Task Team Meeting - Rolling Agenda and Minutes 2021
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. | |
|---|---|---|
| Gangrene, NOS | can we use this code for necrosis or necrotic wounds? Lisa Kaita 11:57, 2024 April 17 (CDT) | 17 April 2024 17:03:39 |
| Hemothorax or hemopneumothorax, nontraumatic | Just wondering whether this code could be combined with iatrogenic causes similar to the guideline for:
Guideline for Iatrogenic Pneumothorax According to our general rule of not coding iatrogenic events as traumas, code an iatrogenic pneumothorax as
Plus the most appropriate of the following; Pneumothorax, tension, nontraumatic Pneumothorax, nontension, nontraumatic Pneumothorax, nontraumatic, NOS Thanks, Pamela Piche 08:55, 2024 March 19 (CDT)
| 5 April 2024 20:03:05 |
| ICD10 Guideline Sepsis | When the progression is very fast eg. admitted at 0100 with severe sepsis, lactate 1.7, then at 0220 lactate is now 2.7 do we use the admit severe sepsis and code the septic shock as acquired? Lisa Kaita 12:17, 2024 April 17 (CDT) How hard of a rule is lactate >2? If they meet the criteria for septic shock with the exception of a high enough lactate, can we code septic shock Lisa Kaita 12:17, 2024 April 17 (CDT) | 17 April 2024 17:17:33 |
| Iatrogenic, mechanical complication/dysfunction, internal prosthetic device or implant or graft NOS | At our last TASK meeting the decision was made to exclude spontaneous rupture of an ETT cuff or cuff leak, but we are wondering if this is correct based on what is listed in the includes section of this page and what is in Iatrogenic, mechanical complication/dysfunction, internal orthopedic prosthetic device or implant or graft or bone device and Iatrogenic, mechanical complication/dysfunction, cardiac or vascular prosthetic device or implant or graft, NOS Lisa Kaita 12:37, 2024 March 20 (CDT) | 20 March 2024 17:37:32 |
| Myocardial infarction, acute (AMI), NOS | ICD 10 has this code for STEMI:
2024 ICD-10-CM Diagnosis Code I21.3
ICD 10 has this code for NSTEMI: 2024 ICD-10-CM Diagnosis Code I21.4
Would it be less labor intensive for collectors to be able to use these codes instead of MI codes dependent upon development (or not) of Q waves as this is problematic to determine. Thank you, Pamela Piche 07:49, 2024 April 5 (CDT)
| 5 April 2024 20:10:42 |
| Task Questions | ||
Also see Task Team Meeting - Rolling Agenda and Minutes 2020
ICU Database Task Group Meeting – February 10, 2021
- Present: Allan, Tina, Julie, Trish, Barret, Sherry, Val, Joyce, Tail, Stephanie, Gladys, Pam
- Minutes prepared by: AG
- Action items in BOLD
1. Continued discussion of following location and service of patients admitted to an ICU service
- There was recognition that Cognos data is not sufficiently accurate to rely entirely on it, i.e. collectors must verify changes in location, changes in service, and the timing of changes. Thus, they will, for the forseeable future, need to use both, as Cognos is of value as a starting point. Sherry and Tina to clarify this on the Wiki.
- Regarding the button Tina created on the laptops that collectors can use to send a templated email to admitting offices when they identify an error regarding an ICU admission by either service or location. Allan to call admitting offices at Grace and HSC to identify the person at each site to whom this email would be sent.
2. Update regarding having data collectors do all TISS coding at all sites. Trish reports that not all collectors have yet learned how to use the laptop tool to do this.
3. No update today on locations listed in Cognos that are variously called Swap or Swing at the different hospitals. These may or may not actually related to a change in physical locations. We need to sort out how we are going to handle these. Tina will review and we’ll discuss further.
4. Allan to recheck the ICD-10 coding for the APACHE comorbid conditions.
5. Regarding attribution of infection. This appears to exist in 2 separate pages (Attribution of infections and Template:ICD10 Guideline Como vs Admit. Allan to consolidate and simplify these.
6. Revisiting topic of the new temp entries of boarding location and service.
- There are common errors (e.g. duplicate data, conflicting data). Cross-checks are being created and with those many/most of these problems should go away. But some aren’t easily amenable to cross-checks, and this has to do with cross-checking against records which are not yet complete.
- After discussion we leaned towards only doing cross-checks against complete data -- but Julie pointed out that she needs information prior to completion of records of whether TISS is completed or not. Allan, Tina, Trish and Julie will have a separate meeting to discuss this -- DONE, see minutes from special AJTT meeting February 11, 2021, above.
7. Allan, Julie and Tina reported that they had an offline discussion about the best way to deal with Transfer Ready date/time (meaning to a location of a LOWER level) in the “patient follow” method of assigning patients to collectors.
- It was finally decided that there should be a mandatory entry of this item for each boarding location, and if there was no transfer ready date for a location then a box will be checked denoting that there was no such date/time. And in particular, with respect to collection of this information, we do NOT want collectors to refer back to such date/time in any prior locations, i.e. only use information written by the primary team at the current location.
- Sherry and Tina will communicate on making the laptop tool for doing this easier to use.
- Allan reported that Bojan said that "unnecessary days" calculation should NOT include such days if spent in ED.
- Sherry pointed out that this new mandate seems to duplicate the similar Z75 “family” of ICD10 codes (e.g. Awaiting/delayed transfer to long-term care/PCH inside or outside of Winnipeg). At our next task meeting we will discuss this further.
8. New item: Gail inquired about coding VAP in somebody already having severe COVID pneumonia. Discussion highlighted that it is very difficult to discern a new VAP on top of an existing COVID lung process, but that nonetheless we should simply follow the VAP guideline on this.
9. Followup on trying to get hospital-level data elements from EPR.
- Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.
10. Followup about working to reduce collector workload. Things that need to be done:
- After the COVID emergency passes, Allan to talk with Medicine leadership (including Ebi, Nick, Mary Anne, others) about precisely what information they need/want reported for Medicine ward patients within each hospital. The issue here is whether, within each hospital, they really need to distinguish data by ward, or by teaching vs. nonteaching.
- Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
- Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
- Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].
ICU Database Task Group Meeting – January 20, 2021
- Present: Allan, Tina, Julie, Trish, Barret, Lisa, Stephanie, Pam, Joyce, Gladys, Mailah, Iris, Gail, Sherry, Val
- Minutes prepared by: AG
- Action items in BOLD
1. Continued discussion of following location and service of patients admitted to an ICU service.
- Tina reported that she has not yet created a button (Eyes button) on the laptops that will allow collectors to send a templated email to St. B admitting when they identify an error regarding an ICU admission by either service or location. Furthermore, she’ll ensure that we can count the number of these. We’ll do this for at most a few months, with the hope that this feedback will allow St. B admitting to improve their processes and reduce these errors.
- Tina has created Eyes button / Process for bad data in Cognos but there are some questions in there.
- Allan to call admitting offices at Grace and HSC to identify the person at each site to whom this email would be sent.
- It was also recognized that for ICU it is not too difficult for collectors to manually identify and input the location and service --- Tina and Trish will discuss the option of just doing it manually.
2. Update regarding having data collectors do all TISS coding at all sites. This is to take effect starting December 7, 2020 but not much progress since last meeting given all the COVID issues with collectors and collecting.
3. No update today on locations listed in Cognos that are variously called Swap or Swing at the different hospitals. These may or may not actually related to a change in physical locations. We need to sort out how we are going to handle these. Tina will review and we’ll discuss further.
4. Allan to recheck the ICD-10 coding for the APACHE comorbid conditions.
5. Regarding attribution of infection. This appears to exist in 2 separate pages (Attribution of infections and Template:ICD10 Guideline Como vs Admit. We need to consolidate and simplify these.
5. New topic of the workload involved with the new temp entries of boarding location and service.
- This involves Julie and Pagasa checking that the data makes sense. But there are common errors (e.g. duplicate data, conflicting data). Cross-checks are being created and with those many/most of these problems should go away. But some aren’t easily amenable to cross-checks, and this has to do with cross-checking against records which are not yet complete.
- After discussion we leaned towards only doing cross-checks against complete data -- but Julie pointed out that she needs information prior to completion of records of whether TISS is completed or not. Allan, Tina, Trish and Julie will have a separate meeting to discuss this.
6. Offline, Allan, Julie and Tina discussed the best way to deal with Transfer Ready DtTm tmp entry (meaning to a location of a LOWER level) in the new “patient follow” method of assigning patients to collectors. It was finally decided that:
- There will be a mandatory entry of Transfer Ready DtTm tmp entry for each Boarding Loc, though if there was no transfer ready date for a location then a box will be checked denoting that
- In assessing the # of “unnecessary days” this will be done at a given LEVEL (e.g. ICU>IICU>High Obs>Ward>home, PCH, rehab)
- An approach was worked out in this conversation that included: (i) using the earliest such date/time within a given level, but (ii) resetting the date/time when the a patient moves to a higher or lower level.
- Also, Allan will contact Bojan and Nick to ask whether in the reporting of "unnecessary days" they want to include or exclude such days if spent in ED.
7. Followup on trying to get hospital-level data elements from EPR.
- Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.
8. Followup about working to reduce collector workload. Things that need to be done:
- After the COVID emergency passes, Allan to talk with Medicine leadership (including Ebi, Nick, Mary Anne, others) about precisely what information they need/want reported for Medicine ward patients within each hospital. The issue here is whether, within each hospital, they really need to distinguish data by ward, or by teaching vs. nonteaching.
- Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
- Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
- Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].
ICU Database Task Group Meeting – January 7, 2021
- Present: Allan, Tina, Julie, Trish, Pam, Lisa, Sherry, Val
- Minutes prepared by: AG
- Action items in BOLD
1. Continued discussion of patients admitted to an ICU service.
- Collectors relate that the COGNOS listings are pretty accurate at HSC and Grace, and improving at St. B.
- Tina spoke to Chantal Plaetinck (manager of Admitting at St. B) about the ongoing issues there. After discussion we agreed that Tina will create a button on the laptops that will allow collectors to send a templated email to St. B admitting when they identify an error regarding an ICU admission by either service or location. Furthermore, she’ll ensure that we can count the number of these. We’ll do this for at most a few months, with the hope that this feedback will allow St. B admitting to improve their processes and reduce these errors. (see Process for bad data in Cognos)
- In order to finish mapping COGNOS HSC Critical Care services to either MICU or SICU, Julie updated the following for up to 1/4/2021, so it now includes 4 months of data:
- HSC Critical Care / Adult General -- 1 of these, in SICU
- HSC Critical Care / Amputee -- 0 of these
- HSC Critical Care / General -- 4 of these, in SICU
- HSC Critical Care / Intensive Care -- 4 of these, 2 in MICU, 2 in SICU
- HSC Critical Care / Obstetrics -- 2 of these, 1 in MICU, 1 in SICU
- HSC Critical Care / Oncology -- 3 of these, in SICU
- In response to discussion, Allan indicated that while we DO want to get locations, services and timing all correct, that it is not the end of the world if we are off by 1-2 hours in the actual timing of when a change occurred.
2. Update regarding having data collectors do all TISS coding -- Tina, Trish and the collectors are still working to get this going at all sites.
3. Update on the discrepancy between collection of PRBC transfusions in CCI vs. the Transfusion guideline. After discussion we agreed (largely for simplicity of coding) that the rule will be: Code the 1st date of PRBC administration and the total number of units of PRBC given from that point onward. Tina fixed this discrepancy and Val will look at the Wiki information about it to ensure it is correct.
4. Update on “locations” listed in Cognos that are variously called “Swap” or “Swing” at the different hospitals. These may or may not actually related to a change in physical locations. Clearly we need to sort out how we are going to handle these. Tina will review and we’ll discuss further at the next Task meeting.
5. New questions
- (a) It was identified that there can be discrepancies between the time a transfer (of location or of service) is noted in COGNOS vs. when it truly occurs.
- Example: ICU transfer to ward is listed earlier (and sometimes substantially earlier) in COGNOS then when it actually occurs. In this case the COGNOS time should be the “transfer-ready” time, while the actual time should be the service/location change time.
- As per item#1, above, while we DO want to get timing correct, it is not a huge problem if a service or location time change is recorded an hour off from reality.
- (b) It was pointed out that WHO has begun creating temporary, codes for newly-described COVID complications. An example is COVID-19–related multisystem inflammatory syndrome (U07.3).
- This is a syndrome, so far only described in children, with numerous manifestations depending on which organ or organs are involved.
- As we have only had ONE of these so far, we agreed that we will not give it its own ICD10 code, but instead code it by linking COVID-19–related multisystem inflammatory syndrome to the existing code Disorder of the immune system, NOS. Allan has added this to the COVID-19 Wiki article.
Tina has added Post COVID-19 condition as per discussion with Allan 2021-01-12.
6. Followup on trying to get hospital-level data elements from EPR.
- Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.
7. Followup about working to reduce collector workload. Things that need to be done:
- After the COVID emergency passes, Allan to talk with Medicine leadership (including Ebi, Nick, Mary Anne, others) about precisely what information they need/want reported for Medicine ward patients within each hospital. The issue here is whether, within each hospital, they really need to distinguish data by ward, or by teaching vs. non-teaching.
- Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
- Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
- Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].
ICU Database Task Group Meeting – December 16, 2020
Last from 2020, copied here as a starting point for the first meeting in 2021, these should be overwritten
- Present: Present: Allan, Barret, Tina, Julie, Trish, Pam, Stephanie, Mindy, Gladys, Gail, Lisa, Joyce, Mailah
- Minutes prepared by: AG
- Action items in BOLD
1. Continued discussion of PatientFollow Project, Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry, Definition of a Medicine Laptop Admission
- Further questions arose of which Onc, Renal, Neuro patients to include in the Medicine database. After discussion we recognized that the issue here is whether or not the patient is “using Medicine resources”, which include staff and beds. So, by this criterion:
- We WILL include Onc, Renal, Neuro patients who are physically located on a mixed COVID ward (i.e. locations that have both Medicine and non-Medicine (e.g. surgery) beds). Rationale is that those beds ARE a Medicine resource.
- We will NOT include Onc, Renal, Neuro patients who are in ED (e.g. EMIPs). Rationale is that those beds are NOT a Medicine resource.
2, Continued discussion of patients admitted to an ICU service.
- Last meeting we mapped existing Cognos services to their respective ICUs in each site. This was possible with all except the following 7 services, for which Julie has now gone back and over the past 2 months identified patients with those services:
- HSC Critical Care / Adult General -- 0 of these
- HSC Critical Care / Amputee -- 0 of these
- HSC Critical Care / General -- 2 of these, both in SICU
- HSC Critical Care / Intensive Care -- 3 of these, 2 in MICU, 1 in SICU
- HSC Critical Care / Obstetrics -- 1 of these, in MICU
- HSC Critical Care / Oncology -- 1 of these, in SICU
- So, there seem to few enough of these that categorization isn’t a big problem. HOWEVER, Tina identified that working with Chastity she has now come to recognized that Cognos has 3 concepts within it that relate to service. SO before we go further with assigning patients to ICU services, Tina/Julie will look further into this and we’ll discuss further at our next Task meeting.
3. Followup on the recent changes St. B admitting made as regards to identifying ICU services.
- Collectors report that things have greatly improved, though some mistakes are still being made. In particular, there is use made of the service “SBGH Critical Care / General”. We hope that these errors will decline as Admitting office staff become more familiar.
- But we also decided to defer further discussion of this to the next Task meeting, for same reason as the last point of item#2, above.
4. Followup regarding having data collectors do all TISS coding
- Has only begun at St. B, not yet at HSC or Grace where pink sheets are still being used
- Towards the goal of making this change in all sites, Tina and Trish will work with collectors to fine-tune the laptop tool for collecting TISS info, and to get them trained up to use it.
5. New questions
- Whether and how to code someone who has recovered from COVID-19. After discussion we agreed this is no different from any infection, and that once active infection is gone (even if manifestations such as respiratory fibrosis and respiratory failure remain) that we will NOT code it. Specifically, as the WHO has not seen fit to create an ICD-10 code for past history of COVID-19, we won’t either.
- It was pointed out that there is a discrepency between collection of PRBC transfusions in CCI vs. the Transfusion guideline. After discussion we agreed (largely for simplicity of coding) that the rule will be: Code the 1st date of PRBC administration and the total number of units of PRBC given from that point onwards. Tina to fix this discrepency.
- There are “locations” listed in Cognos that are variously called “Swap” or “Swing” at the different hospitals. These may or may not actually related to a change in physical locations. Clearly we need to sort out how we are going to handle these. Tina will review and we’ll discuss further at the next Task meeting.
- Discussion about what name to use for what has previously been called “Boarding Loc”. In Cognos it goes by the name “assigned unit”, but this may ambiguously imply the final destination. So we agreed to call this field “Unit”.
6. Followup on trying to get hospital-level data elements from EPR.
- Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.
7. Followup about working to reduce collector workload. Things that need to be done:
- Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
- Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
- Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].