Task Team Meeting - Rolling Agenda and Minutes 2020
List of items to bring to task meeting
Add to this by adding the following to the article where the problem is documented:
{{DiscussTask | explanation}}
| Question | Modification date"Modification date" is a predefined property that corresponds to the date of the last modification of a subject and is provided by Semantic MediaWiki. | |
|---|---|---|
| Cognos downtime procedure | Are there any hard commitments? Soft commitments? | 8 October 2025 01:19:28 |
| Decubitus Stage not indicated Details |
| 8 October 2025 01:25:23 |
| Dispo field | If this is actually done then why don't we just make the nursing stations available? We already have s_dispo table entries for them. 35 entries since 2016, 6 in the last 12 months. Are there other things for which this entry is used? Checked for reasons for this decision but they don't appear documented Ttenbergen 19:42, 13 March 2025 (CDT) JALT I thought we had decided at JALT to collect this as presented by EPR... do I remember this wrong? I had already added it in CCMDB.accdb Change Log 2025#2025-03-11-1. Ttenbergen 22:52, 11 March 2025 (CDT)
| 8 September 2025 15:31:26 |
| pre_acute_living_situation field | JALT should we be including Misericordia TCU here? Lisa Kaita 11:57, 5 June 2025 (CDT) | 3 October 2025 15:28:45 |
Also see Task Team Meeting - Rolling Agenda and Minutes 2019
ICU Database Task Group Meeting -- January 23, 2020
- Present: Allan, Barret , Joanna, Julie, Michelle, Tina
- Absent: Trish
- Minutes prepared by: AG
- Action items in BOLD
1. Followup about working to reduce collector workload
- Regarding obtaining CBS TraceLine for all transfusion data. Allan reported that he followed up with Margaret Ring (margaret.ring@blood.ca) on 1/20/2020 and her reply was to expect a response in a few weeks. Allan will follow up with her in the middle of February.
- Regarding obtaining RIS data for radiology tests. Allan reported that he followed up with Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca] on 1/20/2020, who replied that he’ll get back to Allan. Allan will follow up with him at the end of February.
2. Followup on having the ICU nurses do all TISS coding -- we have not implemented this yet because:
- While we have top administrator agreement at HSC, we are waiting for Dan to arrange similar meetings at St. B and Grace
3. Followup on trying to get hospital-level data elements from EPR. Tina discovered that there is an application called Cognos which has capability to extract data elements from existing databases. Tina has opened incident 3845870 and is working with Alex Omsen and Mike Ocko on getting this set up; see Cognos#Phone call with Mike Ocko
4. Follow up on how to code diagnostic sampling of pericardial fluid or the pericardium. See Jan 2, 2020 minutes for decisions. Action item left over is for Tina to add the “body part” item for diagnostic tests of 2.HA = pericardium.
5. Followup on pulling in certain lab results in addition to current counts via re-parsing all DSM data from 1/1/2019.
- Barret proposed a schema, but after discussion we recognized that Julie is already pulling ALL the actual results into a SAS format, and that there is no impediment from doing this going forward. It means that for any specific question/project, Julie will have to write SAS code to pull and format the data elements of interest.
- We will then start to discuss having Julie work to do the programming needed to automatically do the lab-related APACHE II APS score.
6. Following up on fact that some collectors are applying priority 0 to unconfirmed diagnoses with priority 0. The concern about this is that Julie uses the lowest priority diagnosis for reporting of cause of readmission, and this is done with incomplete data (i.e. before the unconfirmed diagnoses are all figured out). But after discussion we realized that this will not be a problem if Julie adds to this analysis the requirement that there ALSO be a “check mark” identifying the primary reason for admission.
7. Followup on coding fistulas
- We already have codes for these: J95.03 for T-E, K31.6 for stomach or duodenum, K60.5 for anorectal, K63.2 for intestinal, N32.2 for bladder, N82 for female genital tract.
- We agreed NOT to add any others, which are rarer, and in those cases use a NOS code -- e.g. Gallbladder or bile duct disorder, NOS
- There are other issues related to fistulae -- e.g. that there are always 2 parts involved. So we decided that the rule will be to combine the two portions together, except when one end of the fistula is to outside (i.e. the skin). Tina will create a template for fistulae, and Allan will populate it with this information -- DONE.
8. Followup on the uncertainty about what to do when in CCI, both diagnostic and therapeutic procedures are done on the same body part. We discussed this previously in the minutes, and under CCI Procedures it states when both are done to code them both.
9. Followup on how to code miscellaneous neuromuscular disorders? The solution(s) are:
- When the disease is KNOWN, and we don’t have a code for that specific disorder, collectors should find out (e.g. wikipedia) whether it is a primary nervous system disorder vs. a primary muscle disorder.
- If nervous system use the appropriate NOS code related to that system -- e.g. Kennedy’s disease, also called “Spinal and bulbar muscular atrophy”, is a degenerative disease of the CNS that results in muscle atrophy and thus the correct NOS code is Degenerative nervous system disorder, NOS. Other potentially useful NOS codes are Muscle disorder/myopathy (primary or secondary), NOS, Disorder of nervous system (any part), NOS, Movement disorder, NOS.
- When the specific diagnosis is not known at all, then we decided we’ll add the following code R29.8 to be called “Other and unspecified symptoms and signs involving the nervous and musculoskeletal systems”. Tina will add this.
10. Followup on issues of ESRD and Acute renal failure.
- Can ESRD be both and Admit and a Comorbid diagnosis? --> Answer is YES, if it was present prior to hospital admission AND it satisfies the criteria for an Admit diagnosis.
- Can a patient have both acute renal failure and ESRD (Stage 5)? --> Answer is YES, with limitation:.
- If the criteria for Stage 5 is being on dialysis, then the answer is No -- this is the limitation
- But if the criteria is creatinine clearance <15 ml/min in someone NOT yet on dialysis, then YES.
- The implications of these is that Tina is going to remove the checks currently in existence relating to each of these 2 items.
11. New items:
- Coding procedures for control of bleeding -- The issue here is that in CCI one currently has two separate options for the “what was done” part of this procedure, i.e. Control of Bleeding of the body part bleeding, or Occlusion of the bleeding vessel (e.g. via clipping or embolization or sclerosis).
- After discussion we agreed that the most informative and favored option is to combine the body part bleeding with Control of Bleeding. Thus for control of bleeding esophageal varices, the body part to go along with it is Esophagus. Allan will add to these wiki articles to make this clear -- DONE.
ICU Database Task Group Meeting – January 2, 2020
- Present: Allan, Barret , Joanna, Julie, Michelle, Tina, Trish
- Absent:
- Minutes prepared by: AG
- Action items in BOLD
1. Followup about working to reduce collector workload
- Regarding obtaining CBS TraceLine for all transfusion data. Allan will follow up with Margaret Ring (margaret.ring@blood.ca) and Tony Loewen (anthony.loewen@blood.ca)
- Regarding obtaining RIS data for radiology tests. Allan will follow up with RIS administrators (Angela Charbonneau 926-9874; Randy Roels 926-9871, rroels@sharedhealth.mb.ca).
- Regarding obtaining automated ABG data at HSC and St. B -- this has been implemented, getting that data from those sites from DSM data.
- Regarding consolidating some of the “what was done” components of CCI therapeutic interventions -- the plans from the 11/11/2019 meeting have been implemented.
2. Followup on having the ICU nurses do all TISS coding -- we have not implemented this yet because:
- While we have top administrator agreement at HSC, we are waiting for Dan to arrange similar meetings at St. B and Grace
3. Followup on trying to get hospital-level data elements from EPR. Tina discovered that there is an application called Cognos which has capability to extract data elements from existing databases.
- Tina has opened incident 3845870 and is working with Alex Omsen and Mike Ocko on getting this set up; see Cognos#Phone call with Mike Ocko
4. Follow up on how to code diagnostic sampling of pericardial fluid or the pericardium. Answers are:
- for therapeutic pericardial drainage combine (T) Pericardium with Drainage, Evacuation
- for diagnostic pericardiocentesis -- we agreed today to add the “body part” item for diagnostic tests of 2.HA, (D) Pericardium. Then this is combined with the appropriate Biopsy (endoscopic) or Biopsy (non-endoscopic) depending how it was sampled. In other words, we are not distinguishing between a “fluid biopsy” of the pericardium and a true tissue biopsy of it. Tina added this.
5. Followup on pulling in certain lab results in addition to current counts vis re-parsing all DSM data from 1/1/2019
- Barret with help from Tina will generate a draft list of which tests to do this for, which we’ll discuss at the next Task meeting. It should include the tests needed to calculate APACHE 2. Care must be taken to balance usefulness with data storage issues.
- As part of this, we will work so that the labs values that are part of APACHE 2 no longer need to be dealt with by the data collectors.
6. Item we didn't discuss yet -- unconfirmed diagnoses with priority 0. We'll discuss next time.
7. Followup on query about coding for the myraid of other fistulas out there
- There are separate codes for all of these when nontraumatic.
- We already have codes for these: J95.03 for T-E, K31.6 for stomach or duodenum, K60.5 for anorectal, K63.2 for intestinal, N32.2 for bladder, N82 for female genital tract.
- We don’t have codes now for: K82.3 for gallbladder, M25.1 for joint, or less common ones (e.g. lacrimal duct) and have to decide whether to add either of them. We also have to decide how to handle the fact that there are always TWO things connected by the fistula. We already have a “Category:Fistula” but probably need to create a template for it too that references the category but also discusses the various issues. If Tina will do this, Allan will populate it.
8. New items:
- There is some uncertainty about what to do when in CCI, both diagnostic and therapeutic procedures are done on the same body part. We discussed this previously in the minutes, and under CCI Procedures it states when both are done to code them both.
- How to code miscellaneous neuromuscular disorders?
- This is problematic because although they are often discussed as if they were a single category of disorders, in fact they are two separate categories, comprising nervous system disorders and muscular disorders. This is why there is no ICD10 code for miscellaneous neuromuscular disorders.
- The example used, Kennedy’s disease, also called “Spinal and bulbar muscular atrophy”, and is a degenerative disease of the CNS that results in muscle atrophy.
- We already have sufficient “NOS” codes within the neuro and muscular disorders to handle this when the disorder is known but we don’t have a specific code for it (as in the Kennedy disease example, where one should use Degenerative nervous system disorder, NOS). The other potentially useful NOS codes are Muscle disorder/myopathy (primary or secondary), NOS and Disorder of nervous system (any part), NOS, and for when it’s a movement disorder Movement disorder, NOS.
- The bigger problem is when it’s not clear whether it’s a primary nervous system vs. muscle disorder. In this case, one can:
- wait to see whether the medical teams decide on nervous vs. muscular disorder
- use a code that represents the symptom(s) not the disease per se. For example, if the symptoms are movement-related, one can use existing code Involuntary movements, NOS. And lastly when none of this is good enough, we might consider adding the code R29.8, to be called “Other and unspecified symptoms and signs involving the nervous and musculoskeletal systems”. We’ll discuss this next meeting.
- Can ESRD be both and Admit and a Comorbid diagnosis? The answer is YES, if it was present prior to hospital admission AND it satisfies the criteria for an Admit diagnosis. This decision also answers the issue of having acute on chronic renal failure.
- What should be done when creatinine clearance is <15 ml/min but the patient is admitted for uremic symptoms? This is an issue because the definition of Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15 is either on dialysis or with clearance<15. But of course, there are some patients who don’t start dialysis until they have GFR<10 or sometimes even lower. The answer is to follow the definition, such a person qualifies for Stage 5 as a comorbid condition, and as directly above, that same code can be used as an Admit diagnosis, along with the specific reason for admission (e.g. hyperkalemia).