condi&on’coding’prac&ce’differences’ between’usa,’asiaand ... ·...
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Condi&on Coding Prac&ce Differences Between USA, Asia and Europe:
Preliminary Results from European Birth Season – Disease Risk Study
Mary Regina Boland, MA, MPhil, PhD Assistant Professor of Informa9cs
Department of Biosta&s&cs, Epidemiology & Informa&cs, University of Pennsylvania
Department of Biomedical and Health Informa&cs, Children’s Hospital of Philadelphia
OHDSI
Bethesda, MD October 12, 2018
What Do These Have in Common? V23 Codes
In ICD Terminology
ICD-‐10 ICD-‐9
Difference Based on Version
Hello Magazine Zachar Law Blog
All Terminologies Mapped to SNOMED
Includes Terminologies from Across the Globe
h[ps://confluence.ihtsdotools.org/display/DOCANLYT/5.2+Mapping+Other+Code+Systems+to+SNOMED+CT
Global − SeaWAS Collaborator Sites
Main climateA: equatorialB: aridC: warmD: snowE: polar
Af Am As Aw BSh BSk BWh BWk Cfa Cfb Cfc Csa Csb Csc Cwa
CwcCwb Dfa Dfb Dfc Dfd Dsa Dsb Dsc Dwa Dwb Dwc Dwd EF ET
What Happens When You Add Another Site?
704
354 354
314298
249
193
168155
102 10184 84 81 79 79 75 71 66 62 62
50 4835 34 27 24 23 21 19 19 19 18 16 15 15 14 14 14 11
0
200
400
600
800
Inte
rsec
tion
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Vanderbilt
Taiwan
Seattle
CUMC
MtSinai
Netherlands
Korea
010002000Set Size
Code%Agreement%USA%Sites%(N=354)%
Code%Agreement%All%Sites%(N=71)%
Non:USA%Sites%Tend%to%Be%Singletons%
Differences S&ll Persist Across Sites
Caveats of EHR data
• 4340 unique condi&on concepts were found across 7 sites
• 4238 out of 4340 were mapped to standard terminologies
• We can leverage the concept ancestor: • 243 / 249 unique Netherlands concepts were in the concept ancestor file
Concept Map SNOMED Congenital anomaly of cardiovascular system
Congenital anomaly of cerebrovascular system
Congenital anomaly of pulmonary artery
Patent ductus arteriosus
Congenital anomaly of coronary artery
Ventricular septal defect
Congenital abnormality of cardiac connec&on
Tetralogy of Fallot Congenital insufficiency of
mitral valve Congenital insufficiency of
aor&c valve
Congenital heart disease
0 1
2
3
4 5
Highest Level At Different Sites Congenital anomaly of cardiovascular system
Congenital anomaly of cerebrovascular system
Congenital anomaly of pulmonary artery
Patent ductus arteriosus
Congenital anomaly of coronary artery
Ventricular septal defect
Congenital abnormality of cardiac connec&on
Tetralogy of Fallot Congenital insufficiency of
mitral valve Congenital insufficiency of
aor&c valve
Congenital heart disease
0 1
2
3
4 5
Taipei
Nashville NYC
SeaKle
RoKerdam
Congenital Heart Disease Can Be Rolled Up to Congenital Anomaly
of Cardiovascular System
RoKerdam Only
Some Concepts Can Be Mapped Genuine Stress Incon&nence
0
1 Female Stress Incon&nence
Mixed Urinary Incon&nence
Suwon did not use the term, or it was infrequently used
Nashville Mount Sinai in NYC
SeaKle RoKerdam
Nashville Mount Sinai and Columbia in NYC
SeaKle Taipei
Caveats of EHR data
Max Code Separation from 243 Unique Netherlands Concept IDs
Max Levels of Separation
Freq
uenc
y0 2 4 6 8 10 12
010
0020
0030
0040
0050
00
Min Code Distance for 96 /235 Concepts with a Match at Another Site
Min. Distance to Code Match at Another Site
Freq
uenc
y
1.0 1.5 2.0 2.5 3.0 3.5 4.0
020
4060
8010
0
Most codes can be mapped within 2 levels of hierarchy!
Two Degrees of Separa&on Congenital anomaly of cardiovascular system
Congenital anomaly of cerebrovascular system
Congenital anomaly of pulmonary artery Congenital heart disease
0 1
2 Taipei
Nashville NYC
SeaKle
RoKerdam
Concluding Remarks
• Many concepts can be mapped within 2 degrees of separa9on within the concept hierarchy
• Must be careful that the correct clinical meaning is preserved before merging concepts
• Unfortunately this requires a lot of manual review due to inconsistencies in seman&cs within the hierarchy
Summary of Relevant Studies • MR Boland, MS Kraus, E Dziuk, AR Gelzer. Inves&ga&ng Cardiovascular Disease – Birth Month Associa&ons in Canines: A Model Organism for Human Heart Disease. Scien&fic Reports; 2018; 8:7130.
• MR Boland, P Parhi, R Mio[o, R Carroll, U Iqbal, P-‐A Nguyen, M Schuemie, SC You, D Smith, S Mooney, P Ryan, Y-‐C Li, RW Park, J Denny, JT Dudley, G Hripcsak, P Gen&ne, NP Tatonen. Uncovering Exposures Responsible for Birth Season – Disease Effects: A Global Study. J Am Med Inform Assoc. 2018; 25(3):275-‐288.
• MR Boland, P Parhi, P Gen&ne, NP Tatonen. Climate Classifica&on is an Important Factor in Assessing Quality-‐of-‐Care Across Hospitals. Scien&fic Reports. 2017; 7:4948.
• L Li*, MR Boland*, R Mio[o*, NP Tatonen, J Dudley. Replica&ng Cardiovascular Condi&on-‐Birth Month Associa&ons. Scien&fic Reports. 2016 ; 6: 33166. *Equal-‐Contribu&on
• MR Boland, Z Shahn, D Madigan, G Hripcsak, NP Tatonen. Birth Month Affects Life&me Disease Risk: A Phenome-‐Wide Method. J Am Med Inform Assoc. 2015; 22(5):1042-‐53.
Dataset Acknowledgments Columbia University: Andrew Gelman, Pradipta Parhi, Fernanda Polubriaginof, Zachary Shahn, David Madigan, George Hripcsak, Pierre Gen&ne, Nicholas P Tatonen Mt Sinai: Li Li, Riccardo Mio[o, Brian Kidd, Joel Dudley Vanderbilt University: Robert Carroll, Josh Denny University of Washington: Don Smith, Sean Mooney Taipei Medical University: Usman Iqbal, Alex Nguyen, Mar&jn Schuemie, Jack Li Ajou University School of Medicine: Seng Chan You, Rae Woong Park OHDSI: Patrick Ryan
Co-‐Authors on This Work
Luis H. John, MSc Erasmus University Medical Center,
Ro[erdam, The Netherlands
Peter R. Rijnbeek, PhD Erasmus University Medical Center,
Ro[erdam, The Netherlands
Ray Bai, PhD Postdoctoral Scien&st
(Joint with Dr. Yong Chen)
Aditya Kashyap Masters Student Data Science
Caroline DeVoto Summer Intern Mathema&cs
Mary Regina Boland, MA, MPhil, PhD Assistant Professor of Informa&cs
Ques&ons? Mary Regina Boland, PhD [email protected]
Twi[er: @MaryRBoland Boland Lab Website:
www.fer9lityandhealthinforma9cslab.org www.med.upenn.edu/bolandlab