Task Team Meeting - Rolling Agenda and Minutes 2021

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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}}
 QuestionModification 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.
ALERT Scale timing of assessment
  • Why would this be an exceptional instruction for STB? What is different about the situation there that would lead to different instructions? Ttenbergen 11:12, 2021 April 1 (CDT)
    • This has always been collected at STB this way. (Pam)
      • That doesn't mean it should stay that way since we used to collect all of this only upon arrival. So let's discuss at Task what this should be. The difference is probably really minor, but if we have exceptions it should be clear why. Ttenbergen 13:57, 2021 April 1 (CDT)
1 April 2021 19:16:40
Acquired Diagnosis / Complicationthis relates to Attribution of infections and we need to be sure to have it consistent.
Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review
Rules 1 and 2 are clear, could rule 3 be further clarified
1 April 2021 17:05:28
CCI Volumes 2019There have been concerns about the volume of work generated by CCI entries. Since we had already reduced certain entries earlier in 2019, the numbers referenced here are only for pts admitted during the third quarter of 2019.4 December 2019 19:40:14
Chronic Health APACHE
  • We are considering changing how this is collected to extracting the data from APACHE Comorbidities in ICD10 codes instead of coding a separate field. Further discussions to come. AG confirmed 2018-11-28 that this is an option
  • Discussed at AJTT:
    • need to discuss with Collectors if they can get the immunocompromising drugs
    • need to update Created Variables for this, and need to do that anyway
11 March 2021 17:51:36
Clinical Assessment Unit
  • do we want to do this?


  • do we need to do anything to get collectors to fill this out right? Or to deal with back-data? Ttenbergen 14:40, 2021 March 11 (CST)


  • as per Julie: "I have checked the database and there are also CAU entries at GRA and STB in pre-admit institution, previous loc and dispo (GRA_CAU, STB_CAU). Do they move location too? Can we ask the DC? If so, make it generic _ward.
  • In the tmp Boarding Loc, there are 12 cases GH-CAU – so it looks like Internal med is borrowing CAU Bed. What to do here – change to GRA boarding?
    • I am not sure if the more recent entries for boarding loc would now list the actual location or still site-CAU.

Discussed at Task; these are now family medicine, we will start to just collect these as <local> ward. Ttenbergen 13:50, 2021 March 24 (CDT)

1 April 2021 22:03:15
Task Questions

Also see Task Team Meeting - Rolling Agenda and Minutes 2020

ICU Database Task Group Meeting – March 24, 2021

  • Present: Allan, Tina, Julie, Trish, Brynn, Gladys, Pam, Mindy, Val
  • Minutes prepared by: AG
  • Action items in BOLD

1. Regarding the APACHE II comorbidities

  • We agreed to initiate the transition to having Julie identify these 5 comorbidities from ICD10 codes entered
  • Allan sent out a list of ICD10 codes to use for each of them, but Tina raised some questions about whether this list has been appropriately adjusted for the subset of ICD10 that WE use --- in response to this Allan revised the list of ICD10 codes and the while the following updated list does include some codes we don’t currently use, those elements are included in other listed codes:
    • Liver: B18.x, I85.x, I86.4, I98.2, I98.3, K70.x, K71.1, K71.3–K71.5, K71.7, K71.9, K72.1, K72.9, K73.x, K74.x, K76.0, K76.2–K76.9, Z94.4
    • Cardiovascular: I05.x-I09.x, I11.x, I13.x, I21.x, I22.x, I23.x, I24.8, I24.9, I25.x, I31.0, I31.1, I34.x-I39.x, I42.x, I43.x, I44.x-I49.x, I50.x, Z45.0x, Z94.1, Z95.0-Z95.4
    • Respiratory: I27.0, I27.2, I27.8x, I27.9, J40.x–J47.x, J60.x–J67.x, J68.x, J70.0, J70.4x, J84.x, J96.1x, J96.9x, Z99.1x
    • Renal: I12.x, I13.x, N03.x, N00.x-N08.x, N11.x, N12.x, N13.x, N14.x N16.x, N18.x, N19.x, N25.x, Z49.x, Z94.0, Z99.2
    • Immunocompromised: C81.x–C86.x, C88.x, C90.x–C97.x, C77.x–C79.x, B20.x–B22.x, B24.x, U92.25, Z51.0, Z51.1, Z92.25, Z92.3, Z92.6, Z92.8, T86.x, Z94.0, Z94.1, Z94.2, Z94.3, Z94.4, Z94.6, Z94.8x, D80.x-D84
  • Regarding the drug-induced immunosuppression portion of the immunocompromise comorbidity:
    • The data collectors agreed that this is doable. The source for this list is Template:List of immunosuppressive drugs
    • We will incorporate this into a custom/new ICD10 code we will call Drug-induced immunosuppression and give it code U92.25 -- this will be coded if the criteria for ANY of the list of immunosuppressive drugs is met. (added Ttenbergen 16:21, 2021 April 1 (CDT))
    • The question arose of whether Tocilizumab is on this list -- answer is Yes, it already is included.

2. Update on dealing with the COGNOS-derived, list of HSC Critical care services, specifically the fact that we decided on March 10 that for the 6 such services that don’t easily map to MICU vs. SICU, the collectors will have to manually identify the correct service. Tina added "HSC Critical Care - MICU" and "HSC Critical Care - SICU" to Service tmp entry options and emailed Julie and Lisa to update instructions how to use this.

3. Regarding attribution of infection. This appears to exist in 2 separate pages (Attribution of infections and Template:ICD10 Guideline Como vs Admit. Allan has now updated/clarified this issue on these two pages.

4. Regarding modifying the laptop input of Transfer ready date/time for each boarding location:

5. New items:

  • Regarding patients whose identity is unknown, including those who are using Stolen identities. Brynn to update the appropriate Wiki pages (Stolen identities, John or Jane Doe patient.
  • Regarding how to code a medicine patient boarding in CAU -- since CAUs at all sites are now being run by Family Medicine with ward nursing, this only comes up for us when such a bed is being used as a boarding location. We agreed (again, actually) that we will not code CAU as a separate boarding location, but include it in with Ward boarding locations. Tina to make this change.
  • This is Trish’s last meeting of the Task group as she retires at the end of this month. We all recognize her enormous contribution to the database and wish her best of luck.

5. 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.

6. 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].

7. Next task meeting March 15 at 11 am.

SPECIAL ICU Database AJTT Task Group Meeting – March 11, 2021

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

1. Regarding Bed holds

  • These relate to patients who are sent away from the current hospital (A), to a different hospital (B) almost always for specific procedures, with the expectation they will return after the procedure. While this is usually the case, sometimes the patient remains after the procedure for an extended period, and (rarely) gets admitted to hospital B due to complications; but if that admission is to a location where we do not collect data, we have no way of knowing.
  • The question arose due to inconsistency about the existing guideline, and to knowing if/when the open record from hospital A should be ended. But in discussion we recognized that with the availability of hospital ADT (admission/discharge/transfer) information from COGNOS and the EMR, we probably do not need this concept at all.
  • We agreed on these rules (which Allan added to the Wiki):
    • If the patient did, at some point, return to hospital A from hospital B, and ADT indicates that the patient was NOT discharged from hospital A during the say in hospital B -- then the entire stay is in hospital A, including all the procedures done during the time at hospital B.
    • If the patient did, at some point, return to hospital A from hospital B, and ADT indicates that the patient WAS discharged from hospital A during the time at hospital B -- then we will consider this as TWO records in hospital A, with the first one ending when the patient physically left to go to hospital B (i.e. not when ADT shows the patient was discharged from A), and the second one starting when the patient returned to hospital A. In this case, the procedures that occurred during the time in hospital B are not included in either record for hospital A unless they include an Admit Procedure for the 2nd admission to hospital A.
    • If the patient did NOT return to hospital A from hospital B then there will be an indication in ADT of the discharge from hospital A, and our single hospital A record is taken to end on the date of ADT discharge.
      • NOTE for Julie -- if such a patient was admitted in hospital B to a location where we collect, then the hospital A and B records will be flagged in the data check as having overlapping times. In that case the end of the hospital A record should be taken as the time of the hospital B admission.
  • We recognized that these new rules mandate alterations to Wiki entries LOS Medicine per hospital admission and Continuous Stay, and likely creation of equivalent entries for ICU. Allan and Julie will work on these.

2. Regarding Group homes

  • The issue here is that in truth there are numerous different types of group homes, with different amounts and types of support (Care levels in the community) provided in them. BUT, the data collectors can’t easily find out these details and this leads to uncertainty about what “level” of care to code group homes. After discussion we agreed that we will put all types of Group Homes as “Supportive Housing”. Tina has fixed this on the wiki.

3. Regarding Chronic Health APACHE

  • Allan has revised the ICD10 codes that we will use to automate identification of the 5 APACHE II comorbid conditions, i.e.:
    • Liver: B18.x, I85.x, I86.4, I98.2, K70.x, K71.1, K71.3–K71.5, K71.7, K72.1, K72.9, K73.x, K74.x, K76.0, K76.2–K76.9, Z94.4
    • Cardiovascular: I50.x, I21.x, I22.x, I23.x, I24.8, I24.9, I25.x, Z94.1, I05.x-I08.x, I11.x, I13.x, I42.x, I43.x, I09.2, I09.9, I31.0, I31.1, I31.9, A52.0, I05.x-I08.x, I09.1, I09.8, I34.x-I39.x, Z95.0-Z95.4, I44.x-I49.x; R00.0, R00.1, R00.8, Z45.0x
    • Respiratory: I27.0, I27.2, I27.8, I27.9, J40.x–J47.x, J60.x–J67.x, J68.4x, J70.1x, J70.3x, J70.4x, J84.x, J96.1x, J96.9x, Z99.1x
    • Renal: I12.x, I13.x, N03.x, N05.2-N02.9, N07.2-N07.9, N08.3x, N08.4-N08.8, N11.x, N12.x, N18.x, N19.x, N25.0, Z49.x, Z94.0, Z99.2
    • Immunocompromised: C81.x–C86.x, C88.x, C90.0, C90.1, C90.x–C97.x, C77.x–C79.x, B20.x–B22.x, B24.x, Z51.0, Z51.1, Z92.3, Z92.6, J70.0x, K52.0, K62.7, L58.0, T86.x, Z94.0, Z94.1, Z94.2, Z94.3, Z94.4, Z94.6, Z94.8, D80.x-D84.xD80.x-D84.x
  • The one remaining issue is immunocompromise due to medications. This Template:List of immunosuppressive drugs (which Allan updated) is long and at our next task meeting we will discuss with collectors whether or not it is feasible to have them review for every patient whether they were on any of them PRIOR to admission.

4. Regarding the “public face” of the databases, i.e. the CCMDB splashpage (https://ccmdb.kuality.ca)

  • Substantial work needs to be done on the links from this page -- many are out of date.
  • This relates to the items on Public Entrance Likely Initial Page
  • It was agreed that in order to start making progress on this myraid of Wiki page modifications, Julie, Tina, and whoever replaces Trish will set aside 3-4pm every Thursday to work on these collaboratively.

ICU Database Task Group Meeting – March 10, 2021

  • Present: Allan, Tina, Julie, Trish, Brynn, Gladys, Sherry, Pam, Micheel, Stephanie, Mindy, Iris, Mailah, Barret, Val
  • Minutes prepared by: AG
  • Action items in BOLD

1. Continued discussion of following location and service of patients admitted to an ICU service

  • Also see the February 10, 2021 minutes
  • Since the last meeting, we have discovered that the long list of “Critical care” services do NOT come directly from hospital admitting offices, which (e.g. at HSC) only code “Medicine”, “Critical care”, and “Intermediate”. The long list is generated subsequently and we do not know exactly how this is done (or why).
  • After considerable discussion we agreed that going forwards we will:
    • Use the COGNOS-derived, long list of Critical care services. The majority of these map easily to the correct ICU service (e.g. MICU vs. SICU, ICMS vs. ICCS). However for those that do not map well to a single ICU service, the collectors will have to manually identify the correct service. Tina to create machinery to do this.
      • The list of these services that do not map well are:
        • HSC Critical Care / Adult General
        • HSC Critical Care / Amputee
        • HSC Critical Care / General
        • HSC Critical Care / Intensive Care
        • HSC Critical Care / Obstetrics
        • HSC Critical Care / Oncology
    • We will cease sending corrections back to the admitting offices.

2. 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.

3. 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.

4. Continued discussion about Transfer ready date/time -- with the recent change to allow such an entry for each “boarding location”

  • We re-clarified that there should only be such a date/time when the intent is for a patient at a given level to go to a LOWER level of care.
  • We re-clarified that for each boarding location entry, collectors should not look back at the entry for prior locations -- i.e. for a given location only put in an entry if the care team wrote such an intention to transfer to a lower level of care during the time the patient was actually on that location.
  • Julie reported that she is seeing such a date/time entered related to every location transfer, even to the SAME level.
  • It was agreed that part of these problems is the way that the temp table appears on the laptops -- Tina will work to make it less confusing.
  • New question raised of what to do when the patient’s care is taken over in ED (either Medicine or ICU) and then the patient goes to Medicine or ICU. The clarification here is that for such location changes, this is considered the SAME level of care.
  • Allan updated the wiki page about all of this.

5. 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.

6. 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].

SPECIAL ICU Database AJTT Task Group Meeting – February 22, 2021

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

1. Discussion regarding HSC critical care service categorization:

  • Allan related that he had emailed with Rachel Porter and espoused to her that this problem could largely be addressed by reconsidering the plethora of potentially unnecessary service categories for critical care, at all sites. He hasn’t heard back from her but will recontact her -- DONE 2/25/2021.
  • But in the interim we need to map the remaining HSC ICU codes to the specific ICUs and have done so as follows:
    • HSC Critical Care / Adult General -- SICU
    • HSC Critical Care / Amputee -- SICU
    • HSC Critical Care / General -- SICU
    • HSC Critical Care / Intensive Care -- MICU
    • HSC Critical Care / Obstetrics -- MICU
    • HSC Critical Care / Oncology -- SICU

2. Update about Green Sheets --- Allan related that the only ICU where at least some of the attendings value them is at HSC. Furthermore, the Bojan and the other ICU directors decided that they will take over all aspects of green sheets.

3. Regarding observation for COVID.

SPECIAL ICU Database AJTT Group Meeting – February 11, 2021

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

1. Julie proposed converting the current temp file collection of: (a) boarding location, (b) transfer ready date/time, and (c) service into permanent database columns. And at the same time terminating the collection of Arrival date/time.

  • There was agreement that this makes good sense. However, Tina demonstrated how this will mandate altering many dozens of Wiki pages which will require perhaps 2 weeks of work by the 4 of us.
  • Given the added workload related to COVID, along with the seconding/absence of most of our data collectors, it was decided that we will revisit doing this in October 2021, with the hope that the COVID-related problems will have resolved, but that we’ll set about this task even if that is not true.

2. It was pointed out by Julie that some data requests and even quarterly reports from early 2020 and early 2021 are seriously compromised by the lack of collectors. This includes TISS data elements.*Julie related that she has been trying to use workarounds to nonetheless obtain some of this data, but there was recognition that while this may be the best we can do for now, that it leads to eventual rework and inefficiencies elsewhere in the system. Consequently, Allan opined that we should cease such workarounds and that he would communicate with Bojan about this. The upshot of that communication is that the ICU program understands and prefers to wait until good quality data is available, rather than reporting data that is substantially incomplete and/or questionable. This likewise applies to attempts to fill in portions of TISS data for reporting to the OIT Committee --- Allan likewise communicated this to Kendiss/Carmen who co-lead the OIT Steering Committee.

  • Thus, it was decided that we will do what we can moving forward, but that with the current COVID-related limitations, we will cease trying to “fill in” gaps in prior data (e.g. 4th quarter 2020), and that it is acceptable to delay reporting problematic items in quarterly reports.

ICU Database Task Group Meeting – February 10, 2021

  • Present: Allan, Tina, Julie, Trish, Barret, Sherry, Val, Joyce, Gail, 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.
  • 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

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].

ICU Database Task Group Meeting – December 11, 2019

See Task Team Meeting - Rolling Agenda and Minutes 2020#ICU Database Task Group Meeting – December 16, 2020