Talk:Emergency Department Encounter Record

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Issue Log

Open Issues

  1. Patients frequently leave the ED prior to documentation being finalized. Triggers in workflow vary. How should the Draft vs. Final Status be handled?
  2. Potential for multiple entries.
  3. Timetable for CCD harmonization?
  4. Target systems discussion.
    1. EDIS  CDR  RHIO
    2. EDIS  RHIO  Ambulatory EHR
    3. EDIS  Ambulatory EHR
  5. Potential need for LOINC codes for new elements.
  6. Use of Co-occurrence Constraint [Conditional Restraint] for Disposition elements.
  7. Snomed vs. DEEDS for Disposition?

Closed Issues

  1. Content vetted by full Patient_Care_Coordination Technical Committee.
  2. The EDER is a multi-authored (but singly attested?) document. How should this best be implemented/reflected: Document to be attested to by ED attending physician.

TCON 04-05-2007

Attending
Rich Hardell, Wellsoft; Benjamin Greco, Wellsoft; Todd Rothehhouse; Keith W. Boone; Karen Lipkind

Todd has updated the LOINC codes. They look pretty good. Keith sent him the latest version of the TF (still being edited). The intention is to make that available on the wiki at some point in time in the future -- dates TBD.

Karen provided the following information, which we should review on the next call:

The 2004 version of the questionnaire is contained in it.


Kboone 16:14, 5 April 2007 (CDT)

Don't over step with the H&P elements!

There is a temptation to try and over-specify what this document will contain in regards that is counter productive. Listing elements of the H&P, while appealing, are problematic for several reasons.

There is no consensus on how to order/organize/lump H&P elements. Is peripheral capillary refill belong under “skin exam,” “hand exam,” “extremity exam,” “vascular exam,” “cardiovascular exam” or “cardiac exam?”

Placing a fixed specification at this level of detail (i.e. specifying the components of the ROS or physical exam) isn’t going to be of use, and will only slow down the adoption of any specification.

Simply specifying the content of a document at a much higher level, whether it is defined as a collection of other documents (as it appears to be now) from multiple individuals, or a document unto its own right, is going to be challenging enough without this added level of distraction.

DEEDS update and revision

DEEDS (q.v. CDC DEEDS page) is undergoing major revisions to bring it in line with existing SDOs, conform with HIPAA, follow NCVHS guidance and reflect the modern emergency care clinical environment.

Changes include deprecating "DEEDS_ID" as a terminology/identifier. Replacement of NDC with RxNorm for drugs, elimination of any DEEDS defined/specific codes, addition of some identified missing elements (e.g. cranial nerve exam), and use of standard reference terminologies for identifiers for response sets. A new DEEDS ID system will be implemented, with each element given a meaningless identifier, and mapped to existing controlled terminologies, such as LOINC or SNOMED-CT Observable Entities. Many, many existing data elements are deprecated, particularly all those which fall into the pattern of:

  1. Some event or observation
  2. ID of the person responsible
  3. The type of provider responsible
  4. The time/date stamp

or

  1. first ED something

These will all be rolled into a single element, which will not have distinct identifiers for the various components. The "first ED something" pattern will be deprecated in favor of simply understanding that the first ED anything will be the head of a list (or element 0 in an array), and everything in DEEDS will have the ability to capture the identity of the person performing it, the identity of anyone supervising, the legal authenticator and time-stamps of the observation, signature acts and availability to the system.

Please visit WikiHIT to monitor progress or comment on the efforts to specify the data elements. An enumeration of those elements slated for inclusion in release 1.1 will be posted within the next few weeks.


--Kevin.coonan 21:09, 19 April 2007 (CDT)