Objectives Describe patient identifier linkages Identify linking methodologies for direct care data Describe Patient Linkages Patient Linkages While the EDIPN is the official identifier for DoD beneficiaries there are systems that were not built to rely upon EDIPN ID: 1033934
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1. Data Linkages for DaVINCI
2. ObjectivesDescribe patient identifier linkages.Identify linking methodologies for direct care data.Describe
3. Patient Linkages
4. Patient LinkagesWhile the EDIPN is the official identifier for DoD beneficiaries, there are systems that were not built to rely upon EDIPN.CHCS uses the CHCS Host + Patient IEN. This is the only patient identifier that is always populated in CHCS data. This field is not available outside of CHCS.CHCS also has an EDIPN and an SSN when the patient has one..AHLTA/CDR uses the CDR Unit ID. This is based off of Sponsor Social SSN and the patient’s relationship to sponsor. This field is corrupt; it not unique.This is the only field that is always populated in AHLTA/CDRAHLTA/CDR has an EDIPN but is also corrupt. Usually only one of a person’s duplicate CDR Unit IDs will have the EDIPN.SSN is also available, if the patient has one.
5. Patient LinkagesNewer systems are usually built with EDIPN as the foundational person identifier.
6. Patient LinkagesMHS Genesis and Patient IdentifiersDuring registration, MHS Genesis assigns person identifiers.Data are exchanged with DEERS so that EDIPN can be provided.MHS Genesis is built around the person key.There is a person table that contains the person key and maps to EDIPN and SSN.(Be sure you have a good policy on how test persons will be entered into the system prior to implementation)In MHS Genesis, this file is updated whenever a patient has an encounter. Attributes of a patient can be “stale” in the person file.The MHS uses DEERS to enhance the data provided from Genesis.
7. Patient LinkagesThere is a DoD – VA person identifier crosswalk that is used to combine records for DaVINCI.EDIPNPatient ICNOMOP Person ID
8. Direct Care Linkages
9. CHCS-Based LinkagesEach CHCS Host uses sequential counters to identify individual records.CHCS Host + Sequential Counter = Unique identifier for a recordTwo very important record IDs are the:Appointment ID Number: Uniquely identifies a professional encounter record.Patient Registry Number: Uniquely identifies an inpatient admission record.CHCS links events associated with an encounter or an inpatient admission with these identifiers.LabRadPharmacy ReferralVitalsAppointmentsEnables analysts to track services associated with a visit or a stay
10. CHCSMom makes appointmentCHCS Appt file entryProvider sees patientProvider orders ancillaries and documents careCAPERLabRadRxInformation in CHCS is generally collected in the course of doing businessExample: Data files prepared from operational process
11. Direct Care Linking Matrix
12. Ambulatory Events – Linking CAPERs to Other ServicesGeneral approach to retrieving CAPERs and related services:Retrieve CAPERs of interest, including Tmt DMIS ID and Appointment IEN.Query ancillary data for matching records, including only records where the Ordering DMIS ID (orddmis) and Appt record ID (apptno) from ancillary match the Tmt DMIS ID (dmisid) and appointment ID number (apptidno) from CAPER=CAPERAncillary
13. Ambulatory Events – Linking CAPER to LabsRecord ID = Appt IENAppointment Record ID = Appt IEN where lab was ordered
14. CAPER and PDTS Link14
15. Example of Linked DataNewborn at an MTF SIDRCAPERMSDRGDescriptionAdmission DateDisposition Date792NEONATE, BIRTHWT >2499G, W/O SIGNIF O.R. PROC, W OTHER PROB4/5/164/6/16DX1DescriptionCPT_4DescriptionMEPRS CodeDescriptionEncounter DateZ3800SINGLE LIVEBORN INFANT, DELIVERED VAGINALLY54150CIRCUMCISION, CLAMP/DEVICE/RING BLOCKAGHAFAMILY PRACTICE NEWBORN NURSERY4/6/16
16. Example of Linked DataEmergency Room Visit at an MTF Linked LabsCAPERLinked Rads
17. CDR Linkages
18. CDR LinkagesBesides linking the CDR data to other MTF files, there are various linkages between the CDR data typesTwo main “helper” files are the CDR Patient and CDR Appointment files which allow CDR data to be linked to data from CHCS and other systemsThe Patient file can be merged by the Unit Number, called CDR_PATIENT_ID in the MDRFor the most part, this merge has already been done in the files available in MDR PUBThere are lots of complicated linkages within the CDR, but in the MDR, most of the linking has already been done for you
19. CDR Data Model
20. CDR LinkagesAll three lab files (Chemistry, Microbiology, Pathology) have a LAB_ORDER_ID, but information from the CDR Lab Orders file has already been appended to these filesMicrobiology can be linked to the Susceptibility results using the MICRO_EVENT_IDPathology can be linked to additional CPT codes using the PATH_EVENT_IDMedication Orders and Fills can be linked using the MED_ORDER_IDThere is also a CDR_PROVIDER_ID on many of the files, but it does not link to anything
21. Example of Linked DataMetabolic Panel and Other Labs Ancillary FileCPTDescription82040ASSAY OF ADP & AMP82247BILIRUBIN, TOTAL82310ASSAY OF CALCIUM82374ASSAY, BLOOD CARBON DIOXIDE82435ASSAY OF BLOOD CHLORIDE82550ASSAY OF CK (CPK)82553CREATINE, MB FRACTION82565ASSAY OF CREATININE82947GLUCOSE; QUANTITATIVE, BLOOD83735ASSAY OF MAGNESIUM84075ASSAY ALKALINE PHOSPHATASE84100ASSAY OF PHOSPHORUS84132ASSAY OF SERUM POTASSIUM84155ASSAY OF PROTEIN, SERUM84295ASSAY OF SERUM SODIUM84450TRANSFERASE (AST) (SGOT)84460ALANINE AMINO (ALT) (SGPT)84484ASSAY OF TROPONIN, QUANT84520ASSAY OF UREA NITROGENLab Test NameResult LOINCResult LOINC NameResult NumericResult TextCMP W/GFR1751-7ALBUMIN:MCNC:PT:SER/PLAS:QN:2.82.8CMP W/GFR1975-2BILIRUBIN:MCNC:PT:SER/PLAS:QN:0.20.2CMP W/GFR17861-6CALCIUM:MCNC:PT:SER/PLAS:QN:8.28.2CMP W/GFR2028-9CARBON DIOXIDE:SCNC:PT:SER/PLAS:QN:2727CMP W/GFR2075-0CHLORIDE:SCNC:PT:SER/PLAS:QN:100100CARDIAC PANEL2157-6CREATINE KINASE:CCNC:PT:SER/PLAS:QN:341341CARDIAC PANEL13969-1CREATINE KINASE.MB:MCNC:PT:SER/PLAS:QN:1.41.4CARDIAC PANEL20569-0CREATINE KINASE.MB/CREATINE KINASE.TOTAL:CFR:PT:SER/PLAS:QN:0.40.4CMP W/GFR2160-0CREATININE:MCNC:PT:SER/PLAS:QN:2.12.1CMP W/GFR2345-7GLUCOSE:MCNC:PT:SER/PLAS:QN:218218MAGNESIUM19123-9MAGNESIUM:MCNC:PT:SER/PLAS:QN:2.42.4CMP W/GFR6768-6ALKALINE PHOSPHATASE:CCNC:PT:SER/PLAS:QN:7474PHOSPHORUS2777-1PHOSPHATE:MCNC:PT:SER/PLAS:QN:3.23.2CMP W/GFR2823-3POTASSIUM:SCNC:PT:SER/PLAS:QN:4.74.7CMP W/GFR2885-2PROTEIN:MCNC:PT:SER/PLAS:QN:66CMP W/GFR2951-2SODIUM:SCNC:PT:SER/PLAS:QN:133133CMP W/GFR1920-8ASPARTATE AMINOTRANSFERASE:CCNC:PT:SER/PLAS:QN:3333CMP W/GFR1742-6ALANINE AMINOTRANSFERASE:CCNC:PT:SER/PLAS:QN:4444CARDIAC PANEL10839-9TROPONIN I.CARDIAC:MCNC:PT:SER/PLAS:QN:.<0.015CMP W/GFR3094-0UREA NITROGEN:MCNC:PT:SER/PLAS:QN:3535CMP W/GFR3097-3UREA NITROGEN/CREATININE:MCRTO:PT:SER/PLAS:QN:16.716.7CMP W/GFR1863-0ANION GAP 4:SCNC:PT:SER/PLAS:QN:1111CMP W/GFR18182-6OSMOLALITY:OSMOL:PT:SER/PLAS:QN:CALCULATED281281CMP W/GFR33914-3GLOMERULAR FILTRATION RATE/1.73 SQ M.PREDICTED:ARVRAT:PT:SER/PLAS:QN:C2525Chemistry Results
22. Example of Linked DataUrinalysis Ancillary FileCPTDescription81001URINALYSIS, AUTO W/SCOPELab Test NameResult LOINCResult LOINC NameResult Name HDDResult NumericResult TextURINALYSIS W/MICROSCOPIC5803-2PH:LSCNC:PT:URINE:QN:TEST STRIPPH5.55.5URINALYSIS W/MICROSCOPIC2965-2SPECIFIC GRAVITY:RDEN:PT:URINE:QN:SPECIFIC GRAVITY1.0121.012URINALYSIS W/MICROSCOPIC25145-4BACTERIA:ACNC:PT:URINE SED:ORD:MICROSCOPY.LIGHTBACTERIA.NONEURINALYSIS W/MICROSCOPIC5778-6COLOR:TYPE:PT:URINE:NOM:COLOR.LIGHT-YELLOWURINALYSIS W/MICROSCOPIC5792-7GLUCOSE:MCNC:PT:URINE:QN:TEST STRIPGLUCOSE.NEGATIVEURINALYSIS W/MICROSCOPIC5797-6KETONES:MCNC:PT:URINE:QN:TEST STRIPKETONES.NEGATIVEURINALYSIS W/MICROSCOPIC5799-2LEUKOCYTE ESTERASE:ACNC:PT:URINE:ORD:TEST STRIPLEUKOCYTE ESTERASE.NEGATIVEURINALYSIS W/MICROSCOPIC5804-0PROTEIN:MCNC:PT:URINE:QN:TEST STRIPPROTEIN.NEGATIVEURINALYSIS W/MICROSCOPIC5802-4NITRITE:ACNC:PT:URINE:ORD:TEST STRIPNITRITE.NEGATIVEURINALYSIS W/MICROSCOPIC11277-1EPITHELIAL CELLS.SQUAMOUS:NARIC:PT:URINE SED:QN:MICROSCOPY.LIGHT.HPFEPITHELIAL CELLS SQUAMOUS.NONEURINALYSIS W/MICROSCOPIC13945-1ERYTHROCYTES:NARIC:PT:URINE SED:QN:MICROSCOPY.LIGHT.HPFRBC11URINALYSIS W/MICROSCOPIC5821-4LEUKOCYTES:NARIC:PT:URINE SED:QN:MICROSCOPY.LIGHT.HPFWBC.<1URINALYSIS W/MICROSCOPIC20505-4BILIRUBIN:MCNC:PT:URINE:QN:TEST STRIPBILIRUBIN.NEGATIVEURINALYSIS W/MICROSCOPIC20405-7UROBILINOGEN:MCNC:PT:URINE:QN:TEST STRIPUROBILINOGEN.<2.0URINALYSIS W/MICROSCOPIC32167-9CLARITY:TYPE:PT:URINE:NOM:CLARITY.CLEARURINALYSIS W/MICROSCOPICBLOOD.NEGATIVEChemistry Results
23. Example of Linked DataChest X-Ray Ancillary FileCPTDescription71010CHEST X-RAYRad TypeResult TextCHEST (PA VIEW) SERIES REPORTPA CHEST ^COMPARISON: NONE AVAILABLE ^FINDINGS: THE LUNGS AND PLEURAL ARE CLEAR. THE HEART, MEDIASTINUM, AND BONY THORAX ARE A… (truncated)Radiology Results
24. Example of Linked DataVisit to Primary Care Clinic for AnxietyCAPERTemperature (°F)Height (in.)Weight (lbs.)Systolic BP (mm Hg)Diastolic BP (mm Hg)Heart Rate (/min.)Appointment Date98.06413311577732/15/16Product Name (use)NDCProduct StrengthDays SupplyDate DispensedEFFEXOR XR (antidepressant)0000808330275 MG452/15/16BUSPIRONE HCL (anti-anxiety)0037811500510 MG302/15/16PROPRANOLOL HCL (beta blocker)0059155551020 MG452/15/16VitalsDX1DescriptionCPT_4DescriptionMEPRS CodeEncounter DateF419ANXIETY DISORDER, UNSPECIFIED90836PSYCHOTHERA,45MIN,PAT&/FAM,E&MBHA22/15/16PDTSNDCGive AmountUnitsDurationMedication Order DateOrder ID0000808330275MG452/15/16XXX0037811500510MG302/15/16YYY0059155551020MG452/15/16ZZZCDR MedicationOrdersOrder IDDispense DateXXX2/15/16YYY2/15/16ZZZ2/15/16CDR Medication Fills
25. Purchased Care Linkages
26. Purchased CarePurchased care records come in as claims.When more than one provider of care is involved in an event, each provider is paid separately and there is no indication that the claims when together to form an event.Building episodes of care is an art rather than a science.The only episode building the MHS does is inpatient acute care episodes.
27. Inpatient Purchased CarePurchased Care:Data element “Admitting TED Number” can be used to link all claims related to an acute care stayTED Institutional contains the facility bill(s)There can be more than one record per stay. Rare with acute care.Diagnosis, procedures, etc. from hospital perspective. TED Non-Institutional contains other bills.Lab and pharmacy information usually N/A because part of DRG payments.Admitting TED Number contains the “TED Number” of the admission record.
28. Admitting TED Number
29. CaveatsSometimes an acute stay will have a non-acute component to it. The Admitting TED Number will not incorporate that part of a stay.Example: Patient is treated for a stroke, then goes to a rehab facility. This information could be obtained by retrieving records for persons with inpatient stays beyond the period of stay.There are also entirely non-acute stays which the admitting TED number does not address.i.e. mental health institutionsResource Sharing stays are not included. For those, there will be an institutional TED record but a CAPER to indicate the professional service.