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<h1 class="title toc-ignore"><strong>Observation Period Considerations
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for EHR Data</strong></h1>
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</div>
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<p><em>By Melanie Philofsky and the EHR Working Group</em></p>
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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>
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<ul>
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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>
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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>
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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>
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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>
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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>
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<ul>
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<li><strong>Date of death + 60 days</strong>
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<ul>
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<li>This is a CDM convention to allow events after death (autopsy, final
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notes, etc).</li>
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</ul></li>
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<li><strong>Last clinical event + 60 days</strong>
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<ul>
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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>
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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>
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<div id="observation-period-gaps-and-persistence-windows"
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class="section level2">
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<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>
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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>
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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>
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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>
|
||
<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
|
||
indicative of a Person not being seen within our EHR/healthcare
|
||
institution. Per convention #4 for Observation Period table, “As a
|
||
general assumption, during an Observation Period any clinical event that
|
||
happens to the patient is expected to be recorded. Conversely, the
|
||
absence of data indicates that no clinical events occurred to the
|
||
patient.” Person 1 has two Observation Periods.</p>
|
||
<p><strong>1st Observation Period</strong></p>
|
||
<ul>
|
||
<li>observation_period_start_date = <strong>01/01/2010</strong></li>
|
||
<li>observation_period_end_date = <strong>08/15/2012</strong> (Per the
|
||
end_date guideline above)</li>
|
||
</ul>
|
||
<p><strong>2nd Observation Period</strong></p>
|
||
<ul>
|
||
<li>observation_period_start_date = <strong>10/01/2018</strong></li>
|
||
<li>observation_period_end_date = <strong>09/01/2020</strong> (Date of
|
||
the data pull, per the end_date guideline above)</li>
|
||
</ul>
|
||
<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
|
||
expected to be recorded? When should we end one Observation Period and
|
||
begin another? What should be the time between events for an Observation
|
||
Period Persistence Window? Wellness checkups/Visits happen approximately
|
||
every 12-18 months depending on a multitude of factors.</p>
|
||
<p><strong>Our recommendation: If Observation Period Gaps are 548 days
|
||
or more, then the previous Observation Period should end and another
|
||
Observation Period should begin on the date of the next clinical event
|
||
as per the Person 1 example above.</strong></p>
|
||
</div>
|
||
</div>
|
||
<div id="additional-etl-considerations" class="section level2">
|
||
<h2>Additional ETL considerations</h2>
|
||
<ul>
|
||
<li>Implementation of your EHR, migration from previous EHR,
|
||
implementation at different sites within your healthcare system,
|
||
implementation of different modules</li>
|
||
<li>Coverage of your healthcare system within your area, population
|
||
served by the healthcare system</li>
|
||
<li>All decisions should be tempered by local understanding of patients
|
||
in the EHR you are ETLing.</li>
|
||
</ul>
|
||
<p>The Observation Period can be created by only one clinical event.
|
||
However, the clinical event must NOT be from the Death table. If a Death
|
||
date does not have any other clinical records 18 months before AND 18
|
||
months after the death date, then an Observation Period will not be
|
||
created. We believe this logic is needed because if a Person only has a
|
||
death death_date without other clinical event records, a Person is most
|
||
likely not being “observed” when the death occurred. If a Person was
|
||
being observed at their time of death, then other records (visit,
|
||
condition, measurement, etc.) would be created. This rule is most
|
||
relevant for those with death registry data since a Person who dies in
|
||
the hospital has many clinical event records.</p>
|
||
</div>
|
||
|
||
|
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