Task Team Meeting - Rolling Agenda and Minutes 2019

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List of items to bring to task meeting

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Deceased patients
  • Is that really what you want? It will give fact that patient died, but miss new location.

  • Is that really what you want? It will give occupancy but miss actual time of death.

to be done likely after DSM: add destinations to organ donor deaths.
1 Julie asks:

Once that is implemented, I can set up Check dx implying death across encounters.
Correcting suspect links also needs to be dealt with when this is done. And needs to be documented.
7 February 2019 17:31:06
Direct Data Access for RIS/PACSShould we pursue this now? Where would it be on our priorities? It might be related to CCI coding.5 April 2018 20:16:16
Eliminating distinction between different ward typesCTU vs NTU - we decided at task that we wanted to eliminate the distinction. A lot of things are part of their network of information, so we will need to work out the details above before we can move ahead.
  • I believe it was only related to transfer ready DtTm between CTU and NTU not eliminate the concept. Medicine program would have to weigh in. Trish Ostryzniuk 16:11, 2018 July 30 (CDT)
    • I seem to remember the reason to stop doing this also involved that we have more and more locations that don't fall into a clean place. For now we pretend we can give medicine this data, but is it true and meaningful? Ttenbergen 15:51, 2018 July 31 (CDT)
      • Allan will contact the medicine stakeholders Ttenbergen 12:18, 2019 January 24 (CST)
24 January 2019 18:18:26
Height and weightZ) decided to revisit SOFA scoring 6 months after ICD10 so same should likely go for this.26 January 2019 01:38:46
IICU consult
  • To cross check query s_tmp_IICU_consult_not_paired I was thinking through special cases and realized that we don't have a definition for what to do if there are multiple consults, e.g. there is a consult, pt deteriorates and consult is no longer applicable, and then pt gets better and there is a second consult. How would that work on ward in real life, and how would we want to code that? Ttenbergen 12:49, 2019 January 22 (CST)
  • would there ever be 4, 6, 8 records, or do we only enter the first consult? Or, for that matter, would there ever be a second consult before the first is acted on?
  • how would this work for patients who leave the unit before the consult is answered?
  • the newest instructions mention that STB might only have the first entry... if so will they need to be excluded from this check?
  • 22 January 2019 18:50:12
    PHIN field
    • What do we do if a person's insurance status changes or they move in or out of Province? Do we change those PHINs? If we wanted to keep the same person_ID for different PHINs we would need to remove the first step in Generate Person IDs that blows away Person_IDs for duplicate PHINs. but: if we remove that step we will no longer make sure that the scenario of multiple PHINs per Person_ID doesn't happen accidentally.
      • Pagasa says: if there is a PHIN in EPR, we always use the PHIN in the current entry and change all previous PHIN entries to that PHIN; we leave alone the Province entries of previous records in that case. However, if the patient used to have a PHIN but doesn't any more (e.g. moved out of province and is then admitted), then it is not clear what we should do.
    • The answer of this needs to take into account how the Person ID generator will deal with this.
    • Likley we would need to assign a pseudoPHIN to this scenario and replace earlier real PHINS with that PseudoPHIN. But that would lose our ability to link with e.g. MCHP.
    11 February 2019 22:40:46
    Reporting from ICD10/CCI
    • We made this page early on to make sure that we address any reporting concerns you have about ICD10. Are the TASK questions still relevant? If not, could you please take them out? If you have other things relating to this that should go to task, pls stick them in here.

    Will Julie be able to come up with usable groupings of diagnoses? In the current system she grouped by main diagnosis, but that concept is gone. Will ICD10 blocks implemented by S ICD10 Block Dxs table be sufficient? Ttenbergen 22:57, 2018 March 20 (CDT)

    • Different procedures would be listed with the same CCI code; will Julie easily interpret and utilize CCI codes for reporting?
    • Do we care that we will not be able to differentiate between a Blakemore tube from an Upper GI scope with banding or hemostasis, when in CCI they both look the same: (T) Stomach, pylorus... and Control of Bleeding. --LKolesar 14:11, 2018 May 1 (CDT)
      • discussed at task 14:08, 2018 June 20 (CDT), Julie to review what she needs and we will discuss again Ttenbergen 14:08, 2018 June 20 (CDT)

    This is part of the discussion with Julie about Apache diagnoses today I think Ttenbergen 08:49, 2019 January 10 (CST)
    10 January 2019 14:49:53
    SOFA scoringZ) decided to revisit 6 months after ICD1017 November 2018 22:23:53

    See Task Team Meeting - Rolling Agenda and Minutes 2018 for previous year's minutes.

    ICU Database Task Group Meeting – February 6, 2019

    • Present: Allan, Con, Joanna, Michelle, Tina, Trish
    • Absent: Julie, Laura
    • Minutes prepared by: AG
    • Action items in BOLD

    1. Further consideration of reinstating CCI code Pharmacotherapy, antineoplastic agent, whole body for chemotherapy: We decided not to do so. The rationale is that what is considered chemotherapy is not quite confusing since: (a) many cytotoxic drugs are given for indications other than cancer, and (b) increasingly the drugs used for cancer are not cytotoxic but are biologics. - Tina updated Pharmacotherapy, antineoplastic agent, whole body with this info

    2. Further consideration of adding a specific ICD10 code for Intravenous drug abuse (IVDA) -- There is no ICD10 code for IVDA and at this time we decided not to add a custom code unless some user really wants this information. - Tina has added this to List of ICD10 Diagnoses we don't code

    3. Regarding coding of FFP and albumin transfusions:

    • Transfusion of FFP: After discussion we decided that when stickers are not used, that the number of units will be determined by the current procedures of Canadian Blood Services that 1 unit is approximately 250 mL.

    as per your request that page is still waiting for an edit from you

    4. Regarding CAM coding. The current methods of collecting this data is in TISS and on the ICU flowsheet.

    • To even be evaluable for CAM assessment, a patient must be conscious. Thus, in reality, a given CAM assessment has 3 possible findings: (i) not evaluable, (ii) evaluable and CAM-positive, or (iii) evaluable and CAM-negative.
    • CAM status is currently recorded in ICUs in two places:
      • On the ICU flowsheet, as an indication of CAM-positive versus not being CAM-positive; as above the latter includes evaluable and CAM-negative or not evaluable. Of note, the ICU nurses evaluate for delerium multiple times per day.
      • On the TISS sheet, as a bubble for being CAM-positive versus not being CAM-positive. Here there is just a single yes/no bubble, so that NOT being CAM-positive can mean either that there were no evaluable assessments during that day or that there was at least one evaluable assessment and all of those were CAM-negative.
    • The users of this data (including Rakesh Arora in ICCS) are mainly counting the number of ICU days in which a patient is CAM-positive -- which of course only includes days on which there is at least one CAM-evaluable assessment.

    - Allan has updated CAM positive (TISS Item) with this info

    5. The data collectors made clear that it would be highly desirable for Wiki searching to be enhanced. Tina will ponder this and has started page Searching the wiki to document.

    6. The idea was floated to (somehow) enhance the inclusion in Wiki pages of synonyms for diagnoses. We’ll come back to this sometime later. - See Searching the wiki

    7. New question about how to code mets to the pancreas. Answer is Gastrointestinal system NOS, metastatic malignancy to it (also code primary site) and that page has been updated.

    8. New question about whether it is OK to code bacterial Colonized with organism (not infected) as a comorbid. Answer is Yes.

    9. After discussion relating to how diabetes might disappear, Allan has added Past history, transplanted pancreas or islet cells.

    10. New question of situation whereby: Patient with ESRD is admitted for a kidney transplant -- gets the TP -- and kidney has trouble leading to acute renal failure/insufficiency in the transplanted organ. A number of questions arose with the following answers:

    11. New question. There appear to be two conflicting ways that the Wiki indicates to code HAP. One listed in Iatrogenic, complication of medical or surgical care NOS and the other in Hospital-acquired pneumonia (HAP) in ICD10. Allan has fixed this with the correct approach being listed in the latter Wiki page.

    Next Task Group Meeting: February 13, 2019 at 11am

    ICU Database Task Group Meeting – January 24, 2019

    • Present: Allan, Con, Joanna, Julie, Tina, Trish
    • Absent: Laura
    • Minutes prepared by: AG
    • Action items in BOLD

    1. There is still concern about the extra workload of ICD10/CCI. We will continue to monitor this and seek pithy suggestions for reducing the workload with minimal loss of content/value.

    2. Consideration of adding Pharmacotherapy, antineoplastic agent, whole body back to the CCI list. This CCI picklist code would be 1.ZZ.35.HA-M0. At the Dec 7, 2018 task meeting we decided to eliminate it, though that item doesn’t explain why. We’ll reconsider at the next task.

    3. Consideration of adding a specific ICD10 code for IVDA -- There is no ICD10 code for IVDA. The drug abuse codes go by the drug, not the route. If we decide we really need/want this, we can add a custom code. At the next meeting we’ll discuss this.

    4. After discussion of whether we want to code CMV(+) status for organ transplants, we decided that we do not.

    5. FFP does not have stickers that come with it from Blood Services. This led to a question of how to quantify FFP for coding Transfusion of FFP.

    • Allan called the Winnipeg office of Canadian Blood Services and was told that for full units (approx. 250 mL) they do have stickers, but when they send half units that those do not have stickers. A solution appears to be to count the stickers, which should be there for whole units, but for half units, count them manually -- as 0.5 of a unit. We’ll discuss this more at the next Task meeting.

    6. Question arose of how to code Factor V Leiden mutation. Allan will look into this ---> DONE, as the Wiki page indicates this is covered in Primary hypercoagulability (thrombophilia).

    7. A complex question was raised about coding/counting CCI admit procedures that are done prior to admission, especially if done in a procedure suite on the way from one hospital ward or ICU to another hospital ward or ICU.

    • Our current criteria are listed in CCI Collection and that works fine when the patient comes to out ICU/ward from the ED or another location where we do not collect.
    • But, it’s complicated by the fact that is a patient goes from one to another of our collecting locations, that they might be counted in each place. Furthermore, a person being transferred from location A to location B may, in between, go to a procedure suite and get admit-type procedures.
    • We agreed to make 4 general rules for procedures:
      • (i) Transfer from collecting location A to collecting location B without any stop in between where procedures might occur -- all procedures done before leaving location A will be collected by location A only
      • (ii) Transfer from collecting location A to collecting location B WITH a stop in between where procedures occur -- all procedures done before leaving location A will be collected by location A only, while procedures done at the stop in between will be coded by location B only.
      • (iii) Transfer from noncollecting location A (which includes ED) to collecting location B without any stop in between where procedures might occur -- any qualifying admit procedures done before leaving location A will be collected by location B
      • (iv) Transfer from noncollecting location A (which included ED) to collecting location B WITH a stop in between where procedures occur -- all procedures done before leaving location A or during the stop in between will be coded by location B only.
    • Allan put the updated information on the wiki, and Tina moved it to CCI_Collection#Moved_patients from Admit Procedure since it applies to both admit and acquired.

    8. Tina raised the issue of the possibility of the following true timing of events: First patient accepted for admission; Second patient deemed transfer ready to a lower level of care; Last is patient arrives. It’s an issue because the current cross-check Function Dispo Chronological() does not allow Transfer Ready DtTm to occur prior to Arrival D/T. After discussion (which unfortunately Tina was not present for), we agreed that the rule should be that Transfer Ready D/T can only be coded at or after Arrival D/T. The rationale has to do with the main desire for avoidable days to refer to actual bed occupancy days avoidable.

    9. Discussion about coding Bacteremia. Although this is a finding and not an actual disease, because of it’s importance, we agreed that even though the general role is that coding findings/signs/symptoms is optional when the underlying cause is known, that for bacteremia we should ALWAYS code it when present. Furthermore, that at the discretion of the data collector, it can be linked to another presumed infection (e.g. Klebsiella pneumonia linked to Klebsiella bacteremia), but if it’s not completely clear that they’re related, to leave the bacteremia as “free standing”. Allan will modify the wiki page for Bacteremia, the sepsis template -- DONE.

    Next Task Group Meeting: February 6, 2019 at 11am

    ICU Database Task Group Meeting – January 9, 2019

    • Present: Allan, Con, Joanna, Julie, Tina, Trish
    • Absent: Laura
    • Minutes prepared by: AG
    • Action items in BOLD

    1. Through discussion it became clear that there’s a need to modify the Kidney, renal tubular acidosis (RTA, all types) wiki page to clarify that by definition it is not an RTA if renal failure (acute or chronic) is present. Said another way, an RTA is a metabolic acidosis due to an inability of the renal tubules to excrete hydrogen ions in the presence of a normal creatinine clearance, as indicated usually by a normal creatinine. Allan will add this to the wiki article -- DONE.

    2. There was substantial concern voiced by Con and Joanna about how long the new system is taking to code. At this point it’s as much as 4-fold longer than before. We discussed possible reasons, which include:

    • ICD10 coding, though this is possibly less burdensome than is CCI coding.
    • The biggest single issue raised was that among the 5 CCI Collection Modes:
      1. Collecting "CCI collect each" items
      2. Collecting "CCI collect count each" items
      3. Collecting "CCI collect count days" items
      4. Collecting "CCI collect count units" items
      5. Collecting "CCI collect first" items
      • We recognized that we probably could downgrade most of ‘1’ to be one of the others
      • And that for at least some of ‘2’, '3' and '4' we could downgrade to ‘5’
        • We decided today to do that for HD, PD, CRRT and ICP monitoring (Done - Tina)
        • Allan will take a look at the entire list, especially CCI Picklist, and consider further items that can be downgraded.
    • Other options for reducing workload for CCI include: (i) compressing the number of body parts, (ii) reducing and/or compressing the number of “what was done to the body part” items.
    • We’ll discuss all this at next Task meeting.

    3. Julie raised the question of Charlson items -- specifically that previously most such items were allowed to be listed either as Admit Diagnosis or Comorbid Diagnosis. (See also Controlling Dx Type for ICD10 codes) The question is what do we want to do now about this. Allan will review both Charlson’s original description, and Quan’s administrative data implementation to see what THEY did regarding this --> DONE. The intention of this coding is to identify conditions that are present prior to admission. Thus, we should include admit and even acquired (post-admit) diagnoses for those Charlson items where it's pretty clear that the condition was almost certainly present prior to admission, even if that wasn't recognized -- and th is applies for 16 of the 17 Charlson conditions, i.e. all except "Myocardial infarction", and the only reason for that one being an exception is that there is an ICD10 code for Past history, myocardial infarction (old MI).


    Charlson Admit Como - I have put several related pages on your list that start with the same words as this one. We need to update them to make sense with any change to this. Some still had other questions in them anyway.

    • AG REPLY --- tina and ag to go through all the separate ICD10 codes Charlson Comorbidities in ICD10 codes that make up the 17 Charlson conditions and one by one decide if they can be included in Charlson EVEN IF they're admit or acquired diagnoses.

    4. It was noted that the Template:ICD10 Guideline Como vs Admit is very confusing. Allan will work on it. (Template was added to Allan's list)