Task Team Meeting - Rolling Agenda and Minutes 2022

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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}}
wiki page question Last modified
wiki page question Last modified
Chronic Health Facility 2025-11-28 1:43:16 PM
Dispo field 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)

  • Yes, I saw that, come to think of it I don't think we decided, not in my notes, but we can use it and I will change the wiki instructions Lisa Kaita 11:25, 13 March 2025 (CDT)
  • If we are going to collect this detail for dispo, should we consider whether or not to also look at SH in preadmit living situation?, currently lumped with community facility with support. Lisa Kaita 14:45, 16 April 2025 (CDT)
  • The entry name includes "TRSF" - is the entry for the previous location equivalent in EPR? Ttenbergen 23:30, 16 April 2025 (CDT)
  • no because the previous location would usually be <site>_ER Lisa Kaita 09:53, 28 May 2025 (CDT)
    • Sorry, I should have asked about "pre-hospital location in ADT". Ttenbergen 16:21, 28 May 2025 (CDT)
2025-12-12 8:44:55 PM
Pre acute living situation field
  • We found some cases where, during the same hospitalization, there are different values for this. For example, the first ward admission may have "house" and the immediate next ICU admission may have "PCH". I think there is no scenario where that makes sense. If you can think of one, tell me.
  • For existing data like this, how would we best treat it heuristically. Would the first record be more likely to be right because the chart is still cleaner and easier to follow? Or would a later record be more likely to be correct since more of the patient's story would have emerged? Thoughts?
  • This may arise when we complete the profiles separately ie. medicine done before ICU or vice versa, and more information may be more available in the chart, or it may have been an error where one was updated the other was not Lisa Kaita 15:32, 26 November 2025 (CST)
  • 2025-12-17 6:07:30 PM
    Selkirk Mental Health Centre JALT - Mental Health Facilities in Addition to Selkirk
  • Should we add Eden Mental Health Centre as well? Are there others, like addiction treatment facilities (eg Bruce Oake), that we should code either as a group or individually?
    • If we don't think this information is needed, should we also de-list our entry for Selkirk for consistency? Another option is to rename the selkirk entry and use it as an aggregate location going fwd.
  • 2025-12-17 6:03:11 PM
    Selkirk Mental Health Centre JALT - Mental Health Facility Coding vs PCH
  • currently aggregated as "PCH" because S dispo.loc type is PCH. That seems wrong. Should it be changed to “unknown/other” or to a new category “Mental Health”? And should we add Eden Mental Health Centre as well? Ttenbergen 16:21, 29 October 2025 (CDT)
    • Julie reviewed, only 6 cases in our data (are we coding this consistently?). Julie emailed OK with “unknown/other”, but also raised how Pre acute living situation should be coded.
  • 2025-12-17 6:03:11 PM
    Sex field
  • I just came across an incomplete record (from S9 laptop) that has a sex entry "Undiff". Our dropdown doesn't contain this so this likely came from Cognos. If this is now being coded in EPR, and considering that this would affect the "biological sex" we use in defining this, should we introduce this as an option? If we do not want to introduce this as an option, do our cross checks catch this? They might not, since this could not have been entered manually. Ttenbergen 00:16, 12 November 2025 (CST)
  • 2025-11-12 6:16:35 AM
    St.Amant Since 2022:

    Pre acute living situation for patients where Dispo is St Amant has been recorded as:

    • 23 Chronic Health Facility
    • 14 Community Facility with support
    • 5 Personal Care Home
    • 2 House
    • 1 other - known but not listed
    • 1 Apartment

    Pre acute living situation for patients where Previous Location is St Amant has been recorded as:

    • 1 Apartment
    • 1 Personal Care Home

    How are we using this code, and how should we use it? Ttenbergen 16:07, 29 October 2025 (CDT)

    * When I have seen this in a chart the address is usually 440 River Road, which is the St Amant facility, I code it as per the wiki instructions, as a chronic care facility. I know that St Amant has several group homes as well, but I wouldn't know their addresses and the documentation is usually not that specific to include who manages the group home. With the new dispo options, group homes would be transfer to group/supportive housing Lisa Kaita 15:46, 26 November 2025 (CST)
    2025-11-26 9:46:22 PM
    Template:Decubitus Stage not indicated Details
    • This instruction is taken from old dx Decubitus (pressure) ulcer, stage not indicated; since we will now have a series of codes for suspected deep tissue injury, we need to change this, but what should be here, and what should move into Template:Decubitus Deep Tissue Damage Details? Ttenbergen 15:29, 30 June 2025 (CDT)
    • This page should remain the same, deep tissue injury is really considered to be a different way to stage/document decubitus ulcers An unstageable ulcer is still used in documentation and grading of decubitus ulcers Lisa Kaita 20:23, 7 October 2025 (CDT)
    2025-10-08 1:25:23 AM
    Template:Decubitus Stage not indicated Details
  • This instruction is taken from old dx Decubitus (pressure) ulcer, stage not indicated; since we will now have a series of codes for suspected deep tissue injury, we need to change this, but what should be here, and what should move into Template:Decubitus Deep Tissue Damage Details? Ttenbergen 15:29, 30 June 2025 (CDT)
  • This page should remain the same, deep tissue injury is really considered to be a different way to stage/document decubitus ulcers An unstageable ulcer is still used in documentation and grading of decubitus ulcers Lisa Kaita 20:23, 7 October 2025 (CDT)
  • 2025-10-24 2:28:08 PM

    Also see Task Team Meeting - Rolling Agenda and Minutes 2021

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    ICU Database Task Group Meeting – March 9, 2022

    • Present: Allan, Julie, Lisa, Tina, Pam, Pagasa, Barret, Pam, Stephanie, Mailah
    • Minutes prepared by: AG
    • Action items in BOLD

    1. Update on new lab listings, which appear to duplicate prior listings. Nothing new to report.

    2. Update on what Shared Health is planning with regards to the databases. Allan reported that as requested, he provided Perry with a document (from Tina) a technical description of what is needed. Awaiting more information from Perry.

    3. Update on agreement to move to automated identification of the five APACHE II comorbid conditions. So, collectors will no longer be specifically identifying these once Julie/Tina implement this change.

    4. Regarding creating new table containing information (metadata) about individual medicine wards (including High Obs). Tina/Julie to implement this, but Tina recently recognized that Cognos contains this information and before implementing it using info supplied by collectors, she has asked Chastity about obtaining it from Cognos instead.

    5. Question from list: How to code if someone has a limb or organ removed during this stay but before they become our patient?

    6. Question from list: Change to replace Accept DtTm with first Service tmp entry, and Arrive DtTm with first Boarding Loc

    • We want to finally retire arrive time and accept time, replacing them with info from the Boarding Loc and Service temp. But Julie notes that we use these data to calculate and report on ER delays, and that in comparing the old with new way methods she has found some inconsistencies. So, before we completely make the changeover,
      • At the next task meeting Julie will show us histograms comparing the two sets of data
      • Lisa will look at the inconsistencies and see if she can figure out why it’s happening

    7. Question from list Drug-induced immunosuppression.

    • Tina made the point that the way we’re currently recording this entity for purposes of APACHE is as a TISS element, but that this is awkward and suboptimal.
    • After discussion we agreed to instead collect this information under existing code Z92.25 Past history of immunosuppressive drugs or corticosteroids, and for that purpose Allan has changed the definition of that ICD-10 code, which is applicable to both ICU and wards. Lisa to notify collectors of this.

    8. Next Task meeting April 6 at 11 am

    ICU Database Task Group Meeting – February 17, 2022

    • Present: Allan, Julie, Sherry, Lisa, Tina, Pam, Pagasa, Mindy, Brynn, Barret
    • Minutes prepared by: AG
    • Action items in BOLD

    1. Update on new lab listings, which appear to duplicate prior listings. Allan has begun working on this. Nothing new to report.

    2. Update on what Shared Health is planning with regards to the databases. Allan reported that as requested, he provided Perry with a document (from Tina) a technical description of what is needed. Awaiting more information from Perry.

    3. Change for Apache Chronic to ICD10 from separate variable - We agreed to move to automated identification of the five APACHE II comorbid conditions. So, collectors will no longer be specifically identifying these. Julie/Tina to implement this change.

    4. Update on the approximately 200 database questions that have been assigned for assessment but not addressed.

    • Tina reports this list is down to about 120 now.
    • After discussion, we agreed to delay aggressively addressing these until our data collectors come back from their COVID assignments.

    5. Location metadata storage - Update on creating new table containing information (metadata) about individual medicine wards (including High Obs). Tina/Julie to implement this. It will require that data collectors notify Julie and/or Tina and/or Pagasa when a specific ward is altered in such ways.

    6. New questions:

    7. Next meeting March 9 at 1pm.

    ICU Database Task Group Meeting – February 3, 2022

    • Present: Allan, Julie, Sherry, Lisa, Tina, Val, Pam, Pagasa, Mindy
    • Minutes prepared by: AG
    • Action items in BOLD

    1. Update on new lab listings, which appear to duplicate prior listings. Allan has begun working on this. Nothing new to report.

    2. Update on what Shared Health is planning with regards to the databases. Allan reported that as requested, he provided Perry with a document (from Tina) a technical description of what is needed. Awaiting more information from Perry.

    3. Update on plan (4/15/2021 Task meeting) to implement automatic coding of APACHE comorbidities

    • Allan is working on refining the ICD10 codes.

    4. Further consideration of T19 - Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2 (TISS Item) and T20 - Supp O2 through any device, delivered via nose, mouth, ETT or trach (TISS Item).

    • The original TISS28 item (CCM 24(1):64-73,1996) of supplemental ventilatory support, worth 2 points, is either of: (a) Breathing spontaneously via ETT without PEEP/CPAP, or (b) Supplemental O2 by any method without mechanical ventilation (invasive or noninvasive)
      • So there’s some overlap here (which is OK since it’s a single TISS item) in that spontaneous breathing via ETT without PEEP/CPAP but with supplemental O2 fits into both ‘a’ and ‘b’
    • On 6/15/2021 we changed TISS19 and TISS20 to:
      • TISS19 = Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2 -- e.g. includes trach mask, T-tube
      • TISS20 = Supplemental O2 though any device, delivered via nose, mouth, ETT or trach [which must be without invasive or noninvasive mechanical ventilation]
      • However, at that time we incorrectly said that TISS19 is just 1 point, while in fact it should be 2 points (and TISS20 is 2 points also)
    • There is still overlap between these versions of TISS19 and TISS20, specifically: breathing via ETT with O2 but without PEEP/CPAP fits both -- but this is not a problem, as when one computes the TISS score for a given domain (e.g. respiratory support), only the single item with the highest point score is counted.
    • Allan suggests that we:
      • Clarify TISS20: Supplemental O2 though any device, delivered via nose, mouth, ETT or trach, without invasive or noninvasive mechanical ventilation
      • Modify TISS19: Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2, without invasive or noninvasive mechanical ventilation
      • Ensure that TISS19 and TISS20 both are 2 points

    5. Update on the approximately 200 questions that have been flagged for assessment but not addressed.

    • Lisa dealt with approximately 40 of these, and referred approximately 70 of them to Julie and Pagasa.
    • The remainder were either assigned to others, or unassigned. Lisa will categorize them into into 3 groups: Need to be addressed; Can be deleted from further consideration; Unclear.

    6. A clarification was made in the Wiki regarding Medical Assistance In Dying (Z51.81). Specifically that it should not be coded in a record if the patient was transferred to a different institution to undergo MAID -- instead it should be coded at that other institution.

    7. It was agreed to stop the manual notation made in the Boarding Loc comment field for COVID patients or those on COVID wards.

    8. Clarification of coding for iatrogenic pneumothorax.

    • The issue was that in coding iatrogenic PTX, the instructions are to combine: Iatrogenic, puncture or laceration, related to a procedure or surgery NOS along with one of the nontraumatic PTX codes. BUT all of the latter indicated not to use them for iatrogenic or traumatic causes --- and this was WRONG. The relevant Wiki pages have now been changed to say not to use them for traumatic pneumothorax, but that can be used for iatrogenic PTX.

    9. After extensive discussion it was agreed to create a new table containing information (metadata) about individual medicine wards (including High Obs). This additional layer will be used to keep track over time of: bed count, ward type (specifically general ward vs. high obs) and other information. We recognize this will increase the work that Julie has to do for reporting on unit-specific information, but it provides flexibility for future. See Location metadata storage for further info. Tina/Julie to implement this. It will require that data collectors notify Julie and/or Tina and/or Pagasa when a specific ward is altered in such ways.

    10. An example was raised that a patient went medicine ward --> endoscopy --> OR --> surgery ward; but there was no appropriate Dispo location from the medicine ward. After discussion, we agreed to add to Dispo locations for each hospital a listing such as: HSC, Procedure location, NOS. Tina to implement this; this is also mentioned at Medical_Assistance_In_Dying#Collection_Instructions_for_MAID so any update needs to fix that as well..

    ICU Database Task Group Meeting – January 6, 2022

    • Present: Allan, Julie, Sherry, Lisa, Stephanie, Tina, Val, Pam, Mailah, Mindy
    • Minutes prepared by: AG
    • Action items in BOLD

    1. Update on new lab listings, which appear to duplicate prior listings. Allan has begun working on this. Nothing new to report.

    2. Update on what Shared Health is planning with regards to the databases. Allan reported that as requested, he provided Perry with a document (from Tina) a technical description of what is needed. Awaiting more information from Perry.

    3. Update on plan (4/15/2021 Task meeting) to implement automatic coding of APACHE comorbidities. Allan is working on refining the ICD10 codes.

    4. Update on the decision from 11/30/2021 meeting to revert to the old system, of starting a new record (with new APACHE score and new admit diagnoses) with service changes. This has been done, with relevant changes to the Wiki and “unwinding” of the 10 records that contain such MICU to SICU or SICU to MICU transfers into separate records.

    5. Allan reported that he is working on drafting a Data Sharing Agreement that all users of line-level (i.e. individual record) data will need to complete to obtain such data. Draft version is in Database_Request_Process#Data_Accessibility_and_Responsibility. Work is ongoing on this. Also, a decision will need to be made about whether we need a similar agreement for users of cumulative/aggregate data.

    6. Discussion about the Minimal Data Set and reporting. We agreed:

    • We will retain the 11 elements of the “true” minimal dataset, all of which come from Cognos.
    • Going forwards, all reporting by Julie will consist of details only from completed records, along with information about what % and # of records for the time interval are incomplete as of the time of the reporting.
    • Lisa will let all collectors know of this change
    • Tina has updated Minimal Data Set regarding it
    • Allan will let Bojan know -- done.

    7. There is a new ICD10 code U07.5 Past history of Covid-19 infection which is meant to be used just like the other “Past history of…” codes. Lisa to let all collectors know about it.

    8. After discussion we agreed that there is no further need for the Wiki page "HSC Boarding Locations". Tina has deleted it.

    9. The question was raised about definition of Emergency Surgery (concept). After discussion we agreed to maintain it as is, i.e. admitted from Operating Room or Recovery AND surgery was classified as E1. Tina has updated wiki Emergency Surgery (concept), Emergency Surgery (TISS Item) and Admit Type for APACHE II to make sure this is defined consistently.

    10. There is confusion about TISS elements T19 - Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2 (TISS Item) and T20 - Supp O2 through any device, delivered via nose, mouth, ETT or trach (TISS Item) .

    • This issue tracks back to the 6/15/2021 and 7/8/2021 minutes where indeed the current versions of TISS#19 and TISS#20 were chosen, both as 2 points, in order to correlate correctly to the original/actual delineation of TISS. So, no changes needed for these.

    11. Tina identified that there are approximately 200 database questions that have been assigned for assessment but not addressed. Lisa will go over this list and categorize them into 3 groups: Need to be addressed; Can be deleted from further consideration; Unclear. We’ll discuss this further next meeting.

    12. Next meeting February 3, 2022 at 11 am.

    2021...

    Also see Task Team Meeting - Rolling Agenda and Minutes 2021