let me know your thoughts!

Nate Apathy
Program Manager, Cerner Research
CONFIDENTIALITY NOTICE This message and any included attachments are from 
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gpc-dev 30 Sept call - PopMedNet participants?

[Apathy,Nate]

Hi everyone,

I've been in discussions with Mike Sullivan at PopMedNet and we've engaged his 
team and engineers to have a meeting with Cerner to discuss our questions 
specific to our i2b2 database design and how we might best enable PopMedNet. As 
a part of that discussion, we asked if Mike and Bruce Swan, the lead PMN 
architect at Lincoln Peak, would be willing to join the GPC-Dev call next 
Tuesday (9/30) to answer questions from the group. Would their participation be 
valuable to the group? I'm happy to forward the meeting on; the only ask would 
be to discuss our PopMedNet questions at the top of the hour so they can drop 
off when we get into non-PMN discussions later on in the agenda.

Let me know your thoughts!

Nate Apathy
Program Manager, Cerner Research

CONFIDENTIALITY NOTICE This message and any included attachments are from 
Cerner Corporation and are intended only for the addressee. The information 
contained in this message is confidential and may constitute inside or 
non-public information under international, federal, or state securities laws. 
Unauthorized forwarding, printing, copying, distribution, or use of such 
information is strictly prohibited and may be unlawful. If you are not the 
addressee, please promptly delete this message and notify the sender of the 
delivery error by e-mail or you may call Cerner's corporate offices in Kansas 
City, Missouri, U.S.A at (+1) (816)221-1024.
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Re: [gpc-informatics] #158: usable view of LOINC lab terms

[GPC Informatics]

#158: usable view of LOINC lab terms
-+---
 Reporter:  rwaitman |   Owner:  jdale
 Type:  enhancement  |  Status:  assigned
 Priority:  major|   Milestone:
Component:  data-stds|  Resolution:
 Keywords:   |  Blocked By:
 Blocking:  68   |
-+---
Changes (by dconnolly):

 * owner:  dconnolly => jdale
 * status:  new => assigned


Comment:

 Justin,

 Based on your work so far, Russ nominates UMN to lead on this. Recall:

  - [https://docs.google.com/spreadsheets/d/1
 -uW2hod63gdlNlLAkhleuMvnQG6zNaw2jd-CAhSLqkk/edit#gid=2012749157 leading
 sites by domain]

 We have a student working on a project in this area; he should be in
 touch.

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[gpc-informatics] #158: usable view of LOINC lab terms

[GPC Informatics]

#158: usable view of LOINC lab terms
--+---
  Reporter:  rwaitman |  Owner:  dconnolly
  Type:  enhancement  | Status:  new
  Priority:  major|  Milestone:
 Component:  data-stds|   Keywords:
Blocked By:   |   Blocking:  68
--+---
 The LOINC hierarchy currently in babel (from #68) has all of the relevant
 terms, but when we consider adopting this terminology in HERON at KUMC, we
 don't think it's sufficiently usable.

 We expect there's a way of viewing or filtering the LOINC materials to get
 something more usable, much like when we reviewed the RxNorm materials and
 discovered the VA hierarchy (#78).

 ''Dan, reporting for Russ''

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