department of defense event types (volume 3) user...

CLINICAL LOOKING GLASS®

Department of Defense Event Types (Volume 3)

USER GUIDEVersion September February 4, 2013 Department of Defense

Date February 4, 2013

Manual Version: 1.3

Clinical Looking Glass (TM) Patent PendingMontefiore Medical Center All Rights Reserved.This document contains unpublished, confidential and proprietary information of Montefiore Medical Center. No disclosure or use of the material may be made without the express written consent of Montefiore Medical Center.

For additional information please contact: Eran Bellin, M.D.ebellin@emer

Background

Every installation of Clinical Looking Glass adapts to the local data availabil-ity. This availability determines the available event types.

Any analyst, administrator, or clinician wishing to ask questions of Clinical Looking Glass must understand the available event types at his institution.

In this manual volume 3, we provide a map of the available event types orga-nized by Clinical Considerations. These event types are increased in number every month.

The user is advised to look through the table of contents reading through selected event types, like hospital admit/discharge to obtain a sense of what is available. Most chapters provide an example of what Browsing the event type looks like.

The user can output to his iPad for use in iBooks. In that format, tapping on the chapter will immediately bring the user to that chapter.

This manual is available in CLG from the drop down menu and from Dropbox on a subscription service from the CLG administrator. For those who use Dropbox on their iPad, the manual will update automatically. However, copies moved to the iBook library, will need to be updated manually by deleting the old manual and updating the more recent version.

Please keep in mind, that while you may be keeping this manual on your iPad, the information carried within are the property of the United States Depart-ment of Defense and are protected by the privacy rules for Quality Improve-ment work of New York State.

Eran Bellin, M.D

Contents

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Chapter 1: Introduction 1Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Event Type and Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Events with Singularity in Time. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Event with Implicit Duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Scope of Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Chapter 2: Hospital Admission/Discharge 5Event Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Event Type: Inpatient Care Admit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Time Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

DRG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Inpatient Medical Provider. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Beneficiary Category . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Disposition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Length of Stay (days) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Inpatient ICD9 Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Primary ICD9 Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Rule Out Rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Displayed Variables when selecting Inpatient ICD9 group in Browse. . . . . . . . 9ICD9DXID. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9ICD9DXCode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9ICD9DXPos. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Present On Admission? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

MEPRS Level Two . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10MEPRS Level Three . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Inpatient Admit Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Browse Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Chapter 3: Lab Test 13

Event Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Event Type: Lab Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Time Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Lab Test Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Lab Test Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Grouped Numeric Labs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Categoric Lab Test Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Test MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Lab Facility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Browse Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Chapter 4: Medication / Prescription 19Event Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Event Type: Med Order Start . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Time Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Med Order Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Ordering MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Dose Amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Med Order Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Event Type: Med Order Stop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Med Order Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Ordering MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Dose Amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Med Order Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Event Type: Prescription Start . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Med Order Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Ordering MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Prescription Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Event Type: Prescription End . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Med Order Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Ordering MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Prescription Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Browse Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Chapter 5: Procedure 23Event Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Event Type: ICD9SX Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Procedure Type. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Procedure MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Procedure Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Event Type: CPT 4 Procedure Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

CPT4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Procedure Provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25CPT4 Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Browse Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Chapter 6: Emergency Department 27Event Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Event Type: ED Admit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Time Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Beneficiary Category . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Billing MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Disposition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27ER Visit ICD9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27ER Admit Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27MEPRS Level 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27MEPRS Level 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Facility and Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Browse Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Chapter 7: Outpatient Visit 31

Event Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

MEPRS Level 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31MEPRS Level 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Outpatient Admit Source. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Browse Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Facility and Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Chapter 8: Ambulatory Surgery 35Event Type: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Event Type: Ambulatory Surgery Admit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Time Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

AmbSurg Medical Provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35AmbSurg Disposition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35AmbSurg Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35AmbSurg ICD9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Primary ICD9 Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Rule Out Rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Displayed Variables when selecting Inpatient ICD9 group in Browse. . . . . . . 37ICD9DXID. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37ICD9DXCode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37ICD9DXPos. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Present On Admission? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

AmbSurg Length of Stay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38AmbSurg Admit Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38MEPRS Level 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38MEPRS Level Three . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Browse Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Chapter 9: Death 41Event Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Event Type: Death - In House Death Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Event Type: Death - Social Security Death Date . . . . . . . . . . . . . . . . . . . . . . . . . . 42Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Event Type: Death - Social Security or in House Death Date . . . . . . . . . . . . . . . 42

Browse Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Chapter 10: Demographics 45Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 PatientID. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 MRN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Patient Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Date of Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Patient Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Primary Care MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Patient Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 ZipCode Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Age at Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Social Security Number Present . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Event ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Event Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Browse Example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Chapter 11: MEPRS 49Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Level 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Level 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Level 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Chapter 1: Introduction Clinical Looking Glass User Guide

Background 1

Chapter 1: Introduction

BackgroundClinical Looking Glass (CLG) allows the user to qualify patients and events related through time. The result of a cohort or event collection build is a group of events with an index date.

In the case of a cohort, we have one event representing that one person as peo-ple are represented only once in the cohort.

In the case of an event collection, we may have numerous events per person, but each group member is made up of a unique triple - patient id - event type - index date.

Within each of the manual’s chapters, we provide the specific event types that allow the user to build a cohort or event collection based upon the chapter clinical topic.

Event Type and Time

Events in CLG may be associated with a single date time (singularity) or two date times - a start and and end date:time in a durational event.

Events with Sin-gularity in Time Some events are associated with a single time. For example, a hematocrit (the

measurement of blood count) is associated with the time it is drawn. By con-vention, the laboratory test has a singularity - the time of blood draw.


Scope of Data 2

Event with Implicit Dura-tion

Some events like a hospitalization have an implicit duration with two associ-ated date times. There is an admit date and a discharge date and a duration in between when events can occur.CLG names these durational events to make it clear what their implicit index date should be. For example, Inpatient Admit is clearly a hospitalization event but its implicit index date is the date of admission. In fact, whenever you use Inpatient Admit CLG will be looking for the inpatient admit date to qualify the patient in calendar time periods such as Jan 1, 2010 - Dec 21, 2010. All inpatient Admits will have a 2010 year time stamp. These events may have a discharge in 2011, but their admission will be in 2010.

While qualifying on a durational event will always qualify upon the implicit index date as described above, the resulting cohort member (or event collec-tion member) will have attached to it as its index date the user’s choice of start or end date of the duration.. For Inpatient Admission for example, while teh implicit index date used for qualifying the cohort is the date of admssion the user can use the End Point Event control in the Event Definition Builder to choose the endpoint for use as the resulting cohort member’s index date.

Figure 1-1End Point Event Control in Event Definition Palette

A Duration Event when referenced by another criterion line in the event can-vas can constrain the possible events to those events taking place during the implicit duration. A criterion line looking for a med order when in (refer-encing the Inpat Admit date line would only consider med orders occuring during the referenced hospitalizations.

Scope of DataThe data available for the first evaluation training class February 8, 2013 includes three years of inpatient and outpatient data for individuals who


Scope of Data 3

passed through the Washington DC MHS in the three years preceding Novem-ber of 2012. A few stray data from Nov 2012 is found. Data is obtained both from the electronic medical record and from out of MHS insurance source systems. The latter with less detail. In addition, once a person qualifies as a Washington DC MHS patient, his subsequent clinical data whether within our outside of Washington DC is supposed to be within the dataset available through CLG.

Like all first efforts we should expect imperfections which you will surface. We appreciate feedback both on the application Clinical Looking Glass and the completeness of the data. We hope in the course of your Quality Improve-ment work, you will be able to directly test the utility of CLG to identify rele-vant patients. We hope to have data refreshes over the next few months to keep the data available to you relevant.

To give the reader a sense of the scope of the informational content, we pro-vide a summary for each event type of the number of unique individuals with at least one of the listed events.in the year 2011. (data run in clg 2/1/13)

Type of Event Unique patients Outpatient Visits 583,288Ambulatory Surgery Admit 174,506ED 163,321ICD9sx 30,517Inpatient Admit 54,598Inpatient Discharges 54,644Labs 225,807Medication orders start 208,014Medication orders stop 179,227Prescription Start 205,948Prescription Stop 175,884CPT4 581,928Death in house 249Death Social Security 1,923Death Social Sec or in house 1,993

We believe there is reason to suspect underdetection of death.

To obtain a sense of scale and believability, we present a table comparing the number of unique individuals discharged from Montefiore’s Moses Division (745 bed) as a point of comparison to Walter Reed’s 345 beds.


Scope of Data 4

CHFPrimaryorsecondaryPosition,uniquepatients,incalendaryear,ages65‐75inclusive:

Moses Division has 726 beds. Walter Reed is noted to have 345 beds.

Ref: http://www.goarmy.com/amedd/health‐care/facilities/walter‐reed‐army‐

medical‐center.html(Analytic date: 2/4/13 Montefiore; MHS data last upload Nov 2012 and is there‐

fore incomplete in a number of the calendar years reporting)

Year Walter Reed Moses Division

Montefiore2012 (incomplete data*) 41 1,1502011 134 1,1102010 134 1,1102009 136 1,0602008 134 9932007 (incomplete data*) 46 948

Chapter 2: Hospital Admission/Discharge Clinical Looking Glass User Guide

Event Types 5

Chapter 2: Hospital Admission/Dis-charge

Event TypesInpatient Care AdmitInpatient Care Discharge

Background

Event Type: Inpatient Care Admit

Time Quality Durational Time. This event has an implicit default index time which is the date of admission for Inpatient Admit. All selection of patients based on cal-endar time will look for patients who are admitted during the calendar win-dow recorded. The CLG user can tell the program to attach to the cohort as index date the discharge date (End Point Event). The CLG user can build a criterion line in event canvas where the event of that line points to this dura-tional event with a “when in” command and thereby restricts its events to those occurring during the hospitalization.

Attributes DRGSet name: DRG

Diagnosis Related Groups - a computer grouper program reviews all the ICD9 codes and creates a Diagnosis Related Group that best summarizes the admis-sion and resource consumption.


Event Type: Inpatient Care Admit 6

Inpatient Medical ProviderSet name: Provider

Beneficiary CategorySet name: Beneficiary Category

DispositionSet name: Disposition

DescriptionActive DutyDependent of Active DutyDependent of Guard/ReserveDependent of Inactive Guard/ReserveDependent of RetireeDependent of SurvivorDirect Care OnlyGuard/ReserveInactive Guard/ReserveNATONo valid match found. DefaultedOtherRetireeUnknown

DescriptionAdmittedAdvice AssessmentContinued stayDeathDischarged homeDischarged to ICFDischarged to SNFExpiredExpiredHome, Self-careImmediate referralLeft against medical adviceLeft without being seenMedication Refill ForwardedNo valid match found. DefaultedOther (DOA, died in ER, KIA, etc.)Other Not Elsewhere ClassifiedReferred for AppointmentReferred to ERReleased to Self Care



Facility Discharge FacilitySet name: Facility - all encounter types

Length of Stay (days)Official number of days in the hospital. Every time you cross midnight, you capture a day. This is not the real time in hospital which you can obtain by doing a time to outcome from the admit date:time to the discharge date:time.

Inpatient ICD9 GroupSet name: ICD9DX Diagnosis

The user has the option to build a set of ICD9 diagnoses which is stored as usr: (name of the set), or he can use a system set offered by CLG. These sys-tem ICD9 sets are based upon the 2011 AHRQ CCS -Clinical Classification System (CCS). Behind the scenes the system set is storing a set of ICD9 codes and using those codes in CLG. When the CSS classification scheme changes old cohorts will remain unchanged until rerun.

Released with work duty limitationsReleased without limitationsSick at home/quartersTransfer to OtherTransfer to Short Term FacilityTransferred to another clinical serviceTransferred to another hospitalTransferred to s killed nursing facility (SNF)Unknown



Examples of Clinical Classification System Sets (CSS Sets) (available through view set in set builder when looking at the viewing the set ICD9 Diagnosis.

Primary ICD9 Code

The Uniform Hospital Discharge Data Set (UHDDS) defines Principal Diag-nosis as “the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care”.



This means that if a patient had been admitted for a strep throat day one and on day two developed a heart attack, infarcted 75% of his heart, was intu-bated, and only discharged on day 14, the primary diagnosis would be strep throat.

However, the DRG would take into consideration the secondary diagnoses and complications to construct the DRG diagnosis.

Keep in mind that the VA uses another definition for primary - the condition most responsible for the length of stay so VA primary and other hospitals pri-mary or principal diagnoses are not comparable.

Rule Out Rule“If the diagnosis documented at the time of discharge is qualified as ‘proba-bly’, ‘suspected’, ‘likely’, ‘questionable’, ‘possible’ or ‘still to be ruled out’ code the condition as if it existed or was established. The basis for this guide-line is that diagnostic workup, arrangements for further workup or observa-tion, and initial therapeutic approach correspond most closely with an established diagnosis.”

See: ICD-9-CM Coordination and Maintenance Committee, April 1, 2005http://www.cdc.gov/nchs/ppt/icd9/att_probable_apr05.ppt

The “Rule out Rule” only applies to inpatients. Most outpatient coding is done by physicians at the Department of Defense (DOD).

Displayed Variables when selecting Inpatient ICD9 group in Browse

ICD9DXID Primary ICD9 diagnosis. Even if the qualifying ICD9 was a secondary diag-nosis, this field will provide only the primary. To get a list of all the ICD9 codes (primary, secondary..) see Smart Report Diagnosis Summary.This field provides both the ICD9 code as well as text.

ICD9DXCodeProvides ICD9 primary diagnosis as a code without any text. It is the same as the preceding variable ICD9DxID without the text explanation.



ICD9DXPosThe ICD9X position displayed in the Excel spreadsheet is always =1; the pri-mary position

ICD9 Positions offered in the CLG drop down when building a cohort or event collection include:

0=Admit1=Primary only2=Secondary onlyAny position

Present On Admission?TrueFalse

MEPRS Level TwoSet name: MEPRS Level 2

Medical Expense and Performance Reporting System (MEPRS) provides a uniform healthcare cost management system. It defines a set of functions work centers/cost centers, applies a uniform performance system and pre-scribes a cost assignment methodology. MEPRS Level 2 is an encounter drill down level based off of the encounter linked to a MEPRS Level 1.

MEPRS Level 2

MEPRS Level ThreeSet name: MEPRS level 3



This is a 3rd level of drill down. This is linked to Level 2 which is linked to Level 1.

MEPRS Level 3

Inpatient Admit SourceSet name: Admit source

The source from which the patient was admitted to the hospital.

DescriptionClinic referralCourt/Law EnforcementEmergency RoomExtramural babyHMO referralInformation Not AvailableNo valid match found. DefaultedNormal DeliveryPhysician referralPremature DeliveryReadmission to the Same Home Health AgSick BabyTransfer from a Critical Access HospitalTransfer from a hospitalTransfer from a skilled nursing facilityTransfer from another health care facilityTransfer from Another HHATransfer from Hospital in same facility resu



Browse Exam-ple

Browse mode Excel spreadsheet:

PatientID 15340607

MRN clg-15340607

Beneficiary Category Dependent of Guard/Reserve

Disposition Home, Self-care-01

DRG UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC-359

End EventDateTime 1/11/2011 12:00:00 AM

EventDateTime 1/10/2011 12:00:00 AM

EventID 1217358189

EventName Event1

EventType InpatientAdmissionDate

Facility 60TH MED GRP-TRAVIS

Inpatient Admit Source No valid match found. Defaulted

Inpatient Medical Provider ROYSTER, G D

LengthOfStay (days) 1

MEPRS Level Three Obstetrics-ACB

MEPRS Level Two Surgical Care-AC

Start EventDateTime 1/10/2011 12:00:00 AM

bPOA Y

DiagnosisTypeId Primay Diagnosis or First Diagnosis Recorded

ICD9DXId 628.9-FEMALE INFERTILITY NOS

ICD9DXPos 1

Chapter 3: Lab Test Clinical Looking Glass User Guide

Event Types 13

Chapter 3: Lab Test

Event Types

Lab Test

BackgroundNote: The lab test time is recorded at the time that the specimen was collected and not at the time the results are reported.

Event Type: Lab Test

Time Quality Singularity - one date:time associated with the lab test.

Attributes

Lab Test TypeSet name: Categoric Labs Set Builder

This attribute allows you to select a singular lab test or a Lab Test Set.

A Lab Test Set refers to a single lab test and allows you to select certain ranges (as many as you like) an any categoric value. For example: a set can be built to identify potassium from 5.5 - 15 or the categoric hemolyzed.

Example:


Event Type: Lab Test 14

Lab Test ValueBelow are the symbols provided by CLG that allow you to create a value range.

= equals> greater than>= greater than or equal< less than <= less than or equalBETWEEN between two values and including those two values



Grouped Numeric LabsSet Name: Lab Test Type

The Lab set allows the user to create sets by specific names of labs, for which you can attach a value condition, as described below. When a lab test shows up in the DOD repository with different names (calcium, ca..), you can build a set of lab test and they will be treated as one.

Categoric Lab Test ValueThis attribute is used when searching for a non-numeric value from a lab test



Test MDSet name: Provider

Lab FacilitySet name: Facility - all encounter types

Browse Exam-ple


PatientID 3450929

MRN clg-3450929

Categoric Lab Test Value SEE NOTE

End EventDateTime NA


EventID 890374276

EventName Event1



EventType LabTestDate

Grouped Numeric Labs 1130

Lab Test Type B PERTUSSIS IGG PT

Lab Test Value NA

LabFacility SAN ANTONIO MMC-JB SA LAF-RAF-FSH

Start EventDateTime NA

Test MD BELL, DAVID G

Chapter 4: Medication / Prescription Clinical Looking Glass User Guide

Event Types 19

Chapter 4: Medication / Prescription

Event TypesMed Order StartMed Order StopPrescription StartPrescription Stop

BackgroundMedication can be administered in the hospital (Med Order Start) or pre-scribed in the outpatient (Prescription Start Date). Because the information system makes a distinction, we can easily separate out the outpatient and inpa-tient medications. Of note, while in the inpatient, we know that the patient actually received the medication, in the outpatient, we only know that it was prescribed.

Event Type: Med Order StartEnd Point Event: Med Order Stop Med Order Start

Background Medication orders are medication administered in the hospital. Medications are only recorded if the patient actually received at least one dose of the drug. An order alone cancelled before execution would not result in data flow to this field. When the order is discontinued the Med Order Stop is set to the date of the termination of the order.

Time Quality Durational Time. This event has an implicit default index time which is the date:time of medication administration start. All selection of patients based


Event Type: Med Order Stop 20

on calendar time will look for patients who are started on medication during the calendar window recorded. The CLG user can tell the program to attach to the cohort as index date the date of medication stop (End Point Event). The CLG user can build a criterion line in event canvas where the event of that line points to this durational event with a “when in” command and thereby restricts its events to those occurring during the medication administration period. Please note that each start-stop cycle creates its own duration even if the same medication is used throughout the entire hospital stay. The software does not recognize the sameness of medication from two stop-start cycles that are contiguous in time.

Attributes

Med Order TypeSet name: Medication

Ordering MD Set name: Provider

Dose AmountValue Range: = equals> greater than>= greater then or equals< less than<= less than or equals

Med Order FacilitySet name: Facility - all encounter types

Event Type: Med Order StopEnd Point Event: Med Order Stop Med Order Start


Event Type: Prescription Start 21

Attributes



Dose AmountValue Range: = equals> greater than>= greater then or equals< less than<= less than or equals

Med Order FacilitySet name: Facility - all encounter types

Event Type: Prescription StartEnd Point Event: Prescription End Prescription Start

Background Prescriptions are medications ordered in the outpatient.

Attributes




Event Type: Prescription End 22

Prescription FacilitySet name: Facility - all encounter types

Event Type: Prescription EndEnd Point Event: Prescription End Prescription Start

Attributes



Prescription FacilitySet name: Facility - all encounter types

Browse Exam-ple

Browse mode in Excel spreadsheet:

PatientID 963023

MRN clg-963023



EventID 271595875

EventName Event1

EventType PrescriptionStartDate

Med Order Type ZOLPIDEM TARTRATE

Ordering MD NGUYEN, MARK M

Prescription Facility NBHC NAF ATSUGI


Chapter 5: Procedure Clinical Looking Glass User Guide

Event Type 23

Chapter 5: Procedure

Event TypeICD9SX ProcedureCPT4 Procedure Date

BackgroundProcedures can be performed in the inpatient or in the outpatient including ambulatory surgery. All outpatient procedures are coded in CPT4 (AMA standard).Lookup of CPT4 codes by number or name with relative value units and reim-bursement can be done at the ama website: https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp All inpatient procedures are coded in ICD9SX. The event canvas recognizes in the event ICD9SX PROCEDURE those inpa-tient and outpatient procedures using the ICD9SX codes. The event canvas recognizes in the event type CPT4 only outpatient proce-dures. And all outpatient procedures have a CPT4 code. Warning: There are a few sites where the procedures are coded in both ICD9SX and CPT4. If your interest is in counting procedures you need to cre-ate on the event canvas one condition line for "CPT4 event" and a group within which you have the "procedure event" condition line for the same time period and another condition line of the "CPT4 event" using the "not within 0-1 days" of the "CPT4 event". The root of the group should point to the first condition within the group "CPT4 event" using the word all.

Neither Procedure Date nor CPT4 have a real date:time. Both are assigned a date:time from the midnight preceding their actual time.


Event Type: ICD9SX Procedure 24

Event Type: ICD9SX Procedure

Time Time is artificially set to be midnight of the date of the procedure.

Attributes Procedure TypeSet name: ICD9SX Procedure

Procedure MDSet name: Provider

Procedure FacilitySet name: Facility- all encounters


Note: Procedure is not a durational event so there is only an Event Datetime of midnight of the day the procedure was done. EndEventDateTime and StartE-ventDateTime are NA because the source of information is a billing code that does not record duration of the procedure.

Also, procedures can include any procedure billed for such as:

PatientID 2267082MRN clg-2267082End EventDateTime NAEventDateTime 1/12/2012 12:00:00 AMEventID 3EventName procedureEventType ProcedureDateICD9SXCode 84.12Procedure MD Gobikrishna Md , Ariaratnam ,Procedure Type 84.12 -AMPUTATION THROUGH FOOT Start EventDateTime NA


Event Type: CPT 4 Procedure Date 25

Event Type: CPT 4 Procedure Date

Time Time is artificially set to be midnight of the date of the procedure.

Attributes

CPT4Set name: CPT4 Procedure

Procedure ProviderSet name: Provider

CPT4 FacilitySet name: Facility-all encounters.

Browse Exam-ple Browse mode Excel spreadsheet:

PatientID 1174710MRN clg-1174710CPT4 99284-EMERGENCY DEPARTMENT VISIT

HIGH/URGENT SEVERITYCPT4Code 99284


Event Type: CPT 4 Procedure Date 26

Note: CPT4 Procedure date is not a durational event so there is only an Event Datetime of midnight of the day the procedure was done. EndEventDateTime and StartEventDateTime are NA because the source of information is a billing code that does not record duration of the procedure.

Other examples of CPT4:

End EventDateTime NAEventDateTime 1/12/2012 12:00:00 AMEventID 3492832EventName cpt4 jan 12 2012EventType CPT4DateProcedure Provider Lee Md , Conroy S,Start EventDateTime NA

Chapter 6: Emergency Department Clinical Looking Glass User Guide

Event Types 27

Chapter 6: Emergency Department

Event TypesED Admit

Event Type: ED Admit

Time Quality No Durational Time.

Attributes Beneficiary CategorySet name: Beneficiary Category

Billing MDSet name: Provider

DispositionSet name: Disposition

FacilitySet name: Facility - all encounter types

ER Visit ICD9Set name: ICD9DX Diagnosis

ER Admit SourceSet name: Admit source

MEPRS Level 2Set name: MEPRS Level 2

Medical Expense and Performance Reporting System (MEPRS) provides a uniform healthcare cost management system. It defines a set of functions


Facility and Service 28

work centers/cost centers, applies a uniform performance system and pre-scribes a cost assignment methodology. MEPRS Level 2 is an encounter drill down level based off of the encounter linked to a MEPRS Level 1.

MEPRS Level 2

MEPRS Level 3Set name: MEPRS level 3


MEPRS Level 3

Facility and ServiceFor inpatient, ambulatory surgery and emergency room encounters, the physi-cal facility and service level is an important business dimension with which



analysts may want to create studies and reports. For these types of encounters, we can choose a single facility or a set of facilities and the service levels, MEPRS 2 or MEPRS 3.

Our Facility (Facility-all encounter types) and service (MEPRS Level 2 and MEPRS Level 3) sets located in the CLG builder allows the user to build a group of location and level of service to represent the appropriate business dimension.


PatientID 6860761

MRN clg-6860761

Beneficiary Category Dependent of Active Duty

Billing MD MARLEY, CHAD T

Disposition Released without limitations-1


Er Admit Source No valid match found. Defaulted


EventID 1217383275

EventName Event1

EventType ErSeenDate

Facility EISENHOWER AMC-FT. GORDON

Meprs Level 2 Emergency Medical Care-BI

Meprs Level 3 Emergency Medical Clinic-BIA



ICD9DXId 346.90-MIGRAINE,UNSP,WO INTRAC WO MIG

ICD9DXPos 1

ErVisitId 1217383275

Chapter 7: Outpatient Visit Clinical Looking Glass User Guide

Event Types 31

Chapter 7: Outpatient Visit

Event TypesOutpatient Visit

BackgroundAs more medical management is being pushed into the outpatient arena, the ability to assess data from outpatient visits is critical. The CLG data ware-house contains recorded outpatient visit billing data.

Attributes

Beneficiary CategorySet name: Beneficiary Category

ICD9 GroupSet name: ICDDX diagnosis



MEPRS Level 2


Background 32



MEPRS Level 3

Ambulatory FacilitySet name: Facility- all encounter types



Outpatient Admit SourceSet name: Admit Source

Browse Exam-ple


Facility and ServiceFor inpatient, ambulatory surgery and emergency room encounters, the physi-cal facility and service level is an important business dimension with which analysts may want to create studies and reports. For these types of encounters, we can choose a single facility or a set of facilities and the service levels, MEPRS 2 or MEPRS 3. Our Facility (Facility-all encounter types) and service (MEPRS Level 2 and MEPRS Level 3) sets locted in the CLG builder allows the user to build a group of location and level of service to represent the appropriate business dimension.

PatientID 861788MRN clg-861788EventID 41691198EventName user selected event nameEventDateTime 1/2/2011 12:11:00 PMStart EventDateTimeEnd EventDateTimeBeneficiary CategoryVisit MD Feingold Md , Robert E,DiagnosisTypeId PrimaryICD9DXId V56.0 -ADMIT FOR RENAL DIALYSIS ICD9DXPos 1OpVisitId 41691198

Chapter 8: Ambulatory Surgery Clinical Looking Glass User Guide

Event Type: 35

Chapter 8: Ambulatory Surgery

Event Type:Ambulatory Surgery Admit

Event Type: Ambulatory Surgery Admit

Time Quality Time is artificially set to be midnight of the date of the procedure.

Attributes

AmbSurg Medical ProviderSet name: Provider

AmbSurg DispositionSet name: Disposition

AmbSurg FacilitySet name: Facility - all encounter types

AmbSurg ICD9Set name: ICD9DX Diagnosis

The user has the option to build a set of ICD9 diagnoses which is stored as usr: (name of the set), or he can use a system set offered by CLG. These sys-tem ICD9 sets are based upon the 2011 AHRQ CCS -Clinical Classification System (CCS). Behind the scenes the system set is storing a set of ICD9 codes and using those codes in CLG. When the CSS classification scheme changes old cohorts will remain unchanged until rerun.


Event Type: Ambulatory Surgery Admit 36

Examples of Clinical Classification System Sets (CSS Sets) (available through view set in set builder when looking at the viewing the set ICD9 Diagnosis.

Primary ICD9 Code

The Uniform Hospital Discharge Data Set (UHDDS) defines Principal Diag-nosis as “the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care”.



This means that if a patient had been admitted for a strep throat day one and on day two developed a heart attack, infarcted 75% of his heart, was intu-bated, and only discharged on day 14, the primary diagnosis would be strep throat.

However, the DRG would take into consideration the secondary diagnoses and complications to construct the DRG diagnosis.

Keep in mind that the VA uses another definition for primary - the condition most responsible for the length of stay so VA primary and other hospitals pri-mary or principal diagnoses are not comparable.

Rule Out Rule“If the diagnosis documented at the time of discharge is qualified as ‘proba-bly’, ‘suspected’, ‘likely’, ‘questionable’, ‘possible’ or ‘still to be ruled out’ code the condition as if it existed or was established. The basis for this guide-line is that diagnostic workup, arrangements for further workup or observa-tion, and initial therapeutic approach correspond most closely with an established diagnosis.”

See: ICD-9-CM Coordination and Maintenance Committee, April 1, 2005http://www.cdc.gov/nchs/ppt/icd9/att_probable_apr05.ppt

The “Rule out Rule” only applies to inpatients. Most outpatient coding is done by physicians at the Department of Defense (DOD).

Displayed Variables when selecting Inpatient ICD9 group in Browse

ICD9DXID Primary ICD9 diagnosis. Even if the qualifying ICD9 was a secondary diag-nosis, this field will provide only the primary. To get a list of all the ICD9 codes (primary, secondary..) see Smart Report Diagnosis Summary.This field provides both the ICD9 code as well as text.

ICD9DXCode



Provides ICD9 primary diagnosis as a code without any text. It is the same as the preceding variable ICD9DxID without the text explanation.

ICD9DXPosThe ICD9X position displayed in the Excel spreadsheet is always =1; the pri-mary position

ICD9 Positions offered in the CLG drop down when building a cohort or event collection include:

0=Admit1=Primary only2=Secondary onlyAny position

Present On Admission?TrueFalse

AmbSurg Length of StayOfficial number of days in the hospital. Every time you cross midnight, you capture a day. This is not the real time in hospital which you can obtain by doing a time to outcome from the admit date:time to the discharge date:time.

AmbSurg Admit SourceSet name: Admit Source



MEPRS Level 2



MEPRS Level ThreeSet name: MEPRS level 3


MEPRS Level 3


PatientID 16555567

MRN clg-16555567

Ambsurg Admit Source No valid match found. Defaulted

AmbSurg Disposition Released without limitations-1



AmbSurg Facility EISENHOWER AMC-FT. GORDON

AmbSurg LengthOfStay 0

Ambsurg Medical Provider HOWARD, NELSON



EventID 1217383923

EventName Event1

EventType AmbSurgAdmitDate

Meprs Level 2 Medical Care-BB

Meprs Level 3 Otolaryngology Clinic-BBF



ICD9DXId 478.70-DISEASE OF LARYNX NOS

ICD9DXPos 1

bPOA Y

Chapter 9: Death Clinical Looking Glass User Guide

Event Types 41

Chapter 9: Death

Event Types

Death - In House Death DateDeath - Social Security Death DateDeath - Social Security or In House Death Date

BackgroundIn November 2011, the Social Security Administration reduced the death matches (person’s death status matched with their social security number) it shares with the public. Our studies demonstrate a 50% loss of sensitivity (death matches reported by SSA to known deaths) when comparing deaths reported during the same time period, in an older CLG download to a post reduction current CLG download that looked back to that time period.

In the meantime in order to continue to provide a more complete and consis-tent accounting of deaths post November 2011, we have created three new death events:

Death - In House Death DateDeath - Social Security Death DateDeath - Social Security or In House Death Date

Automatic censorship of follow up time (one of CLG's core features) will con-tinue to use the best available evidence of death and will records of death from both sources: inpatient reported deaths and Social Security number matches.

Chapter 9: Death Clinical Looking Glass Adhoc Reports User Guide

Event Type: Death - In House Death Date 42

Event Type: Death - In House Death Date

BackgroundDeath - In House Death Date recognizes the fact of death from our clinical information system - as a result of an in hospital death.

Event Type: Death - Social Security Death Date

BackgroundDeath - Social Security Death Date only reports on deaths known by Social Security and Released by the Social Security Administration through public access files. Prior to November 2011, all the deaths known to Social Security were released. After November 2011, a decision was made to eliminate from the releasable information those deaths obtained only through the referral of state and local municipalities. Other sources of information were permitted to be released.

Analysts looking at death using Social Security as sole source or to augment their knowledge of death must be aware of this dramatic change in the mean-ing of Social Security reported death in this application.

Event Type: Death - Social Security or in House Death

Date

This is the best available data. We use social security death surveillance and our own hospital information system to determine fact of death. In the event of conflict in actual date of death between social security report and the hospi-tal information system, date of death in our hospital information system takes

Chapter 9: Death Clinical Looking Glass User Guide

Event Type: Death - Social Security or in House Death Date 43

precedence. See attribute Death - Social Security Death Date for information on the changing quality of Social Security Death information.


PatientID 10005350 10006745

MRN clg-10005350 clg-10006745

EventDateTime 5/11/2011 12:00:00 AM 2/8/2011 12:00:00 AM

EventID 10005350 10006745

EventName Event1 Event1

EventType SSAOrInHouse SSAOrInHouse

Chapter 9: Death Clinical Looking Glass Adhoc Reports User Guide

Event Type: Death - Social Security or in House Death Date 44

Chapter 10: Demographics Clinical Looking Glass User Guide

Background 45

Chapter 10: Demographics

BackgroundWhile not really an event type, the demographics are an option offered in browse in event canvas and list method in Study Designer.

Note: this list is provided in the restricted mode. Elements with ***** are only visible in privileged mode with identifiers requested.

PatientID In restricted mode this is the internal patient pointer for clg - unique for each patient with a one to one relationship to the patient’s medical record number.

MRN Medical Record Number in the Privileged Mode with identifiers requested. In the restricted mode, this number is merely the patient pointer preceded by “clg-”.

Patient Address First line of Patient address

Date of Birth month/day/year

Ethnicity No valid match found. DefaultedOther HispanicUS or Canadian Indian TribeOther AsianPuerto RicanFilipinoMexicanEskimoAleut

Chapter 10: Demographics Clinical Looking Glass Adhoc Reports User Guide

Background 46

CubanIndianMelanesianChineseGuamanianJapaneseKoreanPolynesianPacific Islander NECLatin American with Hispanic descentVietnameseMicronesianOtherNoneUnknown

Gender-0 ( No valid match found. Defaulted)M (MALE)F (FEMALE)

Patient Name First and last name.

Primary Care MD

Primary Care MD is the primary care physician at run time

Patient Phone Patient’s most recent home phone number on record.

Race Racial categories as reflected in system. These categories reflect ancient descriptors of legacy systems some of which are jarring to our modern sensi-bilities and should be recoded before presenting in any forum.

ZipCode Set Zipcode or Zipcode Set

Age at Index Age of the cohort member on the index date that qualified him for member-ship in the cohort or event collection.

Chapter 10: Demographics Clinical Looking Glass User Guide

Background 47

Social Security Number Present

Yes / No

Event ID The number associated with the event in the database. This number may be reused for different events but the combination of Event ID and Event Name is unique.

Event Name The name of the Event Type. In this case “Admissions” or “Discharges”. The Combination of Event Name and Event ID creates a unique event.

Browse Exam-ple


PatientID 1066365MRN clg-1066365Patient Address ******Date Of Birth 8/17/1916 12:00:00 AMEthnicity Not Hispanic or LatinoGender FPatient Name ******Primary Care MD Set Bradlow Md , Jonathan A,Patient Phone ******Race WhiteZip Code Set 10458Social Security Number Present YESSES -5.033815Age at Index Date 93

Chapter 10: Demographics Clinical Looking Glass Adhoc Reports User Guide

Background 48

Chapter 11: MEPRS Clinical Looking Glass User Guide

Background 49

Chapter 11: MEPRS

BackgroundThe Medical Expense & Performance Reporting System is the standard cost accounting system for the Military Health System (MHS). It defines a set of function work centers/cost centers, applies a uniform performance system and prescribes a cost assignment methodology.

MEPRS was evolved from two historical systems, the Uniform Chart of Accounts (UCA) and the Uniform Staffing Methodologies (USM). UCA focused on tracking expenses and the USM was concerned with manpower resources.

In January 1985, UCA and USM were combined, and MEPRS started.

Level 1 Level 1 is described as the functional workcenter. These codes are a part of a hierarchy of accounts constructed to allow all expenses and corresponding workload data to be grouped into 7 functional categories.

Level 2 Level 2 represents the summary account.

A Inpatient CareB Ambulatory

CareC Dental Care

D Ancillary Services

E Support Services

F Special Programs

G Readiness

Chapter 11: MEPRS Clinical Looking Glass User Guide

Background 50

Level 3 Level 3 represents a subaccount (workcenter) such as Internal Medicine Inpa-tient Care.

Medical CareSurgical Care

OB/GYN Care

Pediatric Care

Orthopedic CarePsychiatric CareFamily Practice CarePrimary CareEmergency Medical CareFlight Medicine Care

Underseas Medicine CarePhysical Ambulatory ServicesServices

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