Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  preeder
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  snow-shrine-2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  411   |
--+
Changes (by dconnolly):

 * cc: gpc-dev@… (removed)
 * cc: astoddard, dconnolly, preeder, Phillip.Reeder@…, mwennberg (added)
 * owner:  astoddard => preeder


Comment:

 Phillip to write an email and a few queries that show how to make use of
 modifiers and send that to gpc-dev for Jim Campbell’s evaluation.

 per Nov 21 call #12

--
Ticket URL: 

gpc-informatics 
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[Phillip Reeder]

For the GPC SHRINE, the approach of starting without modifiers, then
adding them later seems appropriate.  I¹d rather have some data available
in SHRINE, then none.

For the modifiers, at UTSW, we simply added our local modifiers under the
SCILHS modifiers.  So, the ³Primary² modifier had all of the various
billing, claims, encounter, professions, etc. primary modifiers.  We did
the same for the other modifiers as best we could as well.

If you are using the GPC modifiers in your local data,  it¹s possible we
could share this mapping across GPC sites to have better alignment of the
modifiers.  And it would allow you to support the SHRINE PCORI modifiers
with little local effort.

Phillip


On 11/2/17, 12:35 PM, "Gpc-dev on behalf of GPC Informatics"
 wrote:

>#90: Diagnoses Modifiers for data attribution
>--+
> Reporter:  campbell  |   Owner:  astoddard
> Type:  design-issue  |  Status:  assigned
> Priority:  major |   Milestone:  snow-shrine-2
>Component:  data-stds |  Resolution:
> Keywords:|  Blocked By:
> Blocking:  411   |
>--+
>
>Comment (by astoddard):
>
> MCW has not implemented the PCORnet CDM build from i2b2 (i2p-transform).
> We are not alone in this. Non i2p-transform sites will all likely have
> higher costs for getting PCORnet/ SCILHS / ARCH modifiers properly
>aligned
> in i2b2.
>
> Going without modifiers we can expose the diagnosis ontology in SHRINE
> trivially within a few days.
>
> I estimate implementing the modifiers for diagnosis in our i2b2 is a week
> of dedicated work for MCW. Scheduling that with existing priorities, the
> need to bring new team members up to speed, and coordinating with
>internal
> data release schedules means actual availability of PCORnet  modified
> diagnosis queries in MCW Shrine is likely to be early Jan 2018.
>
> There remains some ambiguity to resolve on PCORnet /ARCH / SCILHS
>modifier
> use - eg. the PDX axis which is "Principle Discharge Diagnosis" in CDM3.x
> and defined to only be relevant to inpatient encounters but is called
> "Primary Diagnosis Flag" in the ontology itself and could be expected to
> apply more widely as a result.
>
> Even i2b2 deployments that sit upstream of PCORnet CDM builds may not
>have
> modifier use perfectly aligned, the CDM spec itself is vague at times,
>and
> I would be unsurprised if some post-processing of CDMs will have happened
> in order to pass data-checks.
>
> MCW's preference is to make un-modified SHRINE ontology queries available
> across procedure and diagnosis domains early and then improve on that.
>
>--
>Ticket URL:
>
>gpc-informatics 
>Greater Plains Network - Informatics
>___
>Gpc-dev mailing list
>Gpc-dev@listserv.kumc.edu
>http://listserv.kumc.edu/mailman/listinfo/gpc-dev




UT Southwestern


Medical Center



The future of medicine, today.


___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  astoddard
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  snow-shrine-2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  411   |
--+

Comment (by astoddard):

 MCW has not implemented the PCORnet CDM build from i2b2 (i2p-transform).
 We are not alone in this. Non i2p-transform sites will all likely have
 higher costs for getting PCORnet/ SCILHS / ARCH modifiers properly aligned
 in i2b2.

 Going without modifiers we can expose the diagnosis ontology in SHRINE
 trivially within a few days.

 I estimate implementing the modifiers for diagnosis in our i2b2 is a week
 of dedicated work for MCW. Scheduling that with existing priorities, the
 need to bring new team members up to speed, and coordinating with internal
 data release schedules means actual availability of PCORnet  modified
 diagnosis queries in MCW Shrine is likely to be early Jan 2018.

 There remains some ambiguity to resolve on PCORnet /ARCH / SCILHS modifier
 use - eg. the PDX axis which is "Principle Discharge Diagnosis" in CDM3.x
 and defined to only be relevant to inpatient encounters but is called
 "Primary Diagnosis Flag" in the ontology itself and could be expected to
 apply more widely as a result.

 Even i2b2 deployments that sit upstream of PCORnet CDM builds may not have
 modifier use perfectly aligned, the CDM spec itself is vague at times, and
 I would be unsurprised if some post-processing of CDMs will have happened
 in order to pass data-checks.

 MCW's preference is to make un-modified SHRINE ontology queries available
 across procedure and diagnosis domains early and then improve on that.

--
Ticket URL: 

gpc-informatics 
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  astoddard
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  snow-shrine-2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  411   |
--+
Changes (by dconnolly):

 * owner:  huhickman => astoddard
 * status:  reopened => assigned


Comment:

 Alex, care to estimate the cost of supporting the PCORNet / ARCH / SCILHS
 modifiers in your SHRINE spoke? Either a number of hours / days / weeks of
 work or a guestimate at a calendar date when you would have it done?

 As I think about collecting requirements, I realize that our previous
 position on this #90 is that we will support something like them, and our
 6 Sep decision to align with ARCH / SCILHS (#411) strongly suggests
 supporting exactly these. And all the CDM EDC QA process sets an
 expectation that they're supported locally. So before we consider hiding
 them, I think we would need an argument that supporting them in SHRINE is
 somehow particularly onerous.

--
Ticket URL: 

gpc-informatics 
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  huhickman
 Type:  design-issue  |  Status:  reopened
 Priority:  major |   Milestone:  snow-shrine-2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  411   |
--+
Changes (by dconnolly):

 * status:  closed => reopened
 * resolution:  fixed =>
 * blocking:  70, 91, 216 => 411
 * milestone:  data-domains3 => snow-shrine-2


Comment:

 Alex writes:
 > Are all the pcornet_diag SCILHS (now rebranded as ARCH) diagnosis
 modifiers, some or none, expected to be exposed and supported in SNOW
 Shrine diagnosis queries?
 > Or do we have a different common reference set of diagnosis modifiers to
 be supported?

 We used to have a different set, but I don't suppose maintaining it is
 worthwhile.

 I think the KUMC SHRINE front-end currently shows the ARCH / SCILHS /
 PCORNet modifiers, which suggests they are supported. But I don't think
 the KUMC spoke has mappings for them. I haven't tested. The cost of hiding
 them (and postponing support) is about one SQL update statement.

 I suppose the next step is to look into the benefits of supporting them
 and then consider the costs...

--
Ticket URL: 

gpc-informatics 
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  huhickman
 Type:  design-issue  |  Status:  closed
 Priority:  major |   Milestone:  data-domains3
Component:  data-stds |  Resolution:  fixed
 Keywords:|  Blocked By:
 Blocking:  70, 91, 216   |
--+

Comment (by lv):

 Is there a data dictionary that defines what each of the modifiers mean?

 We're working to implement what's posted to Babel as GPC:Diagnoses #63
 but don't understand the difference between Encounter and Billing.
 Definitions of what to include for all would be helpful.

 Thanks!

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:38
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  huhickman
 Type:  design-issue  |  Status:  closed
 Priority:  major |   Milestone:  data-domains3
Component:  data-stds |  Resolution:  fixed
 Keywords:|  Blocked By:
 Blocking:  70, 91, 216   |
--+

Comment (by dconnolly):

 My understanding is that Encounter diagnosis is determined by a clinician,
 whereas billing diagnosis is determined by billing coders.

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:39
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  huhickman
 Type:  design-issue  |  Status:  closed
 Priority:  major |   Milestone:  data-domains3
Component:  data-stds |  Resolution:  fixed
 Keywords:|  Blocked By:
 Blocking:  70, 91, 216   |
--+
Changes (by dconnolly):

 * status:  assigned = closed
 * resolution:   = fixed


Comment:

 LV, PR, DC concur. sold.

 detail:

 {{{
 modifier
 level3/level
 applied_path\i2b2\DiagnosesV3\%/applied_path
 
key\\i2b2_DiagnosesV3\modifier_dx\encounter_diagnosis\enctr_dx_discharge\/key
 fullname\modifier_dx\encounter_diagnosis\enctr_dx_discharge\/fullname
 nameEncounter Diagnosis - Discharge/name
 visualattributesDA /visualattributes
 synonym_cdN/synonym_cd
 totalnum xmlns:xsi=http://www.w3.org/2001/XMLSchema-
 instance xsi:nil=true /
 basecodeDX|ENC:DISCHARGE/basecode
 facttablecolumnMODIFIER_CD/facttablecolumn
 tablenameMODIFIER_DIMENSION/tablename
 columnnameMODIFIER_PATH/columnname
 columndatatypeT/columndatatype
 operatorLIKE/operator
 dimcode\modifier_dx\encounter_diagnosis\enctr_dx_discharge\/dimcode
 comment /
 tooltipEncounter Diagnosis - Discharge/tooltip
 /modifier
 }}}

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:37
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  huhickman
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains3
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 216   |
--+

Comment (by lv):

 Are there thoughts on the proposal Phillip made on 3/17/15 (below)? Would
 this meet current needs?

 Thanks,
 Laurel

 -Original Message-
 From: Phillip Reeder [mailto:phillip.ree...@utsouthwestern.edu]
 Sent: Tuesday, March 17, 2015 1:14 PM
 To: gpc-dev@listserv.kumc.edu; campb...@unmc.edu;
 huhick...@nebraskamed.com; dconno...@kumc.edu; Verhagen, Laurel A;
 nate.apa...@cerner.com; ngra...@kumc.edu; westr...@umn.edu
 Subject: Re: [gpc-informatics] #90: Diagnoses Modifiers for data
 attribution

 I still feel that the source of the data is an important aspect that we
 need to be maintained. And the CDM Modifiers are not specific enough to
 describe the data. We could add a second modifier to every diagnosis.  The
 negative being that a billing admit primary diagnosis requires three
 entries into the observation fact table the the single observation.  One
 for source, one for admit, and one for primary.

 If we must change it,  I¹d suggest the following, and give the folders a
 concept_cd so that the epic sites can continue with the existing model and
 other sites can go deeper on the primary/non-primary for admit and
 discharge encounter diagnosis:

 * Encounter Dx
 * Encounter Dx Primary
 * Encounter Dx Non-Primary
 * Encounter Admit
 * Encounter Admit Primary
 * Encounter Admit Non-Primary
 * Encounter Discharge
 * Encounter Discharge Primary
 * Encounter Discharge Non-Primary

 If there is an additional source, or modifier that a site needs, we can
 save it up for a future release, but we need to lock the changes on this
 at some point so that we can move on.


 Phillip

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:35
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  huhickman
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 216   |
--+

Comment (by dconnolly):

 Hubert,

 In case it's not clear who has the ball at this point, trac says it's you.
 :)

 I'm still standing by w.r.t. your Jan 6 offer to implement something in
 this space, whether it be a then-current design proposal or something
 influenced by more recent discussions.

 Or if you'd rather nominate somebody else to take the next step, feel free
 to re-assign the ticket instead.

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:34
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  huhickman
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 216   |
--+

Comment (by dconnolly):

 Replying to [comment:30 lv]:
  Is there value in mapping to modifiers not required for the CDM?

 Good question. I was wondering about that on today's call - trying to
 remember what requirements motivate the current design.

 I can think of a couple items beyond CDM just now:
   - the ability to query for primary billing diagnosis
   - distinguishing Clinical vs. billing diagnoses

 But maybe those are not actually required by GPC research in the near
 term? Maybe sites that want these can just deal with them locally.

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:33
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  huhickman
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 216   |
--+

Comment (by huhickman):

 I would second (or third ?) what Laurel says above - a simpler approach
 would be easier to implement and understand.

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:32
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[Phillip Reeder]

I still feel that the source of the data is an important aspect that we
need to be maintained. And the CDM Modifiers are not specific enough to
describe the data. We could add a second modifier to every diagnosis.  The
negative being that a billing admit primary diagnosis requires three
entries into the observation fact table the the single observation.  One
for source, one for admit, and one for primary.

If we must change it,  I¹d suggest the following, and give the folders a
concept_cd so that the epic sites can continue with the existing model and
other sites can go deeper on the primary/non-primary for admit and
discharge encounter diagnosis:

* Encounter Dx
* Encounter Dx Primary
* Encounter Dx Non-Primary
* Encounter Admit
* Encounter Admit Primary
* Encounter Admit Non-Primary
* Encounter Discharge
* Encounter Discharge Primary
* Encounter Discharge Non-Primary

If there is an additional source, or modifier that a site needs, we can
save it up for a future release, but we need to lock the changes on this
at some point so that we can move on.


Phillip


On 3/17/15, 12:29 PM, GPC Informatics d...@madmode.com wrote:

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  huhickman
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 216   |
--+

Comment (by nateapathy):

 I agree - it may be more straightforward to use the CDM as our guiding
 design target rather than the intricacies of each EHR and the source
 tables we have available. While my proposed hierarchy above leverages the
 deep approach to it's fullest capacity, the Dev call discussion today
 has proven that in practice that granularity isn't practical given the
 source data. At the risk of invalidating the amount of conversation had
 thus far, I think it's worthwhile to pursue Laurel's suggestion above.
 Perhaps plus PR and NP for primary and nonprimary?

--
Ticket URL:
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:31
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev




UT Southwestern


Medical Center



The future of medicine, today.


___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  huhickman
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 216   |
--+

Comment (by nateapathy):

 I agree - it may be more straightforward to use the CDM as our guiding
 design target rather than the intricacies of each EHR and the source
 tables we have available. While my proposed hierarchy above leverages the
 deep approach to it's fullest capacity, the Dev call discussion today
 has proven that in practice that granularity isn't practical given the
 source data. At the risk of invalidating the amount of conversation had
 thus far, I think it's worthwhile to pursue Laurel's suggestion above.
 Perhaps plus PR and NP for primary and nonprimary?

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:31
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  huhickman
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 216   |
--+

Comment (by lv):

 Is there value in mapping to modifiers not required for the CDM? Seems
 like taking a simple approach and capturing the DX_SOURCE top three (AD,
 DI, FI) would address the immediate need?

 AD=Admitting
 DI=Discharge
 FI=Final
 IN=Interim
 NI=No information
 UN=Unknown
 OT=Other

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:30
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  preeder
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+
Changes (by dconnolly):

 * owner:  ngraham = preeder


Comment:

 Phillip, go ahead and update babel.

 (Nathan sent details Tuesday, January 06, 2015 12:21 PM)

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:25
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  ngraham
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+
Changes (by dconnolly):

 * owner:  campbell = ngraham


Comment:

 Reeder writes (Monday, January 05, 2015 3:22 PM)
  I’ve uploaded my most recent version of a proposed GPC demographics
 terminology and diagnosis modifiers to central desktop under the GPC i2b2
 metadata folder.  Could you load it onto Babel for me?

 also Tuesday, December 23, 2014 1:36 PM

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:24
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  campbell
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+
Changes (by dconnolly):

 * owner:  lv = campbell


Comment:

 In this week's teleconference (#12):

  - should we survey users for preference of v1 or v2? a.
a. JC/UNMC: will poll users by next week
b. Bonnie/UMN: will poll users
c. other sites are encouraged to do likewise

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:21
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  lv
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+

Comment (by ngraham):

 Replying to [comment:19 dconnolly]:
  DC: Hubert, Nathan flip coins to load into Babel
 I've loaded the modifiers from Nathan A. into Babel.  See
 ticket:91#comment:26.

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:20
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[Phillip Reeder]

I prefer the V1 as it most closely matches what had been discussed in the
previous iteration of diagnosis modifiers, and it allows me to easily
search for admit diagnosis or discharge diagnosis, etc.  Additionally, I
think it will be flexible for adding additional diagnosis types and for
grouping the modifiers in different ways.  For example, if V2 were to use
the exact same modifier codes as V1,  I think it could easily be deployed
along with V1.  Simply adding the modifiers for the primary diagnosis into
a separate grouping.   Something like:
\modifier\primary_dx\
\modifier\primary_dx\billing\
\modifier\primary_dx\billing\Admit Primary  Billing Diagnosis - Admit
Primary N   RA  DX|BILL:ADMIT PRIMARY
\modifier\primary_dx\billing\Discharge Primary  Billing Diagnosis -
Discharge Primary   N   RA  DX|BILL:DC PRIMARY
\modifier\primary_dx\billing\Professional Primary   Billing Diagnosis -
Professional PrimaryN   RA  DX|PROF:PRIMARY
\modifier\nonprimary_dx\
\modifier\nonprimary_dx\billing\
\modifier\nonprimary_dx\billing\Admit Primary   Billing Diagnosis - Admit
Non-Primary N   RA  DX|BILL:ADMIT NONPRIMARY
\modifier\nonprimary_dx\billing\Discharge Primary   Billing Diagnosis -
Discharge Non-Primary   N   RA  DX|BILL:DC NONPRIMARY
\modifier\nonprimary_dx\billing\Professional PrimaryBilling Diagnosis -
Professional Non-PrimaryN   RA  DX|PROF:NONPRIMARY


By adding that to V1, you would be able to search for just primary
diagnosis, just secondary, or go into a specific source and get all admit
diagnosis.  So it would give you have the best of both.

Phillip


On 12/3/14, 9:45 AM, GPC Informatics d...@madmode.com wrote:

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  lv
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+

Comment (by ngraham):

 Replying to [comment:19 dconnolly]:
  DC: Hubert, Nathan flip coins to load into Babel
 I've loaded the modifiers from Nathan A. into Babel.  See
 ticket:91#comment:26.

--
Ticket URL:
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:20
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev




UT Southwestern Medical Center
The future of medicine, today.

___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  lv
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+
Changes (by dconnolly):

 * owner:  nateapathy = lv


Comment:

 from today's teleconference (#12):

 Laurel: OK, I can look at the diagnosis modifiers Nate put together within
 the spreadsheet and give some feedback.
 DC: Hubert, Nathan flip coins to load into Babel

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:19
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[Campbell, James R]

So, if I am hearing you correctly Nate, we will change 'Deleted' to 
''Deleted/Cancelled' and use across Cerner and Epic and change 'Secondaty' to 
'Secondary/Nonprimary' for convergence since in Epic we are using Secondary to 
annotate diagnoses 2-N and it does not mean 'second'
JIM

James R. Campbell MD
campb...@unmc.edu
Office: 402-559-7505
Secretary: 402-559-7299
Pager: 402-888-1230

 On Nov 17, 2014, at 2:33 PM, GPC Informatics d...@madmode.com wrote:

 #90: Diagnoses Modifiers for data attribution
 --+
 Reporter:  campbell  |   Owner:  nateapathy
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
 Component:  data-stds |  Resolution:EC
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
 --+

 Comment (by nateapathy):

 That's correct - in the Cerner Millennium Problem List the valid statuses
 are Active, Cancelled, and Resolved, and Cancelled would be used for the
 use case you are describing re: Deleted from Epic.

 We keep the Problems List and Diagnoses List separate (you can turn
 problems into diagnoses in the chart, of course, but on the database side
 there are distinct and separate tables (PROBLEM and DIAGNOSIS). For
 modifiers on diagnosis codes, we only specify between primary and non-
 primary, as Laurel described earlier in this thread, so I wouldn't vote
 for Secondary as the modifier of choice. We are using Primary and non-
 Primary in our current i2b2 projects. It's not reflected in Babel yet
 because we haven't finished the deployment but I'll have an updated
 diagnosis ontology in December.

 --
 Ticket URL: 
 http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:16
 gpc-informatics http://informatics.gpcnetwork.org/
 Greater Plains Network - Informatics

The information in this e-mail may be privileged and confidential, intended 
only for the use of the addressee(s) above. Any unauthorized use or disclosure 
of this information is prohibited. If you have received this e-mail by mistake, 
please delete it and immediately contact the sender.

___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[Apathy,Nate]

That sounds like a reasonable convergence of cancelled/deleted terms to
me. Laurel, those terms work for Marshfield as well, correct?

My only adjustment would be on your second point to simplify it to
³non-primary² since it seems that the ³secondary² term is not truly
reflective of an ordinal relationship in any of our source systems. It
could confuse users if we have both secondary and non-primary in the term.

Thanks,

Nate Apathy
Program Manager, Cerner Research



-Original Message-
From: Campbell, campb...@unmc.edu campb...@unmc.edu
Date: Tuesday, November 18, 2014 at 8:28 AM
To: gpc-dev@listserv.kumc.edu gpc-dev@listserv.kumc.edu
Cc: Nate Apathy nate.apa...@cerner.com, Dan Connolly
dconno...@kumc.edu, Laurel Verhagen verhagen.lau...@mcrf.mfldclin.edu
Subject: Re: [gpc-informatics] #90: Diagnoses Modifiers for data
attribution

So, if I am hearing you correctly Nate, we will change 'Deleted' to
''Deleted/Cancelled' and use across Cerner and Epic and change 'Secondaty'
to 'Secondary/Nonprimary' for convergence since in Epic we are using
Secondary to annotate diagnoses 2-N and it does not mean 'second'
JIM

James R. Campbell MD
campb...@unmc.edu
Office: 402-559-7505
Secretary: 402-559-7299
Pager: 402-888-1230

 On Nov 17, 2014, at 2:33 PM, GPC Informatics d...@madmode.com wrote:

 #90: Diagnoses Modifiers for data attribution
 --+
 Reporter:  campbell  |   Owner:  nateapathy
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
 Component:  data-stds |  Resolution:EC
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
 --+

 Comment (by nateapathy):

 That's correct - in the Cerner Millennium Problem List the valid statuses
 are Active, Cancelled, and Resolved, and Cancelled would be used for the
 use case you are describing re: Deleted from Epic.

 We keep the Problems List and Diagnoses List separate (you can turn
 problems into diagnoses in the chart, of course, but on the database side
 there are distinct and separate tables (PROBLEM and DIAGNOSIS). For
 modifiers on diagnosis codes, we only specify between primary and non-
 primary, as Laurel described earlier in this thread, so I wouldn't vote
 for Secondary as the modifier of choice. We are using Primary and non-
 Primary in our current i2b2 projects. It's not reflected in Babel yet
 because we haven't finished the deployment but I'll have an updated
 diagnosis ontology in December.

 --
 Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:16
 gpc-informatics http://informatics.gpcnetwork.org/
 Greater Plains Network - Informatics

The information in this e-mail may be privileged and confidential,
intended only for the use of the addressee(s) above. Any unauthorized use
or disclosure of this information is prohibited. If you have received this
e-mail by mistake, please delete it and immediately contact the sender.


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.
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

RE: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[Dan Connolly]

Now that I think about it, primary/non-primary is orthogonal to data 
attribution. I'm inclined to make that a separate issue, if only to simplify 
teleconference discussion.

--
Dan


___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

RE: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[Dan Connolly]

I just realized this proposal doesn't facilitate the main distinction our users 
are accustomed to: billing vs. clinical diagnosis. They'd have to know to 
choose the union of Enounter, Order, Problem list, and Professional. In HERON 
at KUMC, the union of Problem List and Encounter is represented as a Clinical 
folder.

And we don't (yet?) support Professional Diagnosis nor Order Diagnosis. What 
are those? I'd appreciate somebody filling me/us in on what workflows those 
represent.

-- 
Dan



From: Phillip Reeder [phillip.ree...@utsouthwestern.edu]
Sent: Wednesday, November 12, 2014 2:13 PM
To: gpc-dev@listserv.kumc.edu; campb...@unmc.edu; Dan Connolly
Cc: gpc-...@listserv.kuc.edu
Subject: Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

Based on the emails I found, and what is on babel, this is what I think
the modifiers should be.  The only difference from Babel is in the Billing
Diagnosis modifiers where I tried apply what was in the various emails.

Cerner had Inactive and Canceled modifiers for the Problem List Diagnosis
in one of the emails.  I¹m unsure if they need to be added or if they
could be mapped to the three modifiers from Epic.

For consistency, is there a preference for Principle vs Primary?  Does it
make a difference?

ModifierModifier Code   Clarity 
Table

Billing Diagnosis
Admit Diagnosis Principle   DX|BILL:ADMIT PRINCIPLE 
HSP_ACCT_ADMIT_DX
Admit Diagnosis Secondary   DX|BILL:ADMIT SECONDARY 
HSP_ACCT_ADMIT_DX
Discharge Diagnosis Principle   DX|BILL:PRINCIPAL   
HSP_ACCT_DX_LIST
Discharge Diagnosis Secondary   DX|BILL:SECONDARY   
HSP_ACCT_DX_LIST
Discharge Diagnosis Present on Admis..  DX|BILL:POA 
HSP_ACCT_DX_LIST
Encounter Diagnosis
Admit Encounter Diagnosis   DX|ENC:ADMIT
HSP_ADMIT_DIAGNOSIS
Discharge Encounter Diagnosis   DX|ENC:DISCHARGE
HSP_DISCH_DIAGNOSIS
Primary Encounter Diagnosis DX|ENC:PRIMARY  
PAT_ENC_DX
Secondary Encounter Diagnosis   DX|ENC:SECONDARY
PAT_ENC_DX
Medical History Diagnosis   DX:HISTORY  
MEDICAL_HX
Order Diagnosis
Order Medication Diagnosis  DX|ORDER:MED
ORDER_DX_MED
Order Procedure Diagnosis   DX|ORDER:PROC   
ORDER_DX_PROC
Problem List Diagnosis
Active Problem  DX|PROB:ACTIVE  
PROBLEM_LIST
Deleted Problem DX|PROB:DELETED 
PROBLEM_LIST
Resolved ProblemDX|PROB:RESOLVED
PROBLEM_LIST
Professional Diagnosis
Primary Professional Diagnosis  DX|PROF:PRIMARY 
ARPB_TRANSACTIONS
Secondary Professional DiagnosisDX|PROF:SECONDARY   
ARPB_TRANSACTIONS


On 11/12/14, 1:33 PM, GPC Informatics d...@madmode.com wrote:

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  preeder
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+
Changes (by dconnolly):

 * cc: gpc-dev@Š (added)
 * owner:  dconnolly = preeder
 * status:  reopened = assigned


Comment:

 Phillip, I re-opene this because your question (Wednesday, November 12,
 2014 12:44 PM) shows we clearly didn't carry out the recorded decision.

 Do you have a preference on what the modifiers actually should be?

--
Ticket URL:
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:7
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics




UT Southwestern Medical Center
The future of medicine, today.

___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

RE: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[Wanta Keith M]

An order diagnosis originates from a clinical system and eventually makes its 
way into one of the two billing systems (Hospital or Professional).  Typically 
the physician needs to sign for an order, so you shouldn't trust a diagnosis on 
an order unless it was signed.

In the revenue cycle for professional billing (this normally means outpatient 
visits), you will find diagnoses on charges that originated from one of the 
many clinical systems.  Many would assume these all show up on professional 
billing claim types, but that isn't always the case if the charges are not 
billed to insurance.

-Original Message-
From: gpc-dev-boun...@listserv.kumc.edu 
[mailto:gpc-dev-boun...@listserv.kumc.edu] On Behalf Of Dan Connolly
Sent: Tuesday, November 18, 2014 10:52 AM
To: Phillip Reeder; gpc-dev@listserv.kumc.edu; campb...@unmc.edu
Cc: gpc-...@listserv.kuc.edu
Subject: RE: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

I just realized this proposal doesn't facilitate the main distinction our users 
are accustomed to: billing vs. clinical diagnosis. They'd have to know to 
choose the union of Enounter, Order, Problem list, and Professional. In HERON 
at KUMC, the union of Problem List and Encounter is represented as a Clinical 
folder.

And we don't (yet?) support Professional Diagnosis nor Order Diagnosis. What 
are those? I'd appreciate somebody filling me/us in on what workflows those 
represent.

-- 
Dan



From: Phillip Reeder [phillip.ree...@utsouthwestern.edu]
Sent: Wednesday, November 12, 2014 2:13 PM
To: gpc-dev@listserv.kumc.edu; campb...@unmc.edu; Dan Connolly
Cc: gpc-...@listserv.kuc.edu
Subject: Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

Based on the emails I found, and what is on babel, this is what I think
the modifiers should be.  The only difference from Babel is in the Billing
Diagnosis modifiers where I tried apply what was in the various emails.

Cerner had Inactive and Canceled modifiers for the Problem List Diagnosis
in one of the emails.  I¹m unsure if they need to be added or if they
could be mapped to the three modifiers from Epic.

For consistency, is there a preference for Principle vs Primary?  Does it
make a difference?

ModifierModifier Code   Clarity 
Table

Billing Diagnosis
Admit Diagnosis Principle   DX|BILL:ADMIT PRINCIPLE 
HSP_ACCT_ADMIT_DX
Admit Diagnosis Secondary   DX|BILL:ADMIT SECONDARY 
HSP_ACCT_ADMIT_DX
Discharge Diagnosis Principle   DX|BILL:PRINCIPAL   
HSP_ACCT_DX_LIST
Discharge Diagnosis Secondary   DX|BILL:SECONDARY   
HSP_ACCT_DX_LIST
Discharge Diagnosis Present on Admis..  DX|BILL:POA 
HSP_ACCT_DX_LIST
Encounter Diagnosis
Admit Encounter Diagnosis   DX|ENC:ADMIT
HSP_ADMIT_DIAGNOSIS
Discharge Encounter Diagnosis   DX|ENC:DISCHARGE
HSP_DISCH_DIAGNOSIS
Primary Encounter Diagnosis DX|ENC:PRIMARY  
PAT_ENC_DX
Secondary Encounter Diagnosis   DX|ENC:SECONDARY
PAT_ENC_DX
Medical History Diagnosis   DX:HISTORY  
MEDICAL_HX
Order Diagnosis
Order Medication Diagnosis  DX|ORDER:MED
ORDER_DX_MED
Order Procedure Diagnosis   DX|ORDER:PROC   
ORDER_DX_PROC
Problem List Diagnosis
Active Problem  DX|PROB:ACTIVE  
PROBLEM_LIST
Deleted Problem DX|PROB:DELETED 
PROBLEM_LIST
Resolved ProblemDX|PROB:RESOLVED
PROBLEM_LIST
Professional Diagnosis
Primary Professional Diagnosis  DX|PROF:PRIMARY 
ARPB_TRANSACTIONS
Secondary Professional DiagnosisDX|PROF:SECONDARY   
ARPB_TRANSACTIONS


On 11/12/14, 1:33 PM, GPC Informatics d...@madmode.com wrote:

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  preeder
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+
Changes (by dconnolly):

 * cc: gpc-dev@Š (added)
 * owner:  dconnolly = preeder
 * status:  reopened = assigned


Comment:

 Phillip, I re-opene this because your question (Wednesday, November 12,
 2014 12:44 PM) shows we clearly didn't carry out the recorded decision.

 Do you have a preference on what the modifiers actually should be?

--
Ticket URL:
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:7
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 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   |
--+
Changes (by dconnolly):

 * owner:  dconnolly = nateapathy
 * status:  accepted = assigned


Comment:

 JRC writes:
  I think that Cerner was researching their problem list installation at
 the time of the Hackathon and we should add their modifiers to problem
 diagnoses but I would ask Nate Apathy if ?Cerner:Cancelled=Epic:Deleted?
 or are there differences in meaning between Cerner and Epic on that issue
 of an erroneous entry that was backed out?

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:15
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 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   |
--+

Comment (by nateapathy):

 That's correct - in the Cerner Millennium Problem List the valid statuses
 are Active, Cancelled, and Resolved, and Cancelled would be used for the
 use case you are describing re: Deleted from Epic.

 We keep the Problems List and Diagnoses List separate (you can turn
 problems into diagnoses in the chart, of course, but on the database side
 there are distinct and separate tables (PROBLEM and DIAGNOSIS). For
 modifiers on diagnosis codes, we only specify between primary and non-
 primary, as Laurel described earlier in this thread, so I wouldn't vote
 for Secondary as the modifier of choice. We are using Primary and non-
 Primary in our current i2b2 projects. It's not reflected in Babel yet
 because we haven't finished the deployment but I'll have an updated
 diagnosis ontology in December.

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:16
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 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   |
--+

Comment (by nateapathy):

 Replying to [comment:11 dconnolly]:
  Replying to [comment:10 lv]:
   Are there are requests from researchers at other sites to use these
 alternative types of diagnoses?
 
  My experience with HERON at KUMC includes at least one researcher who
 said something like you can't distinguish primary billing diagnosis?
 Never mind then. Call me when you can. So when i2b2 1.6 came a long with
 modifiers, we enhanced HERON to use modifiers to make the distinction in
 our Sep 2012 release:
   - [https://informatics.kumc.edu/work/blog/heron-waconda-update HERON
 Waconda update introduces new searching modifiers for Medications and
 Diagnosis]
 
  The CDM spec says Please do not include diagnoses generated from
 problem lists, which are a different workflow and data-generating
 activity. HERON at KUMC includes problem list diagnoses, so using a
 modifier is a straightforward way to filter them out for CDM purposes.
  We've also heard this same request on the Cerner side, but the
 meaningful research distinction has always been with Primary vs. Non-
 Primary and no further granularity has been brought to my attention thus
 far.
  Regarding problem list diagnoses, do you mean problems that have
 been deemed diagnosis-worthy and therefore are only those diagnoses that
 originated from the problem list? If that's the case, I know that the
 workflow exists in Cerner to capture that, but I will have to do some more
 digging to find out how we capture that in our extracts and how it might
 be brought in to i2b2. Currently we do not have that flag in i2b2, if it
 is for diagnoses that originated on the problem list. The alternative
 would be records on the problem list that are coded with diagnosis codes,
 which on the clinical side don't make them diagnoses, but could cause
 confusion on this topic.

  I'll add other comments to separate topics as well.

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:17
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 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   |
--+

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
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  lv
 Type:  design-issue  |  Status:  accepted
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+
Changes (by lv):

 * status:  assigned = accepted


Comment:

 Are there are requests from researchers at other sites to use these
 alternative types of diagnoses? MCRF use our main Diagnosis Table for the
 majority of our research. Only in a rare case would we go after anything
 else.

 Notes:
 1. Primary vs. Principle: after a quick, non-comprehensive check, Cattails
 uses Primary.

 2. Primary, Secondary: Currently we pull all diagnoses, without regard for
 position. To fill Primary and Secondary, we'd need to adjust our ETL. How
 would other diagnoses be handled? Are only two being loaded per encounter
 for other sites?

 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.

 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.

 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.

 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.

 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.

 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.

 Let me know if this makes sense or if you would like additional
 clarification.

 Thanks,
 Laurel


 
 From: Phillip Reeder [phillip.ree...@utsouthwestern.edu]
 Sent: Wednesday, November 12, 2014 2:13 PM
 To: gpc-dev@listserv.kumc.edu; campb...@unmc.edu; Dan Connolly
 Cc: gpc-...@listserv.kuc.edu
 Subject: Re: [gpc-informatics] #90: Diagnoses Modifiers for data
 attribution

 Based on the emails I found, and what is on babel, this is what I think
 the modifiers should be.  The only difference from Babel is in the Billing
 Diagnosis modifiers where I tried apply what was in the various emails.

 Cerner had Inactive and Canceled modifiers for the Problem List Diagnosis
 in one of the emails.  I¹m unsure if they need to be added or if they
 could be mapped to the three modifiers from Epic.

 For consistency, is there a preference for Principle vs Primary?  Does it
 make a difference?

 ModifierModifier Code
 Clarity Table

 Billing Diagnosis
 Admit Diagnosis Principle   DX|BILL:ADMIT PRINCIPLE
 HSP_ACCT_ADMIT_DX
 Admit Diagnosis Secondary   DX|BILL:ADMIT SECONDARY
 HSP_ACCT_ADMIT_DX
 Discharge Diagnosis Principle   DX|BILL:PRINCIPAL
 HSP_ACCT_DX_LIST
 Discharge Diagnosis Secondary   DX|BILL:SECONDARY
 HSP_ACCT_DX_LIST
 Discharge Diagnosis Present on Admis..  DX|BILL:POA
 HSP_ACCT_DX_LIST
 Encounter Diagnosis
 Admit Encounter Diagnosis   DX|ENC:ADMIT
 HSP_ADMIT_DIAGNOSIS
 Discharge Encounter Diagnosis   DX|ENC:DISCHARGE
 HSP_DISCH_DIAGNOSIS
 Primary Encounter Diagnosis DX|ENC:PRIMARY
 PAT_ENC_DX
 Secondary Encounter Diagnosis   DX|ENC:SECONDARY
 PAT_ENC_DX

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  dconnolly
 Type:  design-issue  |  Status:  accepted
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+

Comment (by lv):

 Thanks for this clarification; taking another look, we can use the
 Diagnosis Sub Type IDS field here.

 0 *Not Available
 1 Primary
 2 Secondary
 3 Procedure Scheduled
 4 Procedure Incid
 5 Procedure RT SRG
 6 Complication
 8 Other
 9 Unspecified

 Replying to [comment:12 dconnolly]:
   2. Primary, Secondary: Currently we pull all diagnoses, without regard
 for position. To fill Primary and Secondary, we'd need to adjust our ETL.
 How would other diagnoses be handled? Are only two being loaded per
 encounter for other sites?
 
  I think Secondary is a bit of a misnomer; I think it just means not
 primary, and there can be may of them. The database column is just a Y/N
 for primary.
 
   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.
 
  It seems reasonable to me that if your system doesn't distinguish
 primary from secondary, you should just report the more general term, e.g.
 Billing Diagnosis. Or if you don't even know that much, just don't add a
 modifier at all. For studies that require the distinction, MCRF would have
 to evaluate the benefit of participating against the cost of adjusting
 your ETL.
 
  But I think I should escalate this issue, as it bears on
 DataRepositoryManagement, which is included in the GPC data sharing
 agreement by reference.


 Am I missing where we would differentiate a source of insurance? Structure
 seems like it would match Encounter Diagnoses. Could be good to define
 now, if the goal is to incorporate health plans in the future.

--
Ticket URL: 
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:14
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

RE: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[Campbell, James R]

Phillip
What you transcribed is exactly what we agreed at Hackathon I(KU March 2014).  
Hubert just exposed our modifiers deployed on Babel and we have gone part way 
on the installation but we are adding a second ontology layer for SNOMED CT.   
I think that Cerner was researching their problem list installation at the time 
of the Hackathon and we should add their modifiers to problem diagnoses but I 
would ask Nate Apathy if ?Cerner:Cancelled=Epic:Deleted? or are there 
differences in meaning between Cerner and Epic on that issue of an erroneous 
entry that was backed out?
Jim

From: Phillip Reeder [phillip.ree...@utsouthwestern.edu]
Sent: Thursday, November 13, 2014 10:37 AM
To: Campbell, James R
Subject: FW: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

Jim,
How do the modifiers I wrote down look to you?  Should we add the Cerner
Inactive  Canceled modifiers? If we are in agreement on them,  I’ll send
an update to the group and say this is it for the GPC v1 terminology.

Let me know.

Thanks,
Phillip


On 11/12/14, 2:25 PM, Dan Connolly dconno...@kumc.edu wrote:

This looks OK to me, but I'm not really one to judge.

I'd like to get a few more opinions.

To avoid the anoybody/somebody/nobody disease, I rolled my 10 sided die
and it came up 6... MCRF.

Laurel, what do you folks think? Are you happy to deploy this at your
site? If not, what would you prefer?

--
Dan


From: Phillip Reeder [phillip.ree...@utsouthwestern.edu]
Sent: Wednesday, November 12, 2014 2:13 PM
To: gpc-dev@listserv.kumc.edu; campb...@unmc.edu; Dan Connolly
Cc: gpc-...@listserv.kuc.edu
Subject: Re: [gpc-informatics] #90: Diagnoses Modifiers for data
attribution

Based on the emails I found, and what is on babel, this is what I think
the modifiers should be.  The only difference from Babel is in the Billing
Diagnosis modifiers where I tried apply what was in the various emails.

Cerner had Inactive and Canceled modifiers for the Problem List Diagnosis
in one of the emails.  I¹m unsure if they need to be added or if they
could be mapped to the three modifiers from Epic.

For consistency, is there a preference for Principle vs Primary?  Does it
make a difference?

ModifierModifier Code
Clarity Table

Billing Diagnosis
Admit Diagnosis Principle   DX|BILL:ADMIT PRINCIPLE
HSP_ACCT_ADMIT_DX
Admit Diagnosis Secondary   DX|BILL:ADMIT SECONDARY
HSP_ACCT_ADMIT_DX
Discharge Diagnosis Principle   DX|BILL:PRINCIPAL
HSP_ACCT_DX_LIST
Discharge Diagnosis Secondary   DX|BILL:SECONDARY
HSP_ACCT_DX_LIST
Discharge Diagnosis Present on Admis..  DX|BILL:POA
HSP_ACCT_DX_LIST
Encounter Diagnosis
Admit Encounter Diagnosis   DX|ENC:ADMIT
HSP_ADMIT_DIAGNOSIS
Discharge Encounter Diagnosis   DX|ENC:DISCHARGE
HSP_DISCH_DIAGNOSIS
Primary Encounter Diagnosis DX|ENC:PRIMARY
PAT_ENC_DX
Secondary Encounter Diagnosis   DX|ENC:SECONDARY
PAT_ENC_DX
Medical History Diagnosis   DX:HISTORY
MEDICAL_HX
Order Diagnosis
Order Medication Diagnosis  DX|ORDER:MED
ORDER_DX_MED
Order Procedure Diagnosis   DX|ORDER:PROC
ORDER_DX_PROC
Problem List Diagnosis
Active Problem  DX|PROB:ACTIVE
PROBLEM_LIST
Deleted Problem DX|PROB:DELETED
PROBLEM_LIST
Resolved ProblemDX|PROB:RESOLVED
PROBLEM_LIST
Professional Diagnosis
Primary Professional Diagnosis  DX|PROF:PRIMARY
ARPB_TRANSACTIONS
Secondary Professional DiagnosisDX|PROF:SECONDARY
ARPB_TRANSACTIONS


On 11/12/14, 1:33 PM, GPC Informatics d...@madmode.com wrote:

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  preeder
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+
Changes (by dconnolly):

 * cc: gpc-dev@Š (added)
 * owner:  dconnolly = preeder
 * status:  reopened = assigned


Comment:

 Phillip, I re-opene this because your question (Wednesday, November 12,
 2014 12:44 PM) shows we clearly didn't carry out the recorded decision.

 Do you have a preference on what the modifiers actually should be?

--
Ticket URL:
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:7
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics




UT Southwestern Medical Center
The future of medicine, today.






-
This message

RE: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[Dan Connolly]

This looks OK to me, but I'm not really one to judge.

I'd like to get a few more opinions.

To avoid the anoybody/somebody/nobody disease, I rolled my 10 sided die and it 
came up 6... MCRF.

Laurel, what do you folks think? Are you happy to deploy this at your site? If 
not, what would you prefer?

-- 
Dan


From: Phillip Reeder [phillip.ree...@utsouthwestern.edu]
Sent: Wednesday, November 12, 2014 2:13 PM
To: gpc-dev@listserv.kumc.edu; campb...@unmc.edu; Dan Connolly
Cc: gpc-...@listserv.kuc.edu
Subject: Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

Based on the emails I found, and what is on babel, this is what I think
the modifiers should be.  The only difference from Babel is in the Billing
Diagnosis modifiers where I tried apply what was in the various emails.

Cerner had Inactive and Canceled modifiers for the Problem List Diagnosis
in one of the emails.  I¹m unsure if they need to be added or if they
could be mapped to the three modifiers from Epic.

For consistency, is there a preference for Principle vs Primary?  Does it
make a difference?

ModifierModifier Code   Clarity 
Table

Billing Diagnosis
Admit Diagnosis Principle   DX|BILL:ADMIT PRINCIPLE 
HSP_ACCT_ADMIT_DX
Admit Diagnosis Secondary   DX|BILL:ADMIT SECONDARY 
HSP_ACCT_ADMIT_DX
Discharge Diagnosis Principle   DX|BILL:PRINCIPAL   
HSP_ACCT_DX_LIST
Discharge Diagnosis Secondary   DX|BILL:SECONDARY   
HSP_ACCT_DX_LIST
Discharge Diagnosis Present on Admis..  DX|BILL:POA 
HSP_ACCT_DX_LIST
Encounter Diagnosis
Admit Encounter Diagnosis   DX|ENC:ADMIT
HSP_ADMIT_DIAGNOSIS
Discharge Encounter Diagnosis   DX|ENC:DISCHARGE
HSP_DISCH_DIAGNOSIS
Primary Encounter Diagnosis DX|ENC:PRIMARY  
PAT_ENC_DX
Secondary Encounter Diagnosis   DX|ENC:SECONDARY
PAT_ENC_DX
Medical History Diagnosis   DX:HISTORY  
MEDICAL_HX
Order Diagnosis
Order Medication Diagnosis  DX|ORDER:MED
ORDER_DX_MED
Order Procedure Diagnosis   DX|ORDER:PROC   
ORDER_DX_PROC
Problem List Diagnosis
Active Problem  DX|PROB:ACTIVE  
PROBLEM_LIST
Deleted Problem DX|PROB:DELETED 
PROBLEM_LIST
Resolved ProblemDX|PROB:RESOLVED
PROBLEM_LIST
Professional Diagnosis
Primary Professional Diagnosis  DX|PROF:PRIMARY 
ARPB_TRANSACTIONS
Secondary Professional DiagnosisDX|PROF:SECONDARY   
ARPB_TRANSACTIONS


On 11/12/14, 1:33 PM, GPC Informatics d...@madmode.com wrote:

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  preeder
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+
Changes (by dconnolly):

 * cc: gpc-dev@Š (added)
 * owner:  dconnolly = preeder
 * status:  reopened = assigned


Comment:

 Phillip, I re-opene this because your question (Wednesday, November 12,
 2014 12:44 PM) shows we clearly didn't carry out the recorded decision.

 Do you have a preference on what the modifiers actually should be?

--
Ticket URL:
http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:7
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics




UT Southwestern Medical Center
The future of medicine, today.

___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev

Re: [gpc-informatics] #90: Diagnoses Modifiers for data attribution

[GPC Informatics]

#90: Diagnoses Modifiers for data attribution
--+
 Reporter:  campbell  |   Owner:  lv
 Type:  design-issue  |  Status:  assigned
 Priority:  major |   Milestone:  data-domains2
Component:  data-stds |  Resolution:
 Keywords:|  Blocked By:
 Blocking:  70, 91, 120   |
--+
Changes (by dconnolly):

 * cc: gpc-dev@… (removed)
 * cc: gpc-dev@… (added)


--
Ticket URL: http://informatics.gpcnetwork.org/trac/Project/ticket/90#comment:9
gpc-informatics http://informatics.gpcnetwork.org/
Greater Plains Network - Informatics
___
Gpc-dev mailing list
Gpc-dev@listserv.kumc.edu
http://listserv.kumc.edu/mailman/listinfo/gpc-dev