Task Team Meeting - Rolling Agenda and Minutes 2023

List of items to bring to task meeting

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wiki page	question	Last modified
wiki page	question	Last modified
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)	2025-11-14 8:03:52 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?	2025-11-04 8:39:09 PM
Pre acute living situation field	JALT should we be including Misericordia TCU here? Lisa Kaita 11:57, 5 June 2025 (CDT)	2025-11-04 8:39:09 PM
Selkirk Mental Health Centre	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)	2025-10-29 9:21:30 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)	2025-10-29 9:07:10 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 2022

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ICU Database Task Group Meeting – April 19, 2023

• Present: Allan, Julie, Tina, Pagasa, Mindy, Michelle, Gail, Barret, Val, Pam
• Minutes prepared by: AG
• Action items in BOLD

1. Transition to Database Server#Shared Health - Nothing new about either of the possible alternative options for hosting the database.

2. Controlling Dx Type for ICD10 codes -- We agreed that this large task would be difficult, questionable, and not worth the effort.

3. Followup about trying to get ABGs at Grace Hospital to be included in the Lab Info System (LIS).

• Allan reported that Heather Smith is working to arrange a Zoom meeting of the relevant parties.

4. Followup on if/how to deal with proven cases of influenza who are treated also with antibiotics for possible superimposed bacterial pneumonia. After extensive discussion we came to:

• As per our usual practice, we will consider a diagnosis as present if the clinical team thinks it's present and are treating it.
• Regarding use of Pneumonia, NOS versus any of Pneumonia, bacterial, Pneumonia, viral, Pneumonia, fungal/yeast
  • Pneumonia, NOS should be used when there is a presumed pneumonia but the team is unsure what kind of organism is involved (bacteria, virus, fungus). So simply not having an organism from culture doesn't necessarily mean that Pneumonia, NOS should be used. If, for example, the team is assuming that it's a bacterial pneumonia (and treating it as such), but doesn't know which bacterium, then use Pneumonia, bacterial + Infectious organism, unknown
    • this example highlights that Infectious organism, unknown is used when the the specific organism is unknown (this could be either not even knowing the TYPE of organism), while when the organism has been identified but it's not in our bug list, THEN use Bacteria, NOS, Virus, NOS or Fungus or yeast, NOS.
• So, when there is 1 type of organism causing pneumonia (i.e. "proven", e.g. influenza) and the clinical team is treating for another type of organism also (e.g. bacterial):
  • code the "other" type if the team indicates in the progress notes that they believe it is ALSO present (which presumably means they're also treating it)

ICU Database Task Group Meeting – Feb 2, 2023

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

1. Transition to Database Server#Shared Health - Nothing new about either of the possible alternative options for hosting the database.

2. Controlling Dx Type for ICD10 codes

• We had additional discussion on whether this task is worth doing
• Collectors generally expressed that they're not very concerned that errors occur more than rarely in coding the type/bin in which a diagnsosis belongs. However, there was general agreement that we should try to get more data on this issue, and re-discuss it next time.
• Accordingly, Julie will generate a table where for each ICD10 code she identifies the total % that were coded in each of the 3 bins. We will use this as a first step to identify the magnitude and nature of this problem.

3. Followup item about trying to get ABGs at Grace Hospital to be included in the Lab Info System (LIS).

• Allan reported that just today Heather Smith emailed that she's working on it. We'll follow up and if they're willing, Allan will talk to Dr. Soroko about getting it implemented.

4. New item: Many or most proven cases of influenza are treated also with antibiotics for possible superimposed bacterial pneumonia. The question is whether or not to also code bacterial pneumonia in these cases.

• Discussion highlighted that in fact most patients presenting with proven influenza respiratory infection do NOT have bacterial pneumonia superimposed. Evidence from pandemics indicates that:
  • The most common bacterial causing superinfection are Staph aureus and Strep pneumoniae
  • Such superinfection is seen in a much greater fraction of those with severe manifestations -- e.g. in the 2009 H1N1 pandemic it's been estimated that 25-50% of severe cases had bacterial superinfection
  • Superinfection, when it occurs, generally occurs at least a few days after initial presentation
• We decided that before deciding what to do about these cases, that Allan will see if the CDC has a good case definition for bacterial superinfection in influenza ---> There isn't one and neither could he find one elsewhere in the medical literature.
• We'll discuss this further at the next meeting, but given that at least a substantial minority (25-50%) of those with severe manifestations of influenza pneumonia do have bacterial superinfection, the choice that's most consistent with our general philosophy of accepting a diagnosis given by the medical team, is to code them as bacterial pneumonia if the team gives antibiotics.

5. New item: If a nontraumatic brain injury (of any cause/type) is accompanied by a small "shift" seen on brain imaging, should one also code Brain compression, including herniation?

• Answer is "yes". Allan has altered the Wiki accordingly.

6. New item: How to code surgical amputation of a part of a leg (e.g. toes, foot).

• Answer: Indeed we have not included in CCI the subparts of the lower limb, but as no user has ever asked for this level of detail, we agreed to stick with just having (D) Leg, NOS.

7. New item: Clarification of multiple subcategories of COVID.

• It should not be that both asymptomatic COVID and symptomatic COVID are listed as admit diagnoses --- if so only keep the symptomatic one
• Both asymptomatic COVID and symptomatic COVID can be listed as acquired diagnoses, but only if asymptomatic is listed first and the 2 have different dates.

ICU Database Task Group Meeting – Jan 11, 2023

• Present: Allan, Gail, Julie, Michelle, Mindy, Stephanie, Tina, Val, Pagasa, Mailah
• Minutes prepared by: AG
• Action items in BOLD

1. Transition to Database Server#Shared Health - Nothing new about either of the possible alternative options for hosting the database.

2. Controlling Dx Type for ICD10 codes - Regarding the task to improve data collector diagnosis assignment into the 3 "bins" of admission diagnosis, acquired diagnosis and comorbid diagnosis.

• Lisa indicated that for a first pass on this, she will distribute all the codes among all the collectors.

3. New item: Clarification of Pulmonary emphysema or bullous disease without COPD. Allan modified this Wiki entry to make it clearer.

4. New item: Regarding the code Sudden cardiac death (and died)

• After discussion we recognized that we have no need to specifically code patients' cause of death. We know it occurred by virtue of the Dispo field. Thus we agreed to remove this item from the list of ICD-10 codes, and to have Julie go into all records where it has been recorded and remove it. Allan modified the Wiki page also.

5. New question: It was noticed that an error occurs if a diagnosis of Influenza is recorded (which is an implied bug) and one attempts to combine it with a Nosocomial problem code.

• Tina confirmed the error using Influenza pneumonia and Nosocomial infection, NOS; didn't make any changes because I believe in this scenario the code Influenza virus NOS -- should almost never be used should probably be used to satisfy the requirement for a pathogen. Alternative would be to add all or some influenza codes to Category:Double duty pathogen.

6. Followup item from long ago: Seeking to get ABGs at Grace Hospital to be included in the Lab Info System (LIS).

• The last time we tried for this, in 2015, the resp therapy group at Grace was not interested in being required to manually logging this information into LIS, as IS done at HSC and St. B.
• We think they may be more open to it now -- so today Allan emailed Heather Smith, asking her to raise it with them.
• If they indeed are willing, Allan will talk to Dr. Soroko about getting it implemented.

7. New item: Uncertainty of when/how to use Complication of labor and delivery, NOS

• As our database is only for adult patients, this code should not be used to indicate such a complication for a newborn. For example: During hospitalization, such a complication occurs, but it only affects the newborn and has no medical consequence for the mother --- do NOT use this code.
• Of course, for some such complications when the newborn with a complication becomes an adult, that problem persists, e.g. Fetal Alcohol Syndrome. If that adult is then admitted, it is the specific problem (such as Fetal Alcohol Syndrome) that should be listed as a Comorbid Diagnoses -- again you would NOT code Complication of labor and delivery, NOS.
• The only time Complication of labor and delivery, NOS would be coded is when the mother herself incurs a complication of labor or delivery, AND there is not a more specific code for the complication she suffered.
• Allan modified this Wiki page for clarity.

8. New item: Clarification of when/how to use Oral mucositis

• This code is for widespread or diffuse oral mucus membrane involvement -- as often occurs after some chemotherapies, and a few other causes.
• Do not use it for localized oral lesions or involvement in just a part of the oral mucosa. In such a case code the specific cause if known, and otherwise use Disorder of oral mucosa (mouth, lips, tongue), NOS.
• Allan has updated the Wiki to reflect this.

2022...

Also see Task Team Meeting - Rolling Agenda and Minutes 2022