[MT-L] IMO Problem List
Brian....@sih.net
For example:
CQM.AMI.DC Y AMI NQF 0142 ORD Y POM ORD
[f pt prob current]("IMO-PROB-3528")^A,
[f pt prob current]("IMO-PROB-71964")^B,
[f pt prob current]("IMO-PROB-3529")^C,
[f pt prob current]("IMO-PROB-3533")^D,
[f pt prob current]("IMO-PROB-3537")^E,
[f pt prob current]("IMO-PROB-3532")^F,
A!B!C!D!E!F^LIST,
IF{[f pt cur age 2]>18&(LIST) [ord pom]("CQM.AMI.DC",2);
1};
Where can I go to find all IMO-PROB codes for each ICD-9 code? The AMI Aspirin at Discharge rule should look for ICD-9 codes of 410.00, 410.01, 410.10, etc (see list below).
I have tried listing the MIS.NMAP dictionary to a file, and searching it, but there are many of the ICD-9 codes for AMI and Stroke that I couldn't find. It appears that MIS.NMAP gets built as providers select problem descriptions from IMO. The "SAVE" function on the Patient's problem list then adds that IMO-CODE to the MIS.NMAP dictionary.
I believe a rule should include all, or at least the most commonly used IMO codes, so that it gets invoked when the provider selects it. Or Not???
This is what I have started for AMI, but I have seen references to other IMO codes for these ICD-9 codes. I need to do the same thing for Stroke patients' Statin at Discharge.
How are you building your rules to reference the problems? Where are you getting finding the IMO-PROB codes?
Thanks in advance,
Brian
| Table 1.1 Acute Myocardial Infarction (AMI) | |||
|
Code
| ICD-9-CM Description |
Shortened Description
|
IMO Codes
|
|
410.00
| Anterolateral wall, acute myocardial infarction-episode of care unspecified | AMI ANTEROLATERAL,UNSPEC | IMO-PROB-1053843
IMO-PROB-30445 |
|
410.01
| Anterolateral wall, acute myocardial infarction-initial episode | AMI ANTEROLATERAL, INIT | IMO-PROB-1043406
IMO-PROB-21648412 IMO-PROB-29248138 IMO-PROB-30446 |
|
410.10
| Other anterior wall, acute myocardial infarction-episode of care unspecified | AMI ANTERIOR WALL,UNSPEC | IMO-PROB-29240635
IMO-PROB-3529 IMO-PROB-3531 IMO-PROB-3532 IMO-PROB-44037574 IMO-PROB-44414248 IMO-PROB-745443 IMO-PROB-79253 |
|
410.11
| Other anterior wall, acute myocardial infarction-initial episode | AMI ANTERIOR WALL, INIT | IMO-PROB-1043404
IMO-PROB-1585341 IMO-PROB-194836 IMO-PROB-41503698 IMO-PROB-93875 |
|
410.20
| Inferolateral wall, acute myocardial infarction-episode of care unspecified | AMI INFEROLATERAL,UNSPEC | IMO-PROB-1053846
IMO-PROB-29245608 IMO-PROB-30450 IMO-PROB-6315590 |
|
410.21
| Inferolateral wall, acute myocardial infarction-initial episode | AMI INFEROLATERAL, INIT | IMO-PROB-1043408
IMO-PROB-21648657 IMO-PROB-30451 |
|
410.30
| Inferoposterior wall, acute myocardial infarction-episode of care unspecified | AMI INFEROPOST, UNSPEC | IMO-PROB-1053848
IMO-PROB-3536 |
|
410.31
| Inferoposterior wall, acute myocardial infarction-initial episode | AMI INFEROPOST, INITIAL | IMO-PROB-1049818
IMO-PROB-1585209 IMO-PROB-21648504 IMO-PROB-30454 |
|
410.40
| Other inferior wall, acute myocardial infarction-episode of care unspecified | AMI INFERIOR WALL,UNSPEC | IMO-PROB-29241678
IMO-PROB-319218 IMO-PROB-3533 IMO-PROB-745447 |
|
410.41
| Other inferior wall, acute myocardial infarction-initial episode | AMI INFERIOR WALL, INIT | IMO-PROB-1049815
IMO-PROB-194838 IMO-PROB-21648440 IMO-PROB-30457 |
|
410.50
| Other lateral wall, acute myocardial infarction-episode of care unspecified | AMI LATERAL NEC, UNSPEC | IMO-PROB-29242509
IMO-PROB-3537 IMO-PROB-3538 IMO-PROB-3539 IMO-PROB-3540 IMO-PROB-3541 IMO-PROB-79256 |
|
410.51
| Other lateral wall, acute myocardial infarction-initial episode | AMI LATERAL NEC, INITIAL | IMO-PROB-194840
IMO-PROB-21648520 IMO-PROB-30460 |
|
410.60
| True posterior wall, acute myocardial infarction-episode of care unspecified | TRUE POST INFARCT,UNSPEC | IMO-PROB-2030538
IMO-PROB-3543 IMO-PROB-700176 |
|
410.61
| True posterior wall, acute myocardial infarction-initial episode | TRUE POST INFARCT, INIT | IMO-PROB-30463 |
|
410.70
| Subendocardial, acute myocardial infarction-episode of care unspecified | SUBENDO INFARCT, UNSPEC | IMO-PROB-1018507
IMO-PROB-1076014 IMO-PROB-29243260 IMO-PROB-29244550 IMO-PROB-29247726 IMO-PROB-3547 IMO-PROB-44037528 IMO-PROB-44414250 IMO-PROB-514739 IMO-PROB-690715 |
|
410.71
| Subendocardial, acute myocardial infarction-initial episode | SUBENDO INFARCT, INITIAL | IMO-PROB-1047921
IMO-PROB-1047993 IMO-PROB-514735 IMO-PROB-700187 IMO-PROB-703385 |
|
410.80
| Other specified sites, acute myocardial infarction-episode of care unspecified | AMI NEC, UNSPECIFIED | IMO-PROB-1739281
IMO-PROB-27830476 IMO-PROB-30468 IMO-PROB-3472 IMO-PROB-3544 IMO-PROB-3545 IMO-PROB-43842770 IMO-PROB-44037532 IMO-PROB-700280 |
|
410.81
| Other specified sites, acute myocardial infarction-initial episode | AMI NEC, INITIAL | IMO-PROB-1585849
IMO-PROB-30469 |
|
410.90
| Unspecified site, acute myocardial infarction-episode of care unspecified | AMI NOS, UNSPECIFIED | IMO-PROB-1018527
IMO-PROB-1076016 IMO-PROB-1076020 IMO-PROB-1082967 IMO-PROB-1740381 IMO-PROB-1740387 IMO-PROB-3445 IMO-PROB-3528 IMO-PROB-45686 IMO-PROB-50276 IMO-PROB-514066 IMO-PROB-514748 IMO-PROB-71964 IMO-PROB-89896 |
|
410.91
| Unspecified site, acute myocardial infarction-initial episode | AMI NOS, INITIAL | IMO-PROB-15489697
IMO-PROB-194844 IMO-PROB-29245526 IMO-PROB-44414246 IMO-PROB-48666762 IMO-PROB-514749 |
Hefferon, Dennis
Hi, Brian,
An inherent design flaw that we are also battling with. First, some problems are “children” of other problems, so when you add them to a patient problem list, the nomenclature map that populates your Problem Dx is the “parent” (if it isn’t already there). This makes it very hard to correlate the rules in Problem List with the problems you need on your rule. (i.e adding “ST elevation (STEMI) myorcardial infarction” populates the dictionary with “Transmural myocardial infarction.”
Second, the rules work by problem mnemonic, but you only ever have that subset of IMO data in your dictionary that your doctors have ever used before. So, if you put 100 problems on a rule tomorrow, and a doc picks another variation tomorrow, it won’t be included in your rule AND you have no way of being notified that you’re missing something/what you’re missing.
From our MT task we have these references:
1. It is true that the lookups in CS based dictionaries will only show "parent"
IMO nomenclature. FS based searches (ie. Problem List) shows all alias and
parent entries. There is a change either being discussed or in the works to have
both sides display the same search results. I'll try to track down information
on this. While I am not 100% sure it will resolve your issue, it's worth
exploring. I can confirm I've seen this difficulty in tying out the added
problem to the Nomenclature Map Dictionary.
2. I believe the IMO Bundle delivers a DTS where it is now possible to write
rule based orders using Code Sets (ICD-9, ICD-10, etc) instead of the
"IMO-XXX-####" entries. This may alleviate any issues with making use the IMO
Nomenclature is in the Nomenclature Map Dictionary before setting up the rule.
Unfortunately the “bundle” referenced does not include the needed enhancement, so both of these issues remain unaddressed, and serious Achilles’ heels on the ability to write completely reliable rules. As many customers as possible should advocate for enhancements that close these loops.
Good luck to us all!
Dennis Hefferon
Clinical Analyst
CHE Trinity Health, MEDITECH Systems
Suite 415, 5601 N. Dixie Highway, Fort Lauderdale, FL 33334
Office: 954-229-8708 Mobile: 610-608-3705 Fax: 954-267-7055
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Kevin Dorsey-Tyler
What is really needed is some coordination between Meditech, IMO and VSAC. The logical way to do this is to have a keyword that directly references a value set, not individual members of it.
e.g. f current prob vset {value set identifier, code type}
Then you could specify “any ICD-9 code that is in the AMI value set” from one keyword; it would be kept in line with changes and would catch any code that was in the required group, not just a sub-set.
Kevin R. Dorsey-Tyler, M.D., Ph.D.
Medical Director, Clinical Analytics
Enloe Medical Center
Chico, CA, USA
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Acosta, Janie
Hi Brian,
Here is a screen shot of how I built the AMI & Statin rule for discharge.
They both work and function as they should.
I hope these screen prints help.
Janie Acosta
Meditech Support Team Member
IU Health Goshen
200 High Park Avenue
Goshen, Indiana 46526
From: Brian....@sih.net [mailto:Brian....@sih.net]
Sent: Thursday, October 02, 2014 5:08 PM
To: medit...@mtusers.com; CSLis...@SISUnet.org
Subject: IMO Problem List
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Acosta, Janie
Oh and as far as searching for the IMO codes. We are currently on 5.66 pp8 & I searched for the codes through the problem list dictionary. I went through PCM->Dictionaries->Medical Problems->Enter/edit. Search the problem, click Codes, then find the IMO Code.
Thanks, I hope I answered your question.
Janie Acosta
Meditech Support Team Member
IU Health Goshen
200 High Park Avenue
Goshen, Indiana 46526