Task Team Meeting - Rolling Agenda and Minutes 2018

Database Task Group Meeting December 8, 2017

• Present: Allan Garland, Con Marks, Julie Mojica, Laura Kolesar, Tina Tenbergen
• Absent: none Minutes prepared by: AG Action items in BOLD

1. Regarding the influenza coding:

• We discussed the possibility of going forward with 2 categories of influenza: (1) lab-confirmed and (2) suspected.
  • For lab-confirmed: we will use only the FINAL CADHAM result for this. Thus, we will have to wait for it to be finalized before we can finalize influenza coding. Specifically, we will NOT use the hospital lab rapid influenza test results, or the preliminary Cadham result. Cadham results are on eChart, but not on the regular EMR lab computer. Allan will communicate with the WRHA privacy office to try and get all the collectors eChart access.
  • For suspected: here the clinical team wrote believed that it was influenza, gave a “full course” of anti-influenza drug PLUS either: (a) no swab was sent at all, or (b) swab was sent and FINAL CADHAM result negative. Before we finalize this concept, Allan will talk to infection control.
    • Regarding a “full course of tamiflu”: The usual course of oseltamivir is 5 days. But WHO and CDC recommend that in severe cases the drug should be continued until the infection is resolved or there is satisfactory clinical improvement.
• We will talk about this more later, and finish the wiki article called “Influenza in ICD10”.

2. Agreed that our new goal for implementing ICD10 and CCI is April 1, 2018.

3. Agreed that high-flow oxygen will NOT be considered to be CPAP or any form of non-invasive ventilation.

ITEMS FROM PRIOR MEETING THAT WE DIDN’T GET TO YET 2. Regarding Palliative care/palliative service.

• There is an ICD10 code for ‘’’Palliative care’’’. Allan will update the Wiki on this code, to clarify that by this code we mean a person is getting active palliative care, which may or may not concide with being ACP-C, or having a consult from the Palliative care service.

3. Regarding discharge planning and paneling.

• Allan identified that there is an ICD10 code for this: ‘’’Awaiting admission/transfer to other care facility (acute or chronic)’’’

4. Regarding the list of “reasons for CRRT” that is completed by the Nephro team.

• After discussion, we agreed that whatever they code should find it’s way into our general list of diagnoses.
• Towards this end, we agreed that that/those code(s) should be duplicated: (a) in the Temp file for the special purpose of identifying why they were on CRRT, and (b) in our general list of diagnoses. To operationalize this, Allan will identify the ICD10 code(s) that correspond to those diagnoses used by Nephro for this purpose.

5. Regarding Sepsis coding. Allan reported that our coding will follow the new Sepsis-3 definitions.

• This greatly simplifies identification of Septic shock, eliminates SIRS from all sepsis-related definitions, and eliminates what was previously called “sepsis” i.e. SIRS without acute organ failure.
• For what was previously called “severe sepsis”, the new guidelines merely call “sepsis”, which is identified as acute organ failure caused by proven or presumed infection. The official guidelines operationalize new organ failure as an increase in SOFA score by 2 or more points. Since SOFA scoring is nontrivial, there was concern about whether it is practical for the data collectors to try and do this. It was decided that Laura and some other ICU coders will look at the SOFA scoring grid and we’ll discuss this more next time.

6. Switching over to ICD-10

• A number of coders, Tina and Allan are working on Wiki articles for the new ICD10 coding schema.
• Allan is continuing work on making a set of “quick codes” for both ICD-10 and CCI, that can be chosen as unique entities, to represent procedures that are common, or difficult to otherwise figure out how to code.
• Regarding the list of acquired complications that previously were singled out to ensure that they were coded: Trish spoke with collectors who indicated that this list is of “high profile” entities that they don’t really think they need reminding about. So, we will bring this information back to the Steering Committee, with a recommendation that there is no need to continue using this list.

7. Regarding switching over to CCI

• Allan is continuing work on CCI coding.
• There was discussion about whether procedure coding should comprise: (a) fully flexible coding whereby every procedure is constructed by data collectors as a combination of: body part + what was done to it + how it was done, (b) ready-make CCI codes that have been pre-constructed from the native components, or (c) a combination of ready-made codes for the most common procedures, augmented by component construction of codes for the less common procedures. Towards making this decision Allan will send Tina lists of the components to peruse and start sharing with data collectors.

8. Update on seeking data on PHIN validation data, hospitalization data, and mortality data from WRHA.

• Allan is working on the new PIA.

9. Follow-up on seeking eChart access for coders

• Especially regarding the fact that though the collectors have access, there is an explicit notification that it cannot be used only for direct patient care. As even QI is a secondary purpose, before using it, we must contact the WRHA Privacy Office and clarify. Towards this end, Trish will draft a letter to Christina Von Schindler (WRHA Privacy Officer) and send it to Allan.

10. Starting with CLI criteria, there was extensive discussion about the difficulties in adhering to criteria-based diagnoses. *Laura clarified that even more than CLI, VAP requires much checking back and forth at data over time. It was decided that we would like to create wiki-based tools that will make it easier for collectors to do these tasks. The tools would incorporate the diagnosis guidelines into some sort of checklist “machinery”. Trish will assign Laura and a few other coders to work on this.

Next Task Group Meeting: December 20, 2017 at 11:00 am

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