2021-09-22 19:39:44 +00:00
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<!DOCTYPE html>
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<html>
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<head>
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<meta charset="utf-8" />
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<title>Observation Period Considerations for EHR Data</title>
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2023-03-28 16:28:17 +00:00
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2022-01-13 18:59:03 +00:00
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2021-09-22 19:39:44 +00:00
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2022-01-13 18:59:03 +00:00
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<style>h1 {font-size: 34px;}
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code {color: inherit; background-color: rgba(0, 0, 0, 0.04);}
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pre:not([class]) { background-color: white }</style>
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2021-09-22 19:39:44 +00:00
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code{white-space: pre-wrap;}
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span.underline{text-decoration: underline;}
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div.column{display: inline-block; vertical-align: top; width: 50%;}
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div.hanging-indent{margin-left: 1.5em; text-indent: -1.5em;}
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ul.task-list{list-style: none;}
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if (window.hljs) {
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2022-07-27 01:48:28 +00:00
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2021-09-22 19:39:44 +00:00
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<link rel="stylesheet" href="style.css" type="text/css" />
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<style type = "text/css">
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.main-container {
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max-width: 940px;
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margin-left: auto;
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margin-right: auto;
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}
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img {
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max-width:100%;
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}
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.tabbed-pane {
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padding-top: 12px;
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}
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.html-widget {
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margin-bottom: 20px;
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button.code-folding-btn:focus {
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outline: none;
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}
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summary {
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display: list-item;
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}
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2022-07-27 01:48:28 +00:00
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details > summary > p:only-child {
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display: inline;
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}
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2022-01-13 18:59:03 +00:00
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pre code {
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padding: 0;
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}
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2021-09-22 19:39:44 +00:00
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</style>
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<style type="text/css">
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.dropdown-submenu {
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position: relative;
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}
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.dropdown-submenu>.dropdown-menu {
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top: 0;
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left: 100%;
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margin-top: -6px;
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margin-left: -1px;
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border-radius: 0 6px 6px 6px;
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}
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.dropdown-submenu:hover>.dropdown-menu {
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display: block;
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}
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.dropdown-submenu>a:after {
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display: block;
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content: " ";
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float: right;
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width: 0;
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height: 0;
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border-color: transparent;
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border-style: solid;
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border-width: 5px 0 5px 5px;
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border-left-color: #cccccc;
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margin-top: 5px;
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margin-right: -10px;
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}
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.dropdown-submenu:hover>a:after {
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border-left-color: #adb5bd;
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2021-09-22 19:39:44 +00:00
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}
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.dropdown-submenu.pull-left {
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float: none;
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}
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.dropdown-submenu.pull-left>.dropdown-menu {
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left: -100%;
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margin-left: 10px;
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border-radius: 6px 0 6px 6px;
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}
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</style>
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2022-01-13 18:59:03 +00:00
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<script type="text/javascript">
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2021-09-22 19:39:44 +00:00
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// manage active state of menu based on current page
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$(document).ready(function () {
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// active menu anchor
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href = window.location.pathname
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href = href.substr(href.lastIndexOf('/') + 1)
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if (href === "")
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href = "index.html";
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var menuAnchor = $('a[href="' + href + '"]');
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2023-02-08 20:04:22 +00:00
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// mark the anchor link active (and if it's in a dropdown, also mark that active)
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var dropdown = menuAnchor.closest('li.dropdown');
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if (window.bootstrap) { // Bootstrap 4+
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menuAnchor.addClass('active');
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dropdown.find('> .dropdown-toggle').addClass('active');
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} else { // Bootstrap 3
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menuAnchor.parent().addClass('active');
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dropdown.addClass('active');
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}
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2022-01-13 18:59:03 +00:00
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// Navbar adjustments
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var navHeight = $(".navbar").first().height() + 15;
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var style = document.createElement('style');
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var pt = "padding-top: " + navHeight + "px; ";
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var mt = "margin-top: -" + navHeight + "px; ";
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var css = "";
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// offset scroll position for anchor links (for fixed navbar)
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for (var i = 1; i <= 6; i++) {
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css += ".section h" + i + "{ " + pt + mt + "}\n";
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}
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style.innerHTML = "body {" + pt + "padding-bottom: 40px; }\n" + css;
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document.head.appendChild(style);
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2021-09-22 19:39:44 +00:00
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});
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</script>
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<!-- tabsets -->
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<style type="text/css">
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.tabset-dropdown > .nav-tabs {
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display: inline-table;
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max-height: 500px;
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min-height: 44px;
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overflow-y: auto;
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border: 1px solid #ddd;
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border-radius: 4px;
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}
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2023-03-28 16:28:17 +00:00
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.tabset-dropdown > .nav-tabs > li.active:before, .tabset-dropdown > .nav-tabs.nav-tabs-open:before {
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content: "\e259";
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2021-09-22 19:39:44 +00:00
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font-family: 'Glyphicons Halflings';
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display: inline-block;
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padding: 10px;
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border-right: 1px solid #ddd;
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}
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.tabset-dropdown > .nav-tabs.nav-tabs-open > li.active:before {
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2023-03-28 16:28:17 +00:00
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content: "\e258";
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2021-09-22 19:39:44 +00:00
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font-family: 'Glyphicons Halflings';
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2023-03-28 16:28:17 +00:00
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border: none;
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2021-09-22 19:39:44 +00:00
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}
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.tabset-dropdown > .nav-tabs > li.active {
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display: block;
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}
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.tabset-dropdown > .nav-tabs > li > a,
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.tabset-dropdown > .nav-tabs > li > a:focus,
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.tabset-dropdown > .nav-tabs > li > a:hover {
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border: none;
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display: inline-block;
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border-radius: 4px;
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background-color: transparent;
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}
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.tabset-dropdown > .nav-tabs.nav-tabs-open > li {
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display: block;
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float: none;
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}
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.tabset-dropdown > .nav-tabs > li {
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display: none;
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}
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</style>
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<!-- code folding -->
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</head>
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<body>
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<div class="container-fluid main-container">
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<div class="navbar navbar-default navbar-fixed-top" role="navigation">
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<div class="container">
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<div class="navbar-header">
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2022-07-27 01:48:28 +00:00
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<button type="button" class="navbar-toggle collapsed" data-toggle="collapse" data-bs-toggle="collapse" data-target="#navbar" data-bs-target="#navbar">
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2021-09-22 19:39:44 +00:00
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<span class="icon-bar"></span>
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<span class="icon-bar"></span>
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<span class="icon-bar"></span>
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</button>
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<a class="navbar-brand" href="index.html"><div><img src="ohdsi16x16.png"></img> OMOP Common Data Model </div></a>
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</div>
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<div id="navbar" class="navbar-collapse collapse">
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<ul class="nav navbar-nav">
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<li>
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<a href="index.html">
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2023-02-08 20:04:22 +00:00
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<span class="fa fa-house"></span>
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2021-09-22 19:39:44 +00:00
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</a>
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</li>
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<li class="dropdown">
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2022-07-27 01:48:28 +00:00
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<a href="#" class="dropdown-toggle" data-toggle="dropdown" role="button" data-bs-toggle="dropdown" aria-expanded="false">
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2022-01-13 18:59:03 +00:00
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<span class="fa fa-landmark"></span>
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2021-09-22 19:39:44 +00:00
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Background
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<span class="caret"></span>
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</a>
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<ul class="dropdown-menu" role="menu">
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<li>
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<a href="background.html">Model Background</a>
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</li>
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<li>
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<a href="cdmRefreshProcess.html">CDM Refresh Process</a>
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</li>
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<li>
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<a href="vocabulary.html">How the Vocabulary is Built</a>
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</li>
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</ul>
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</li>
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<li class="dropdown">
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2022-07-27 01:48:28 +00:00
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<a href="#" class="dropdown-toggle" data-toggle="dropdown" role="button" data-bs-toggle="dropdown" aria-expanded="false">
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2022-01-13 18:59:03 +00:00
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<span class="fa fa-list-alt"></span>
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2021-09-22 19:39:44 +00:00
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Conventions
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2023-02-08 20:04:22 +00:00
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<h1 class="title toc-ignore"><strong>Observation Period Considerations
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for EHR Data</strong></h1>
|
2021-09-22 19:39:44 +00:00
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</div>
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<p><em>By Melanie Philofsky and the EHR Working Group</em></p>
|
2023-02-08 20:04:22 +00:00
|
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<p>The EHR WG convened on July 24, August 7, and August 21, 2020 to
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discuss the creation of an Observation Period from EHR data. The current
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and future conventions are not prescriptive enough and leave room for
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various ways of interpretation. The goals of our discussions were to
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increase the standardization for the implementation of the
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OBSERVATION_PERIOD table by providing some general guidelines for
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determining the start, end, and gaps in Observation Periods. The
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suggestions we came up with are only “suggestions” at this point. More
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research should be done to understand how these choices might impact
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evidence generated using these data. All of these decisions should be
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tempered by local understanding of patients in the EHR you are
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ETLing.</p>
|
2021-09-22 19:39:44 +00:00
|
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<ul>
|
2023-02-08 20:04:22 +00:00
|
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<li><em>Note - These suggestions are not intended for HMO EHR sites
|
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since HMO EHR Observation Periods more closely resemble claims data
|
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Observation Periods.</em></li>
|
2021-09-22 19:39:44 +00:00
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</ul>
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<div id="observation-period-start-date" class="section level2">
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<h2>Observation Period Start Date</h2>
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<ul>
|
2023-02-08 20:04:22 +00:00
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<li>Generally an Observation Period does NOT begin before birth,
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however, it might begin before birth IF the pregnant mother receives
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care recorded in your EHR. The child’s record is then split from the
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mother’s record at birth but may retain care given during pregnancy. For
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these children in your dataset, the field
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<strong>observation_period_start_date should be the birth date minus 9
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months</strong></li>
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<li>An <strong>Observation Period does NOT begin before the
|
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implementation of the EHR at your site</strong>. Any records prior to
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implementation are probably “history of” record types and not a complete
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EHR record of clinical events.</li>
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<li>Special consideration should be given to migration from previous
|
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EHR, implementation at different sites within your healthcare system,
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implementation of different modules, etc.</li>
|
2021-09-22 19:39:44 +00:00
|
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</ul>
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</div>
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<div id="observation-period-end-date" class="section level2">
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<h2>Observation Period end date</h2>
|
2023-02-08 20:04:22 +00:00
|
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<p>Set the <strong>observation_period_end_date</strong> as the first
|
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date from the following:</p>
|
2021-09-22 19:39:44 +00:00
|
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<ul>
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<li><strong>Date of death + 60 days</strong>
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<ul>
|
2023-02-08 20:04:22 +00:00
|
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<li>This is a CDM convention to allow events after death (autopsy, final
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notes, etc).</li>
|
2021-09-22 19:39:44 +00:00
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</ul></li>
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<li><strong>Last clinical event + 60 days</strong>
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<ul>
|
2023-02-08 20:04:22 +00:00
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<li>The assumption is that person will return to the same health
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provider if an adverse reaction/complication/unresolved condition
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occurs.</li>
|
2021-09-22 19:39:44 +00:00
|
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</ul></li>
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<li><strong>Date of the data pull from the system</strong></li>
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</ul>
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</div>
|
2023-02-08 20:04:22 +00:00
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|
<div id="observation-period-gaps-and-persistence-windows"
|
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class="section level2">
|
2021-09-22 19:39:44 +00:00
|
|
|
|
<h2>Observation Period Gaps and Persistence Windows</h2>
|
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|
<div id="observation-period-gaps" class="section level3">
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<h3>Observation Period Gaps</h3>
|
2023-02-08 20:04:22 +00:00
|
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|
<p>Periods of time when a Person does not receive care from your
|
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institution and therefore is not observed and should not have an
|
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Observation Period. These gaps are usually hard to determine because
|
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most Persons don’t announce their departure from an EHR/healthcare
|
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institution. Therefore, a heuristic will need to be instituted to
|
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determine Observation Period Gaps where the information is not
|
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explicit.</p>
|
2021-09-22 19:39:44 +00:00
|
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</div>
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|
|
<div id="observation-period-persistence-window" class="section level3">
|
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|
<h3>Observation Period Persistence Window</h3>
|
2023-02-08 20:04:22 +00:00
|
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|
<p>Defined as the maximum time allowed between two clinical events under
|
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the assumption a Person would have a clinical event recorded, if they
|
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are not healthy and seek care.</p>
|
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<p><strong>Example:</strong> Person 1 has a series of clinical events
|
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|
recorded from <strong>Jan. 1, 2010 to June 15, 2012</strong>, where the
|
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time between clinical events does not exceed 60 days. The next clinical
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event for Person 1 is on <strong>Oct. 1, 2018</strong>. Starting Oct. 1,
|
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|
2018 Person 1 has clinical events occurring at least every 90 days up to
|
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the present date.</p>
|
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|
|
|
<p>There is a 6+ year gap between groups of clinical events recorded in
|
|
|
|
|
|
the CDM. After discussion in the EHR WG, we believe this 6+ year gap is
|
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indicative of a Person not being seen within our EHR/healthcare
|
|
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institution. Per convention #4 for Observation Period table, “As a
|
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|
|
|
general assumption, during an Observation Period any clinical event that
|
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|
happens to the patient is expected to be recorded. Conversely, the
|
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|
absence of data indicates that no clinical events occurred to the
|
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|
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patient.” Person 1 has two Observation Periods.</p>
|
2021-09-22 19:39:44 +00:00
|
|
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|
<p><strong>1st Observation Period</strong></p>
|
|
|
|
|
|
<ul>
|
|
|
|
|
|
<li>observation_period_start_date = <strong>01/01/2010</strong></li>
|
2023-02-08 20:04:22 +00:00
|
|
|
|
<li>observation_period_end_date = <strong>08/15/2012</strong> (Per the
|
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|
end_date guideline above)</li>
|
2021-09-22 19:39:44 +00:00
|
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</ul>
|
|
|
|
|
|
<p><strong>2nd Observation Period</strong></p>
|
|
|
|
|
|
<ul>
|
|
|
|
|
|
<li>observation_period_start_date = <strong>10/01/2018</strong></li>
|
2023-02-08 20:04:22 +00:00
|
|
|
|
<li>observation_period_end_date = <strong>09/01/2020</strong> (Date of
|
|
|
|
|
|
the data pull, per the end_date guideline above)</li>
|
2021-09-22 19:39:44 +00:00
|
|
|
|
</ul>
|
2023-02-08 20:04:22 +00:00
|
|
|
|
<p>Now, there are cases where a Person only receives care within you EHR
|
|
|
|
|
|
system when absolutely necessary. And if your EHR doesn’t offer primary
|
|
|
|
|
|
care services, the majority of Persons who lack healthcare insurance or
|
|
|
|
|
|
any other reason why Persons are only seen in urgent or emergent
|
|
|
|
|
|
situations, the above heuristic might be too restrictive. This is a
|
|
|
|
|
|
guideline. A question the EHR WG debated was how long between clinical
|
|
|
|
|
|
events should we assume any clinical event that happens to the Person is
|
|
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|
|
|
expected to be recorded? When should we end one Observation Period and
|
|
|
|
|
|
begin another? What should be the time between events for an Observation
|
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Period Persistence Window? Wellness checkups/Visits happen approximately
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every 12-18 months depending on a multitude of factors.</p>
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<p><strong>Our recommendation: If Observation Period Gaps are 548 days
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or more, then the previous Observation Period should end and another
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Observation Period should begin on the date of the next clinical event
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as per the Person 1 example above.</strong></p>
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2021-09-22 19:39:44 +00:00
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</div>
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</div>
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<div id="additional-etl-considerations" class="section level2">
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<h2>Additional ETL considerations</h2>
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<ul>
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2023-02-08 20:04:22 +00:00
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<li>Implementation of your EHR, migration from previous EHR,
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implementation at different sites within your healthcare system,
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implementation of different modules</li>
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<li>Coverage of your healthcare system within your area, population
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served by the healthcare system</li>
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<li>All decisions should be tempered by local understanding of patients
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in the EHR you are ETLing.</li>
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2021-09-22 19:39:44 +00:00
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</ul>
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2023-02-08 20:04:22 +00:00
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<p>The Observation Period can be created by only one clinical event.
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However, the clinical event must NOT be from the Death table. If a Death
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date does not have any other clinical records 18 months before AND 18
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months after the death date, then an Observation Period will not be
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created. We believe this logic is needed because if a Person only has a
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death death_date without other clinical event records, a Person is most
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likely not being “observed” when the death occurred. If a Person was
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being observed at their time of death, then other records (visit,
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condition, measurement, etc.) would be created. This rule is most
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relevant for those with death registry data since a Person who dies in
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the hospital has many clinical event records.</p>
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2021-09-22 19:39:44 +00:00
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</div>
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</div>
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<script>
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// add bootstrap table styles to pandoc tables
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function bootstrapStylePandocTables() {
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$('tr.odd').parent('tbody').parent('table').addClass('table table-condensed');
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}
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bootstrapStylePandocTables();
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</script>
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<!-- tabsets -->
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<script>
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$('.tabset-dropdown > .nav-tabs > li').click(function () {
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2022-01-13 18:59:03 +00:00
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2021-09-22 19:39:44 +00:00
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</script>
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