COVID-19 Model Attributes First Draft - Please Comment!
Preston Lee
Russ Leftwich
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<CovidModelingDataCompiled_v1-watermark.xlsx>
Mark Kramer
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Radov, Nicholas O
I assume that stage/symptom status of the confirmed case would go in the Condition.stage.summary element but it appears that most of the work done so far on defining an example value set was for oncology. Do you have suggestions on an appropriate SNOMED CT value set for COVID-19 stage/symptom status? There are a variety of different types of “severity” concepts split between findings, assessment scales, observable entities, and qualifier values.
Nick Radov | Director, Interoperability Standards & Compliance
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Carol Macumber
Is there an agreed upon/documented staging for COVID-19? If so we can certainly help identify the appropriate SNOMED codes.
All I could find was a proposed three staging system out of Brigham and Women's Hospital and Harvard Medical: https://www.jhltonline.org/article/S1053-2498(20)31473-X/fulltext?rss=yes
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Preston Lee
Radov, Nicholas O
Thanks for the link. Will it be possible to get an IG build job running soon? That would make it a lot easier for some of us to review the content instead of doing local builds or reviewing source code files on Github.
Nick Radov | Director, Interoperability Standards & Compliance
)+1 612-632-2612 | * nra...@uhc.com | unitedhealthgroup.com
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UNITEDHEALTH GROUP • INTEGRITY • COMPASSION • RELATIONSHIPS • INNOVATION • PERFORMANCE
From: Preston Lee [mailto:pre...@logicahealth.org]
Sent: Monday, March 30, 2020 9:37 AM
To: COVID-19 Interoperability Assets
Cc: cmi...@gmail.com; pre...@logicahealth.org
Subject: Re: COVID-19 Model Attributes First Draft - Please Comment!
Working repo is https://github.com/logicahealth/covid-19
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Mark Kramer
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Kramer, Mark A.
My ID is “markkramerus”
One long string. Thanks autocorrect?
From: Mark Kramer <krame...@gmail.com>
Sent: Monday, March 30, 2020 12:53 PM
To: Radov, Nicholas O <nra...@uhc.com>
Cc: COVID-19 Interoperability Assets <co...@logicahealth.org>; Preston Lee <pre...@logicahealth.org>; cmi...@gmail.com
Subject: [EXT] Re: COVID-19 Model Attributes First Draft - Please Comment!
I will link up autobuild if I can get committer permission. My Git I’d is mark kramer us
On Mon, Mar 30, 2020 at 12:42 PM 'Radov, Nicholas O' via COVID-19 Interoperability Assets <co...@logicahealth.org> wrote:
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Russ Leftwich
Radov, Nicholas O
I don’t have permission to add committers for the FHIR build site. Could you post a request with your username on Zulip chat?
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Riccardo Grandi
does anyone care about the topic?
it would be interesting to study a fhir profile
Riccardo Grandi
Il giorno dom 29 mar 2020 alle ore 23:27 Preston Lee
<pre...@logicahealth.org> ha scritto:
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Stan Huff
This sounds interesting, but I am not sure what you mean by "self-certification to motivate the movements." Can you give a bit more description about how this works? Thanks, Stan
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Subject: Re: COVID-19 Model Attributes First Draft - Please Comment!
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James Tcheng, M.D.
Signs / symptoms:
Lines 15/16 - presence/absence of chills: not a prominent feature of COVID-19, consider removing
Line 42 - general weakness: consider using the term fatigue instead of general weakness, fatigue is a very prominent feature (and is the term typically used in the medical literature)
Consider adding lightheadedness (pre-syncope)
Staging
3 stage system (4 parts to staging) is in the literature - see attached
Stage I: early infection: viral response phase
Stage IIA: pulmonary phase without hypoxia
Stage IIB: pulmonary phase with hypoxia
Stage III: systemic hyperinflammation
Hospitalization assessment - SOFA Score (Sequential Organ Failure Assesment)
SOFA Score: value set 0, 1, 2, 3, 4
Elements
PaO2
FiO2
Platelet count
Bilirubin
Creatinine
Hypotension
Glasgow Coma Score
James Tcheng, M.D.
Yes – that is the staging system that has been proposed. jimmy
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Preston Lee
Russ Leftwich
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James Tcheng, M.D.
Staging is across all manifestations across all body systems of COVID-19 – disease is not limited to pulmonary system. In fact, a fair proportion of the mortality is due to cardiac complications related to an over-exuberant “storm” inflammatory response.
I agree with the need for a COVID disease expression classification (not a pathophysiologic staging system). Starting with Russ’ original suggestion, perhaps something along the lines of the following:
Asymptomatic
Mild symptoms (fever <102.5, URI symptoms)
Moderate (fever >=102.5, fatigue, dyspnea, myalgias, nausea / vomiting / diarrhea)
Hospitalized – not critical
Hospitalized – critical condition
Recovered
From: Russ Leftwich <cmi...@gmail.com>
Sent: Wednesday, April 1, 2020 12:07 PM
To: Preston Lee <pre...@logicahealth.org>
Cc: COVID-19 Interoperability Assets <co...@logicahealth.org>
Subject: Re: COVID-19 Model Attributes First Draft - Please Comment!
This seems to be staging for pulmonary COVID-19 disease and it is hard to align with what we are told is the clinical course of the majority of SARS-CoV2 infections.
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Radov, Nicholas O
From a modeling standpoint it might make sense to place hospitalization (or lack thereof) on a separate axis from clinical disease stage. We should be able to determine if the patient is currently hospitalized based on encounter status and class. But there may be some patients who have severe symptoms but are not yet hospitalized for various reasons.
From: James Tcheng, M.D. [mailto:james....@duke.edu]
Sent: Wednesday, April 1, 2020 9:51 AM
To: Russ Leftwich; Preston Lee
Cc: COVID-19 Interoperability Assets
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