Analysis of Document Types in an EHR of NIH Clinical Center

We have been analyzing the 80% most frequent document types at NIH Clinical Center.







I have a question to the forum:



We wanted to map

Admission Assessment (CC, CRIS)

which is used 157250 times . So quite often.

There are too many candidates.

64070-6 Admission evaluation note Find Pt Hospital Doc Medical student.critical care
64074-8 Admission evaluation note Find Pt Hospital Doc Medical student.thoracic surgery
64053-2 Admission evaluation note Find Pt Hospital Doc General medicine
64054-0 Admission evaluation note Find Pt Hospital Doc Medical student.general medicine
64058-1 Admission evaluation note Find Pt Hospital Doc Critical care
64060-7 Admission evaluation note Find Pt Hospital Doc Thoracic surgery
64062-3 Admission evaluation note Find Pt Hospital Doc Pulmonary disease
64066-4 Admission evaluation note Find Pt Hospital Doc Medical student.general surgery
64078-9 Admission evaluation note Find Pt Hospital Doc Medical student.pulmonary disease
34862-3 Admission evaluation note Find Pt Inpatient Doc Attending physician.general medicine
34873-0 Admission evaluation note Find Pt {Setting} Doc Surgery
34744-3 Admission evaluation note Find Pt {Setting} Doc Nursing
51849-8 Admission history and physical note Find Pt {Setting} Doc {Provider}
47039-3 Admission history and physical note Find Pt Inpatient Doc {Provider}
34763-3 Admission history and physical note Find Pt {Setting} Doc General medicine
34094-3 Admission history and physical note Find Pt Hospital Doc Cardiology

a good way would be to map it to the parent concept, however, this is a LOINC part concept.
RELMA does not allow mapping to LOINC part concepts.

However there are "panel" LOINC concepts which are full loinc concepts.

Seems like in this case, mapping to the LOINC part concept would be the best match.

What is the official clinical LOINC committe position on part concepts and using them in mapping efforts?

Our mapping efferts advanced and we have a good mapping of top 80% of document types (2 mappers) and a draft mapping for all 174 distinct document types in our IDR.



Few things we are finding out:

• legacy doc. types and active doc types (mapping old to new using LOINC DO)
  
• some local doc. types could be renamed to fit better
  
• some new LOINC codes can be created and we will submit those
  
• LOINC part codes vs. LOINC codes and the higher level hierarchy - sometimes it would be nice to map our doc. type to a class concept (parent), e.g., like for example lab panel
  
  
  
  
  
  
  
  here are the new concepts which might be interesting:
  
  
  
  Nursing doc: Vascular Access Device Observation Document
  
  Nursing doc: Skin and Hygiene Observation Document
  
  
  
  I downloaded the template for submission (Basic Template - MS Excel (.xls))
  
  but the file is more optimized for lab LOINC.
  
  What template should I use for clinicalLOINC DO domain?
  
  
  
  see the fiels here:
  
  REFERENCE_ID NAME ORGANIZATION PHONE FAX EMAIL ORG_SOURCE_CARE_ORG PROJECT_DESCRIPTION LOCAL_BATTERY_CODE LOCAL_BATTERY_DESCRIPTION LOCAL_TEST_CODE LOCAL_TEST_DESCRIPTION REFERRAL_LAB_CODE REFERRAL_LAB TEST_DESCRIPTION LOCAL_TEST_UNITS TEST_INSTRUMENT TEST_INSTRUMENT_MODEL TEST_REAGENT_KIT SIMILAR_LOINC UNITS EXAMPLE_ANSWERS ANSWER_COMMENTS EXAMPLE_REPORT GENERAL_COMMENTS REFERENCE_INFO NORMAL_RANGE ANALYTE DIVISOR SUFFIX CHALLENGE ADJUSTMENT COUNT PROPERTY TIME_ASPCT TIME_MOD SYSTEM SUPER_SYS SCALE_TYP METHOD_TYP
  
  
  
  Our excel file would have these fields:
  
  LOINC_NUM COMPONENT PROPERTY TIME_ASPCT SYSTEM SCALE_TYP METHOD_TYP

We would certainly encourage the construction of local use-case specific hierarchies based on whatever roll-ups you felt necessary. For that you could use the LOINC parts or the strings to do it (e.g. anything with a component of “Admission Evaluation Note”). We also have a recently implemented policy about creating a “generic” term wherever we have document terms that specify a setting or provider. This generic term could be used as a generic parent for the more specific types. E.g. this term:

67851-6 Admission evaluation note Find Pt {Setting} Doc {Provider}

Could be thought of as the generic parent for these more specific codes:

34744-3 Admission evaluation note Find Pt {Setting} Doc Nursing
34873-0 Admission evaluation note Find Pt {Setting} Doc Surgery
68552-9 Admission evaluation note Find Pt Emergency department Doc Emergency medicine
67852-4 Admission evaluation note Find Pt Hospital Doc {Provider}
68471-2 Admission evaluation note Find Pt Hospital Doc Cardiovascular disease
64058-1 Admission evaluation note Find Pt Hospital Doc Critical care
64053-2 Admission evaluation note Find Pt Hospital Doc General medicine
68483-7 Admission evaluation note Find Pt Hospital Doc Medical student.cardiovascular disease
64070-6 Admission evaluation note Find Pt Hospital Doc Medical student.critical care
64054-0 Admission evaluation note Find Pt Hospital Doc Medical student.general medicine
64066-4 Admission evaluation note Find Pt Hospital Doc Medical student.general surgery
64078-9 Admission evaluation note Find Pt Hospital Doc Medical student.pulmonary disease
64074-8 Admission evaluation note Find Pt Hospital Doc Medical student.thoracic surgery
34862-3 Admission evaluation note Find Pt Hospital Doc Physician attending.general medicine
64062-3 Admission evaluation note Find Pt Hospital Doc Pulmonary disease
64060-7 Admission evaluation note Find Pt Hospital Doc Thoracic surgery

We don't recommend using the Part codes directly as a "observable" concept code because they don't have the same change management principles applied (e.g. deprecation, concept permanence, etc) as the LOINC codes do. They have several purposes...some internal.

We would, of course, welcome new submissions based on your findings.

I like very much the new policy of creating generic terms where specific exists.

I also feel like my forum post made a difference. Very encouraging.