Task Team Meeting - Rolling Agenda and Minutes 2018

ICU Database Task Group Meeting – March 2, 2017

Present: Allan Garland, Con Marks , Julie Mojica, Laura Kolesar, Tina Tenbergen , Trish Ostryzniuk

Absent: none Minutes prepared by: AG Action items in BOLD

1. Switching over to ICD-10 and CCI - nothing new to report at this meeting.

• There are just a few finishing touches needed to finalize the ICD-10 and CCI framework. These include: (a) to optimize word searching, we will decide upon and implement a common schema for wording (e.g. “liver failure, acute” instead of “acute liver failure”), (b) map the current “buglist” with the ICD-10 schema, (c) figure out how to to implement combining diagnostic codes together as part of the same entity. Allan will work on these.
• We should create crosschecks at this early phase of development (e.g. every metastatic dz code must also have a primary source of cancer code).

2. Update on seeking data on PHIN validation data, hospitalization data, and mortality data from WRHA (Phil Jarman).

• After today’s meeting, Allan and Julie spoke by phone with Phil Jarman who was supportive of our updated request for data. Phil sent an email to Trevor Strome to that effect, and Julie sent Trevor an email to specify what we would like to get in the data dumps.
• We will follow up with Trevor within a few weeks.
• One issue remaining is to clarify why some of the hospitalizations appear to have no overlap with ICU dates.

3. Update on working on updating the databases given to MCHP.

• Julie is in the process of updating the Wiki documentation of the current database structure, but more work needs to be done on this.
• Discussion about if/how to export the “Temp” file to MCHP. Since this file is the repository for a variable number of different (usually) time-limited projects with a 1-to-many data structure, it is heterogeneous. We agreed that to avoid complicating the data collection/importation process we will internally maintain the Temp file, whose contents are well understood by Julie, Tina, etc. But, we agreed also that this heterogeneous structure would create confusion and difficulties for end-users at MCHP, even with all our existing Wiki explanations. So, after spirited debate, it was decided that for MCHP we will process the Temp file into multiple single-purpose 1-to-many files. Tina pointed out that this will mean that MCHP will have different explanations for those data items than we currently have on the Wiki. Julie and Tina will work together to make this conversion work -- likely to be effected via use of Queries. BUT, we as we also agreed not to include temporary (time-limited) data collection projects to the MCHP export, so at least some of the things contained in Temp will not be sent over at all.

4. It was agreed, persuant to the decision to cease counting angiograms/cardiac caths, that we can do so immediately.

5. Regarding aspiration. In light of the solution that will be used in ICD-10, we agreed that for now we will eliminate the option of pneumonia with a listed “pathogen” of 59=aspiration. Thus, as will be the case after ICD-10 implementation, in the current schema a patient with aspiration pneumonitis without infection will be given the diagnosis of aspiration, but with infection he/she will be coded as BOTH aspiration, and pneumonia with appropriate organism.

6. Allan asked Trish to send him the current list of database personnel who have access to identified line-level data, so that he can update the WRHA Privacy Committee on this, as is required yearly.

7. New Collector issues:

• We agreed that in the temporary project on septic shock, we will have collectors record all antimicrobials used, not just antibacterials.
• Discussion, in the context of APACHE II diagnosis categories, of how to categorize patients who come to ICU directly from a procedure suite (e.g. cath lab, angio suite) that is not an OR. This is relevant because APACHE diagnoses are divided by ±post-op, where a patient is considered to be postop if he/she came to ICU directly from OR or PACU. After much discussion, we agreed that we will continue the original definition of this postop designation. To avoid clashing with certain internal data checks, Tina will make changes to make it allowable that procedures that can be done via angio (e.g. TAVI) to have “angio” or “cath lab” as pre-admission locations.

Next Task Group Meeting: Monday April 28, 2017 at 11:00 am

ICU Database Task Group Meeting – April 3, 2017

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

1. Switching over to ICD-10 and CCI - nothing new to report at this meeting. • There are just a few finishing touches needed to finalize the ICD-10 and CCI framework. These include: (a) to optimize word searching, we will decide upon and implement a common schema for wording (e.g. “liver failure, acute” instead of “acute liver failure”), (b) map the current “buglist” with the ICD-10 schema, (c) figure out how to to implement combining diagnostic codes together as part of the same entity. Allan will work on these. • We should create crosschecks at this early phase of development (e.g. every metastatic dz code must also have a primary source of cancer code).

2. Update on seeking data on PHIN validation data, hospitalization data, and mortality data from WRHA (Phil Jarman). • After today’s meeting, Allan and Julie spoke by phone with Phil Jarman who was supportive of our updated request for data. Phil sent an email to Trevor Strome to that effect, and Julie sent Trevor an email to specify what we would like to get in the data dumps. • We will follow up with Trevor within a few weeks. • One issue remaining is to clarify why some of the hospitalizations appear to have no overlap with ICU dates.

3. Update on working on updating the databases given to MCHP. • Julie is in the process of updating the Wiki documentation of the current database structure, but more work needs to be done on this. • Discussion about if/how to export the “Temp” file to MCHP. Since this file is the repository for a variable number of different (usually) time-limited projects with a 1-to-many data structure, it is heterogeneous. We agreed that to avoid complicating the data collection/importation process we will internally maintain the Temp file, whose contents are well understood by Julie, Tina, etc. But, we agreed also that this heterogeneous structure would create confusion and difficulties for end-users at MCHP, even with all our existing Wiki explanations. So, after spirited debate, it was decided that for MCHP we will process the Temp file into multiple single-purpose 1-to-many files. Tina pointed out that this will mean that MCHP will have different explanations for those data items than we currently have on the Wiki. Julie and Tina will work together to make this conversion work -- likely to be effected via use of Queries. BUT, we as we also agreed not to include temporary (time-limited) data collection projects to the MCHP export, so at least some of the things contained in Temp will not be sent over at all.

4. It was agreed, persuant to the decision to cease counting angiograms/cardiac caths, that we can do so immediately.

5. Regarding aspiration. In light of the solution that will be used in ICD-10, we agreed that for now we will eliminate the option of pneumonia with a listed “pathogen” of 59=aspiration. Thus, as will be the case after ICD-10 implementation, in the current schema a patient with aspiration pneumonitis without infection will be given the diagnosis of aspiration, but with infection he/she will be coded as BOTH aspiration, and pneumonia with appropriate organism.

6. Allan asked Trish to send him the current list of database personnel who have access to identified line-level data, so that he can update the WRHA Privacy Committee on this, as is required yearly.

7. New Collector issues: • We agreed that in the temporary project on septic shock, we will have collectors record all antimicrobials used, not just antibacterials. • Discussion, in the context of APACHE II diagnosis categories, of how to categorize patients who come to ICU directly from a procedure suite (e.g. cath lab, angio suite) that is not an OR. This is relevant because APACHE diagnoses are divided by ±post-op, where a patient is considered to be postop if he/she came to ICU directly from OR or PACU. After much discussion, we agreed that we will continue the original definition of this postop designation. To avoid clashing with certain internal data checks, Tina will make changes to make it allowable that procedures that can be done via angio (e.g. TAVI) to have “angio” or “cath lab” as pre-admission locations.