Special Topics - Clinical Looking Glass from Montefiore Medical
Contents
1. EventCollection All of V Any Root Operator Event discharges Update J Event First Admit post discharges 10 Edit Selected Condition ooo EventCollection All of Event discharges V Root Operator Update Update and close The event canvas would have looked like this Di soc Done ZJZ3X35 Name Dc2010AgeGe65 rt fa Event Canvas g Ec JB INDEX EVENT And free ice discharges All of discharges InpatientDischargeDate WHEN IN 2010 WITH age ge 65 Now build N 6 200 There were 6 200 admissions of 65 year olds or older who had a subsequent admission within 30 days of the discharge The result is N This is the number of discharges in 2010 that have a repeat admission within 30 days When you browse this event collection you will see the details of those discharges 11 If instead you want to browse the information on those hospitalizations that occurred within 30 days of the previous discharge then you have to edit the Index event line and point to the First admit post discharge line rebuild the event collection and then browse the rebuilt event collection Any Pl Edit Selected Condition f i Event discharges EventCollection All of wai Event First Admit post discharge RS CES HEEKEXENIN Root Operator ER On IzJl2 xI gt j jEejU i j j j j j je Name D2. Lele Event Canvas Name New EventCollection c46d 2 _c_DJBUSR Unique patients inpatient outpt or ED 2013 Cc B USR Unique patients inpatient outpt 2013 a j r E blood pressure E CEC_JN INDEX EVENT All of Any And J USR bp systolic last 2013 JEW Eventi All of WHEN IN 3 o New Folder A D Training Cohorts Class 1_2 nO Event Collection l 1 EC NN USR New EventCollection c46d 4 F eo Pnel sonia B Cc B USR Pneumonia 2010 Male discharge dc alive Cc J USR Pneumonia 2010 Female discharge dc alive Cc J USR Pneumonia 2010 Female admits dc alive c B USR Pneumonia 2010 Male admits dc alive SA Diabetics i Cc D USR BadDiabetic_Pointing to Original Value CEB usr BadDiabetic fa Ect Selected Condition asa CC B USR Diabetic 4 Tu cna CI NOT AE Vj hew Ben Def V ChfFourGroupsDischarge c B USR ChfMale6GE75_2012 WHEN IN WITH CE Buse chfFemale66E75_2012 __ update ___ Cose a m 8 gt i 1 on the management pane you see an event collection appear in yellow Note the EC as opposed to the C of the cohort 2 a place appears that allows you to enter the name of the event collection 3 the skeleton of the Event collection appears in the event canvas Note the word all in the index event line This is the feature that distinguishes the event collection from cohort 4 The GUI Editor Edit selected
3. To Simple Available Attributes Selected Attributes G 0 1 GroupNo 4 0 0 Common Event Attributes 0 0 1 EventName 5 D 1 PatientID 0 0 2 EventDateTime f D 2 MRN 0 0 3 EventID 0 1 1 4 EventDateTime 0 0 4 EventType Remove from selected attributes Bring count to selected attributes You must remove any variable from outcome event discharges that have a multiplicity Count is a singleton and can be shown in the wide view The Event Date Time for each admission is a multiplicity and if kept in the selected attributes would require the use of long view 4 0 1 DischargesAll0_180dBefore X 4 AR 0 1 1 Discharges 0 1 1 1 Count Outcomes Demographics Group 0 1 1 2 EventType 0 1 1 3 EventID ___ The result of these moves is 42 View Wide Long n Selected Attributes Attributes G 0 1 GroupNo D 1 PatientID D 2 MRN 0 1 1 1 Count You will now have a spreadsheet with one column for the outcome variable admission and that will be the count of the preceding discharges in the preceding 180 days Do the same for ED triage View Wide Long n Available Attributes Selected Attributes gt 0 0 Common Event Attributes G 0 1 GroupNo gt B 0 1 DischargesAllO_180dBefore D 1 PatientID 4 4 0 2 EDAIIO_180dBefore D 2 MRN 4 BR 0 2 1 ED G 0 3 EventDateTime 0 2 1 1 Coun 0 1 1 1 Count
4. 0 2 1 2 EventID 0 2 1 4 EventDateTime 0 2 1 3 EventType 0 2 1 20 Disposition 0 2 1 4 EventDateTime Outcomes Demographics Group 0 2 1 5 EventName 0 2 1 6 End EventDateTime Bring over this singleton for display 0 2 1 7 Arrival Mode Remove the multiplicities from the outcomes which include both EventDateTime and Disposition id E G 0 1 Groupo j D 1 PatientID M p 2 MRN G 0 3 EventDateTime 0 1 1 1 Count 0 2 1 1 Count Resulting in View Wide Long a Selected Attributes Attributes G 0 1 GroupNo f D 1 PatientID f D 2 MRN 6 0 3 EventDateTime 0 1 1 1 Count 0 2 1 1 Count Now run in wide view 44 DischargesAllO_180dBefore Discharges Analysis Instance Count EDAIIO_180dBefore ED Analysis Instance Count jb N O O e O O ON O i e O OOOO ek k OC fF Now you have a column count for the number of preceding hospitalizations and the number of preceding ED visits that did not result in an admission We have answered a practical risk factor for readmission question by getting this baseline information We were able to use a wide view because all of the attributes in the outcome events were singleton We did not bring over any dates or individual values just the overall summary count 45 Use of Box for Security Box creates a virtual drive on your computer In the configuration we have prepared for you no inf
5. 2010 that had another hospital admission within a year If we record the mrn of each of these hospital admission we may find that some people are represented more than once i e the patient was admitted then readmitted and then readmitted again all within the span of one year The second admission would qualify the first for inclusion and the third admission would qualify the second for inclusion A collection of medical record numbers where the medical record numbers are not unique is called an event collection You build an event collection when you are interested in events not in unique individuals but you still need the mrn to force the events to have a natural relationship to other events i e only events belonging to the same person can be used to qualify events for inclusion in the event collection First let us build all hospital discharges for males older than age 65 This is relatively simple You have in the past learned how to build the first earliest discharge the only difference now is that instead of building a cohort your are building an event collection Instead of choosing earliest in the index event line you choose all Let s go through the steps 1 First create an event collection Training Cohorts Class 1_2 i B Event Colles We Mie mcm xt NRA l KRALL An event collection opens up on the event canvas A Management P_ A Edit Selected Selected O Save As
6. After Index Date _ Cohort End Date r Calendar Start Date E o alendar End Date OoOO Tv C Include Left Endpoint C Include Right Endpoint Event Type Inpatient Visits Outpatient Visits Emergency Room Visits 4 Calculator Spreadsheet O csv File Charison Charlson Detail O Elixhauser AHRQ Web Elixhauser AHRQ Web Detail O Labs Non Lab Covariate A B D F G H l J K L M 1 2 2 3 Comorbidity II applies the methodology of the comorbidity report to a patient s experience across a duration which 4 might include many hospitalizations clnic visits and procedures F Comorbidity applied the methodology only to the hospitalization related to the index date The Charlson comorbidity score and the Elixhauser ICD 9 summary technique have not been validated when used this way but do pass the test of clinical reasonableness 2 Lab Covariates and Non Lab Covariates summarize the duration interval as well providing the first last highest 3 lowest value for each covariate in the interval 4 5 i 6 Define Patients 7 Select a Cohort 8 Select Cohort USR Pneumonia 2010 Female admits dc alive E 9 0 Details 1 Cohort 2 Header 3 j Pneumonia 2010 Female 4 zn admits dc alive 5 Last Saved 3 26 2015 10 27 48 PM R User Bellin7 Eran T Summary Comorbidity MultiplePage1 and now look at spreadsheet 26 X Y Z AA AB AC Moderate or Severe Liver Disease Meta
7. Criteria Methods fre ne Index Event Detail i Sir Show Labs i Show Medications H E CLG Admin Reports E a Ad Hoc Reports 3 LT ACE ARB Failure i Sir ACE ARBFailureSecond i E Antibiogram a Birth Report E Cardiac Cath ia Cardiac Echo F R E Cho bi Report Viewer i i E Comorbidity2 i Sir Consultation Report i Sir Continuity of Care i z3 DiabetesPhysPerformance f z Geocoding sy 20 CIG C1G Smart Reports E SReports List S Reports List H O CLG Reports O CLG Admin Reports C Ad Hoc Reports H E CLG Reports H O CLG Admin Reports E C Ad Hoc Reports E ACE ARB Failure 88 ACE ARBFailureSecond Sir Antibiogram L E Birth Report Sir Cardiac Cath Si Cardiac Echo Sir Comorbidity 3 Comorbidity2 za Consultation Report Sir Continuity of Care ir DiabetesPhysPerformance 1H Diagnosis Summary j za Geocoding E HIV Registry Infection Exposure H FM os oe a Smart Reports Diagnosis Summary E ACE ARB Failure H Ba ACE ARBFailureSecond LED Antibiogram 83 Birth Report Cardiac Cath 0 Cardiac Echo E Comorbidity E comorbidity2 Consultation Report i 2 Continuity of Care j U DiabetesPhysPerformance Diagnosis Summary ie Geocoding E HIV Registry Ha Infection Exposure Diagnosis Summary Criteria Summary it Methods Define Patients Select a Cohort O Select an Event Collection O Index Event O Follow u
8. PHQ2 CEMR XVI Findings Type Equal PHQ 9 SCORE CEMR DEPRESSION SCREENING PHQ9 CEMR DEVICE TEMPERATURE C DEXTROSE STICK Diabetic Eye Exam CEMR Diabetic Foot Check CEMR Diastolic Blood Pressure Diastolic Blood Pressure Initial DIASTOLIC PA DILATION DILTIAZEM MG HR DILTIAZEM ML HR DOBUTAMINE MCG KG MIN DOBUTAMINE MUHR CI NOT Findings Type v DOPAMINE ML DOPAMINE DRIP MCG KG MIN Update ie DRIP 3 Edit Options a Name pha2 HEZE update and Close close Event Definition Options El Definition i x y Findings Type Equal DEPRESSION SCREENING PHQ2 CEMR With a final result on the event canvas of F Mere BUILD C Save As Ci X Xe Name phq2 in January 2014 lo 2220 EC JS INDEX EVENT All of Any And e ale phq All of phq2 FindingDate WHEN IN January 2014 37 N 17 532 So there were 17 352 times that a screening phq2 was used in the month of January Notice how idiosyncratic phq2 and phq9 is Notice how differently they are named in the system One begins pha 9 and the other begins as Depression Screening PHQ2 Exercise 1 Look for Apache Scores Where will you find them 2 Look for blood pressure 38 Upload cohort Tutorial 33 Upload Cohort https www vyoutube com watch Pv ubnZoAgx6A8 When you have a list of medical record numbers and index dates and want to enroll this list as a cohort or event collect
9. WITH age ge 65 Loe inpatient admit Earliest of inaptient admit InpatientAdmissionDate within 0 to 30 Days After Event Discharges Alive e CLG Message Box Webpage Dialog x https clg emerginghealthit com CLGNET Modules MessageBox M N 12 420 But what is this 12 420 When you had a cohort it was really simple The 12 420 would have been unique people and those people identified by the condition line to which the index event line pointed In the event collection we have an index line that points to All of Any This means that it is counting the mrn date time of condition line one discharges and condition line 2 First admit post discharge If you wanted only the hospitalizations that had a subsequent readmission in 30 days then you should have had your index event line pointing to the first line discharges These are the discharges that had a readmit in 30 days To achieve this hover over the Index event line and right click El EC 8 INDEX EVENT All of Any Ang fee face discharges All of disct menu appears choose edit left click edit A gui editor for the index event line appears below the event canvas M Edit Selected Condition _ h qg_j C EveniCollection arsr vja M Root Operator RS CCS HEEKEZ Now modify the all of any to be all of discharges ERS Peete Irene ns I
10. condition appears below the event canvas to allow you to enter the criteria that will be painted on the event canvas This is exactly the same gui editor as you saw in the cohort building process with the same capabilities except in the Event Collection the index event line is allowed all in addition to earliest and latest while in the cohort build the Index Event line is only allowed earliest or latest In the cohort build the Index Event line forces a singularity of result per mrn by allowing only earliest or latest While the condition lines on the canvas can be all earliest or latest it is the Index Event line that has the restriction It is the index event line that enforces the singularity the uniqueness of mrn in the resulting group To restate and amplify e Both cohorts and Event Collections are groups of mrn date time combinations e Both cohorts and event collections are qualified by events related to each other through temporal rules and logical and or and subgroups e A group called a cohort has an mrn only once e A group called an event collection can have the same mrn multiple times What is unique in the event collection is not the mrn but rather the mrn date time combination The dyad of MRN and date time is unique in the event collection Let s continue our build 2 Name the event collection Dc2010AgeGe65 3 Build the event collection a Event discharges i Disch
11. sure only to allow the count to be brought into the selected attributes The same is true of number of ED visits without a disposition admission in the past 180 days Details follow First select the two groups of admissions with pneumonia and create two AD s one for the preceding discharges and one for the preceding Emergency Department without admission visits AD for all preceding discharges Al Edit Selected Condition INOT Discharges InpatientDischargeDate Y WITHIN E TO Update 40 A Analysis Canvas ooo E AD DischargesAll0_180dBefore All of Any And L er re ey Discharges All of Discharges InpatientDischargeDate within 0 to 180 Days Before Cohort Collection Date Now we also want an AD with ED triage but disposition not admit Name EDiiage Event Type ED Triage vl Event Definition Options EE Definition k Undefined Condition MINOT Disposiion VI V mpatenAdmssion v Update L NOT All of EDtriage ErTriagedDate Y WITHIN 0______ To Cohort Collection Date V Please Select an Event Definition AT C Save As mi g x x Name EDAIIO_180dBefore E AD EDAIIO_180dBefore All of Any And Ler ey ED All of EDtriage ErTriagedDate within 0 to 180 Days Before Cohort Collection Date Trente Analysis definition USR DischargesAll0_180dBefore j Start Blackout 0 Days
12. 02 12 40 PME 3 19 04 8 34 Ph 2 11 02 9 36 AM 12 13 04 11 19 AM 4 14 06 12 00 PM 2 13 04 6 28 mn ad 7 11 03 8 30 AM 6 28 05 2 25 P K move column b data to column c when column c Is 6 26 02 1 04 PM Select the whole range of Column C Press control G goto Press button Special Press K blanks or select blank from the radial buttons Press Enter OK Press the equals sign Press the left arrow on the keyboard TT m m gg 06 B gt Press control enter The effect is that all the cells in column C that were blank are filled with the value in column B You will have formulas in column C but text values that you can save as a csv 7 Review how to use Pivot Table capability of Excel 51 Common CLG Error Message Custom Exception Handler This is acommon server error that you may come across during use of CLG Lacegtion of type DE Com nen maption tandler Cestembacagtioniandier Certom xap koe wen thrown Wetoege sog Te gt era nent lt cew NETTI v ley eyt erver Error in CLGNET Application ception of type EMIT CommonExceptionHandier CustomExceptionHandlier CustomException An eanset a CAEN occ ed durg Pe eect pt Current Custestaception Exception of type EMIT CommonEncept lontendler Custostacept lootandler Custoetaception was three EMIT Qutcomes CLG CLGAps Controller CLGPage SavePageStateToPers istencetediue Object wlewState 765 Syston Wed Ul Page
13. Attributes Last IOUOUL dle ITU of 4 Last logout time 03 29 PM Search Events and Attributes CG search O EEE Type in depression Search Events and Attributes 33 Now left click on Go Sg depression v Death In House Death Date Search v Cause of Death a Cardiac Arrest CAD HTN HLD Depression GERD Aortic Aneurysm Cardiopulmonary Arrest CHF EHTN Depression Anxiety COPD Kun eens Cardiopulmonary Arrest UTI Escherichia Coli HTN DM Depression Complications of Alzheimer s Disease CHF PUD HTN Depression Hemorrhagic Stroke EHTN Dementia Depression Prior Hx of Stroke Hodgkin Lymphoma NIDDM HTN Coronary Disease Depression Metastatic small cell lung cancer major depression COPD Respiratory Depression Left Lower Lobe Pneumonia Ruptic Aortic Aneurysm Essential Hypertension Depression Notice how anything with depression in it the values in a categoric field the values in a finding type the title of an event will be returned to you Left click on downward arrows to minimize those results you do not want to see 34 Search n v Death In House Death Date Search Cause of Death v Findings Events and Attributes the vertical arrow is now horizontal showing that data is hidden Findings Text Matching search 122 Ren v Findings Type DEPRESSION SCREENING PHQ2 CEMR DEPRESSION SCREENING PHQ9 CEMR v Problem List Close Date we see some
14. CLINICAL LOOKING GLAS S Special Topics Version 30 Eran Bellin M D 11 18 2015 Contents _z zzww wwwrwvrw wrl gt eor gt gt gt s J x e_ gge eeTerer erer zz J a sn 3 REVIEW AN IE COS a a eros ean veer eee O 3 EV EET COSC CIO Ii ae do Cote tie do te de 4 How to convert a cohort to an Event Collection 13 U seT l TrlCck MIS Warning nee Welakin ae ed ee de D ee du 13 Time in Range The third Analytic Pattern in Study Designer 18 How to summarize values in a continuous variable drawn repeatedly in the course of clinical care 18 Find All the hospitalizations ED visits and Outpatient Visits in a temporal window post index 20 Use smart Report Diagnosis SUMIMALY ccsccsseccssccseccseccseccseccseecseccaeetseecseeteeteetseeseetseeseeeseesseetseeses 20 SAT REDONNER Gl BB ee E ee a 24 Comorbidity 2 Charlson extension cccccccccsssseccccccesseccccceeseccceceesecccssueeeceseesuenseeeessugeeesseseugeeeeeesegenes 25 Adjust for Severity using administrative data collected over a prolonged time 25 TO Seal CIA rie a a ba ad a ee E et ne ue 28 use video and reference manual A kk keke kek kek KK KK ERKA K KAKA KAKA KAK KAK KAKA KAWA 28 VEL SOJ CIN 0 5144455154411350 A ps NA KEJE WR RIKA eW DN cas AK K NEN K dus BN We WENE Kek b e W N AN K ENA NW a E H e K SA 33 Which event do want to use to answer m
15. DEX EVENT All of Any And Sue discharges All of discharges InpatientDischargeDate WHEN IN 2010 WITH age ge 65 H H yer Eventi New Event Definition within 0 to 0 select time units select time direction New Abstract Event Definition remm INOT WITHIN O Tto o Days ____v 5 Putin the requirements a Name the condition line First Admit post dischargeNew Event Definiiton Inpatient admit b Change the all in the gui to earliest as want the first readmission not all the downstream readmissions c Within 0 to 30 days The gui editor now looks like this memes BUILD Jsaveas HlIRI X X Name Dc2010AgeGe65 g EC J INDEX EVENT All of Any And alee discharges All of discharges InpatientDischargeDate WHEN IN 2010 WITH age ge 65 han yer Eventi New Event Definition within 0 to 0 select time units select time direction New Abstract Event Definition Edit Selected Condition NOT Inpatient Admit InpatientAdmissionDate Y WITHIN O ss TO 30_ Days After Event discharges Ge Now Update and Close and the conditions in the GUI editor are painted onto the Event Canvas Edit Selected BUILD l Save As amp J X X Name Discharges2010AliveGe65 EC J INDEX EVENT All of Any And Sue Discharges Alive All of Discharges Alive InpatientDischargeDate WHEN IN 2010
16. SevedllState 1158 Syston Wed Ul Page ProcessfequestMain Boolean includeStagetBeforedsyncPoint Boolean includeStagesAfterdsyncPoint 4350 ve Information Merceot NET armes Vereen 40 078 ASP ET versa SOOTE MOP Clearing the Internet Explorer cache and deleting all Internet Explorer browsing history is sometimes sufficient in eliminating the error To do this close out of the current CLG session and any open IE webpages Re open internet explorer and left click on the gear button on the upper right corner of your screen 52 File b Zoom 90 Safety D I Add site to Start menu View downloads Ctrl J Manage add ons F12 Developer Tools Go to pinned sites Compatibility View settings Report website problems Internet options About Internet Explore Left click on Internet options An Internet Option palette opens 53 To create home page tabs type each address on its own ine http intranet amp Browsing history a5 Delete temporary files history 1 and web form information F Delete browsing history on exit Search Change seta Fi Tak gt q h h J T h 7 7_7 k Fi Change how webpages are displayed in Appearance Click on the General tab in Internet options and click Delete The following palette opens up Delete Browsi
17. T All of Any And free EG Pancreatic Cancer All of orders with text Pancreatic Ca OrdersWithText WHEN IN 2014 29 N 4 513 Please note this function is very literal If the text had Pancreatic Ca instead of Pancreatic Cancer it would have been ignored Now browse the event collection and make sure to check off Order Type Browse J Output Type List Y List Type Wide File Type Excel 2003 Demographics Attributes Y Select Analysis Definition optional Please Select an Analysis X Pancreatic Cancer Description Select Events and Attributes x y EventName x y EventType x y Order Account Type y order Facility x y order Note x y Order Provider vi P he Pn bet i Open up excel and insert Pivot table focused on Oder types want to know what sort of texts at Montefiore had the word Pancreatic Cancerinit 30 Name G n Created By ebellin7 i Modified On 2015 05 05T20 34 00 Number of Records R ee Modifed By ebelin7 Created O Built n 2015 05 05T20 34 00 INDEX EVENT All Of Any EM Pancreatic Cancer All Of orders with text Pancreatic Ca OrdersWithText WHEN IN 20 4 Definitions list orders with text Pancreatic Ca OrdersWithText All a Event Type Orders WithText Order Note Contains Pancreatic Cancer StartDate 01 01 2014 12 00 AM EndDate 01 01 2015 12 00 AM Start Date Incl
18. arged alive meaning disposition not equal to expired b Duration 1 1 10 1 1 11 not included on right c Age gt 65 The gui editor now looks like this Cm O NOT All of Vv discharges InpatientDischargeDate W WHEN IN 2010 v WITH agege 65 v Update When you update and close the event canvas looks like this FST su n save as EEx x jka Name Dc2010AgeGe65 Retain the all in l the index event line E EC x INDEX EVENT All of Any And Been Saale discharges All of discharges InpatientDischargeDate WHEN IN 2010 WITH age ge 65 a Retain the index event line as all this is what makes this group an event collection We will now get all the hospital admissions in the year 2010 of people aged 65 or greater N 28 959 admissions discharged alive Now we want to know how many of these admissions in 2010 actually had a readmission 30 days after the first You know how to do this You use a within condition demanding that there is another admission within 0 to 30 days of the discharge The steps follow 1 Hover over the index event line 2 Right click to get the menu 3 Left click on add condition within A Event Canvas EF INDEX EVENT All of An LEC y When In m Si discharges All of dischal ai ca VITH age ge 65 Sub Group axa U 4 This now results in the following on the event canvas and gui editor below rt cor EC JS IN
19. c2010AgeGe65 E ay CES INDEX EVENT All of Fst Admit post discharge And ok discharges AlMof discharges InpatientDischargeDate WHEN IN 2010 WITH age ge 65 l re First Admit post discharge Earliest of Inpatient Admit InpatientAdmissionDate within 0 to 30 Days After Event discharges Resulting in at build N 6 200 the same number as before but now we are pointing to the First admit post discharge and when you browse this group you will get information on the readmission not the original admission Event collections answer different questions from the cohorts You must be careful to understand what your index event line is pointing to and what it is actually counting 12 How to convert a cohort to an Event Collection Useful Trick with a warning Suppose you start with a familiar cohort RMC sevens ex Name Pneumonia 2010 Male admits dc alive J INDEX EVENT Earliest of Any And a Fige admits All of Pneumonia InpatientAdmissionDate WHEN IN 2010 WITH Male This is a cohort so we have the first admission per patient with each patient only admitted once Suppose we wanted to look at all the Male pneumonia patients in 2010 where the patient was discharged alive How can we convert this cohort Earliest of Any into an All Of course we could always build the event collection from scratch But you can not change the index line from earl
20. discharge dc alive Use admit Lc B USR Pneumonia 2010 Male discharge dc alive Use admit beens c J USR Pneumonia 2010 Male discharge dc alive oo Jj USR Pneumonia 2010 Female discharge dc alive Popo _e B USR Pneumonia 2010 Female admits dc alive ir ps Lec li USR Pneumonia 2010 Male admits dc alive310b owe 2 Bere w c D USR Pneumonia 2010 Male admits de alive H D Diabetics A Management FTFE__ gt T5s5as 5 T T T _ 15 Notice how the Event Collection object is yellow in the management pane Ec P USR Pneumonia 2010 Male admits dc alive310b F Le Let s edit the Event Collection and see what it looks like Edit Selected BUILD LI Save As Bl R x x Name Pneumonia 2010 Male admits dc alive310b E _EC JS INDEX EVENT All of Any And baw ale admits All of Pneumonia InpatientAdmissionDate WHEN IN 2010 WITH Male Warning Make sure the first condition line says All The Copy to Event Collection command only alters the Index Event Line If the first condition line says Earliest or Latest you will have to manually alter it Notice how the index event line now says all Left click on build The EC is now green CEC_BJUSR Pneumonia 2010 Male admits dc alive310b 16 The original cohort had 762 people So this means in 2010 there were 762 unique males who were admitted with pneum
21. e hospitalization and produces from its administrative data diagnoses a Charlson comorbidity score called combined which includes age and prediction of 10 year mortality Video Read in User Manual Ad hoc Reports Chapter 11 Comorbidity Sickliness Adjustment Pp 123 145 24 Comorbidity 2 Charlson extension Adjust for Severity using administrative data collected over a prolonged time See video un 3 2 Le LS DURS Se eee 4 Pr CiG Smart Reports E fiReports List Criteria Summary Methods CLG Reports Si ED Returns Si Follow Up Encounter Detail Sir Index Event Detail Sir Show Labs as Show Medications 5 2 CLG Admin Reports x E Da Ad Hoc Reports i LT ACE ARB Failure TA ACE ARBFailureSecond Sir Antibiogram ee Birth Report cardiac Cath ee RC SSE Fo nr aT i ia Cardiac Ech HER Ez NENN Report Viewer i HE Comorbidity 3 Comorbidity ion a ew port Create a Charlson Score looking back 180 days prior to the index Use the pneumonia cohort and go back 180 days to capture the preceding diagnoses from the index date going back Use Hospital ED and outpatient visits as source of diagnoses 25 Criteria Summary Methods Define Patients Select a Cohort O Select an Event Collection Select Cohort USR Pneumonia 2010 Female admits dc alive E Risk Window 180 O After Index Date Before Index Date O Before and
22. efore you submit your final application Each request is assigned a particular associate and you deal with that associate directly 4 The CLG trainer can provide a sample application successfully completed by an Einstein Colleague for reference 5 They have a Routine query death yes no and date of death and a NDI Plus query includes cause of death and a copy of death certificate if required 6 Send an encrypted CD with patient identifiers via overnight mail to CDC 7 The tricky part is when you get back your results Depending on how many identifiers you send them they send back results on possible matches suggest sending as many identifiers as possible First and Last name with date of birth is a must SSN is highly advised Rest are sex state of residence marital status father s last name for women etc Note Social Security number is not available through Clinical Looking Glass even with identifier privilege 8 If you send fewer identifiers they send a long list of matches for each individual patient and it might get tricky to identify the exact match For eg John Doe born on 01 01 1950 might have 20 possible matches in the NDI database But John Doe born on 01 01 1950 residing in NY might have only 4 and with SSN it might come down to only 1 Plus the results are sent back in a notepad free text format and they highly recommend using SAS to write a program to get your proper matches which did as well 9 If you a
23. iest to all So I will now show you how to change the cohort object into an event collection object Go to the management pane hover over the cohort and right click to obtain the menu and left click on Copy to Event Collection 13 l oe Event Collection EC J USR Dc2010AgeGe65 8 Pneumonia ec USR Pneumonia 2010 Male discharge 7 J USR Pneumonia 2010 Female discha cB USR Pneumonia 2010 Male discharge Browse J USR Pneumonia 2010 Male discharge J USR Pneumonia 2010 Female discha cB USR Pneumonia 2010 Female admits PUSR Pneumonia 2010 Male admits de View Summary Left click on Copy to Event Collection The event collection appears in the management pane with the prefix EC Note all that has happened is that the event collection rules have been built The actual event collection itself made up of medical records numbers has not yet been built as you can see the mrn number is zero Type 7 status fo kurs kr Senin ESS Le B USR macrolide gt 65n c B USR gatifloxacin gt 65n test oO Rhematoid Arthritis fossa EC j USR RheumatoidArthritisAdmissions de Cc D USR RheumatoidArthritisPatientsAdmit09 S Le TDiabetes E e B USR Bad Diabetes With RepeatHgbAic c J USR Bad Diabetes A r Event Collection EC JB USR Dc2010AgeGe65 oF Le Pneumonia a Ec j USR Pneumonia 2010 Male discharge dc alive8fd3 Ce J USR Pneumonia 2010 Female
24. ion in CLG you will use this feature See video 39 Tutorial 35 Counting Previous Hospitalizations in Wide List View How to turn a multiplicity into a singularity using only the count attribute and no other fields from an Analysis Definition using All https www youtube com watch Pv EoM7XXaeWBY amp list PLf7raPnmlILOeAWU2cNf2jIMDRqQuUTCum amp index 32 In a previous tutorial pointed out that whenever you use in list method All you must choose the long view to review the results in a spreadsheet There is one exception If you restrict yourself to using only the count variable from the Analysis Definition AD with All the count is functionally a singularity and can be used in the wide view Warning You must be extremely careful You must eliminate from the selected AD with all any variable other than count If for example you choose or retain event date time then every instance of the event will generate another column with the event s date Remember if one person has 100 dates everyone in the spreadsheet will have 100 columns for date The use of AD with all as a singularity is useful when it is the count that you actually care about For example if you are looking at the pneumonia patients and you want to know how many previous hospital discharges were experience by the patients in the preceding 180 days What you are looking for is just the count and the wide view is perfectly appropriate if you make
25. ng History Keep cookies and temporary Internet files that enable your favorite websites to retain preferences and display faster Copies of es images and media that are saved for faster S your computer by websites to save preferences such as login information sites you have visited ist of files you have downloaded ewe BN that you have typed into forms Passwords Saved passwords that are automatically filled in when you sign in to a website you ve previously visited _ ActiveX Filtering and Tracking Protection data A list of websites exduded from filtering and data used by tn Protection to detect where websites might be auto details about your visit About deleting browsing history The options highlighted are ones that you might want to have checked Click delete Make sure that you close out of ALL Internet Explorer windows Open a new Internet Explorer window login to CLG Restart your computer if the same error message appears during your next session in CLG 55 Browser Compatibility Restrictions Currently CLG is built for Internet Explorer version 7 It will NOT work with Firefox Chrome or Safari Although we expect by November 2015 a new release compatible with Firefox and Chrome Internet Explorer 9 can be made compatible by activating compatibility features as described below To set browser compatibility for CLG only Open Internet Explorer Press the Alt key to di
26. ommonly used by new users so you will have available to you once you have mastered them some of the techniques your colleagues have found useful in their analytic efforts at Montefiore Consider this your next challenge for self study Review with Students 1 Rules for test taking You can help your fellow students by pointing out mistakes and giving hints but do not give answers CLG is a collaborative tool for a collaborating community 2 Time notions When in calendaric Within index date When in event duration 3 Index Event Line pointing to line one or line two important to determining which event s attribute will be available through the browse method or group list method This highlights the importance of editing the index event line 4 Important notion of Event Collection and how it differs from cohort next section Event Collection Tutorial 26 Event Collection vs Cohort Admissions all https www youtube com watch v 3SsOlwu G8M So far we have learned to create cohorts We have a group of medical record numbers where each medical record number is represented only once We got these medical record numbers by finding an event one per person and we used that singleton event s date time and the patient s mrn to define the member of the cohort But suppose instead of wanting a group of unique medical record numbers we wanted a group of events As an example suppose we wanted to look at all the hospital admissions in
27. onia and discharged alive There were 812 admissions of these males with a diagnosis of pneumonia and discharged alive So in the same year some of these men came back to the hospital with a pneumonia diagnosis and were discharged from their subsequent admissions alive Warning Whenever you convert a cohort to an Event collection look closely at the Index Event Line and make sure it is pointing to the line you actually want and therefore answering the question of your interest Also make sure your condition lines are properly identifying Earliest Latest or All 17 Time in Range The third Analytic Pattern in Study Designer How to summarize values in a continuous variable drawn repeatedly in the course of clinical care Tutorial 27 Summarizing a Continuous variable sampled repeatedly in the course of clinical care The time in Range Method https www youtube com watch Pv flZckS9JmM4A Watch Streaming video 18 1 Watch the three videos time in Range Lecture Time in Range Intro Time in Range Advanced 2 Read the CLG User manual 573 633 19 Additional Topics of Interest Find All the hospitalizations ED visits and Outpatient Visits in a temporal window post index Tutorial 29 Find multiple diagnoses not just primary Use smart Report Diagnosis Summary See video and manual CG Smart Reports 26tReports List E O CLG Reports Sir ED Returns fe za Follow Up Encounter Detail
28. ormation is stored on your hard drive You merely see an image of a folder and its files All information is encrypted in transit and at rest in the cloud You can only access the virtual hard drive when you are connected to the internet You will be able to access your virtual drive whenever you have a web browser and a connection to the internet This means that from any Montefiore computer you should be able to view all the files you have created in your virtual drive This is an experiment to evaluate acceptability of this solution in the workflow of the researcher 46 Take the Competency Exam Rules for test taking You can help your fellow students by pointing out mistakes and giving hints but do not give answers CLG is a collaborative tool for a collaborating community Read CLG User Manual Chapter 11 p 317 344 text search capability for pathology radiology CT MRI Read the Table of Contents of Event Manual 3 so you know where to go when you need an event or a specific attribute Congratulations on becoming an analytically empowered participant in modern Healthcare 47 Steps to Obtain NDI Mortality Data for CLG Users 1 Get an amendment approved from IRB for obtaining mortality data from NDI for research 2 Visit http www cdc gov nchs ndi htm They have step by step information and all forms in pdf including the application for getting the data 3 Get a draft of your application approved by the NDI staff b
29. p Follow up including Index Event Select Cohort USR nDischarge With Pneumonia Primary dc AliveFemales E N Risk Window After Index Date O Before Index Date O Before and After Index Date L Use Cohort End Date Calendar Start Date i EN End Date Event Type Inpatient Visits Outpatient Visits Emergency Visits Ambulatory Surgery Diagnosis Codes O ICD9 Codes O CPT4 Codes Both Output O Spreadsheet O CSV File Report SSeS eee esse e e e e 100 M K 1of1 3 clg 1535 cig 8063 Cig 8919 clg 9212 cig 9360 cig 16364 clg 16613 clg 17779 cig 17996 clg 20788 clg 20866 clg 30915 cig 38628 cig 42667 cig 45433 cig 53771 cig 57117 clg 57487 clg 58092 clg 60532 clg 60934 clg 62589 so r nd s Group Tree clg 1412 Main Report A CLINICAL Diagnosis Summary LOOKING G EAS S 21 File Format pager Hisia Resets IRET a Microsoft Excel 97 2003 Microsoft Excel 97 2003 Data Only Microsoft Excel Workbook Data only Microsoft Word 97 2003 Microsoft Word 97 2003 Editable Rich Text Format RTF xport Character Separated Values CSV 22 CLINICAL LOOKING GLASS MRN clg 1412 Sex F Age at Index Date 57 Index Date Jan 11 2010 5 47PM PCP Huang Md Hui li 23 Smart Report with Charlson Tutorial 30 Charlson Comborbidity 2 The Charlson comorbidity report looks at a singl
30. re interested in cause of death your approved application qualifies you to obtain death certificates too with the exception of a few states 10 There is always a lag for the data available For eg As of today 27JUL2015 complete data including cause of death is only available until 31DEC2013 For an example of a completed and approved application please contact the CLG trainer 48 Methods Section for Use in Citing Clinical Looking Glass Work CLINICAL LOOKING GLASS Purpose To put in methods section of work citing Looking Glass Name in manuscripts from 5 14 14 on Looking Glass Clinical Analytics Streamline Health Atlanta Georgia Looking Glass Clinical Analytics Streamline Health Atlanta Georgia is a user friendly interactive software application for the evaluation of health care quality effectiveness and efficiency The system integrates clinical and administrative datasets allowing non statisticians to produce epidemiologically cogent self documenting reports globally assessing care quality while identifying the specific patients in need of clinical remediation Company contact info should refer to the headquarters Streamline Health 1230 Peachtree St NE Suite 1000 Atlanta GA 30309 www streamlinehealth net 888 99 STREAM 49 Quick Tricks in Excel for CLG Users 1 Filter your lists click on upper right hand arrow can delete additional unneeded information or keep pertinent info
31. rmation by selecting wanted values in the populated list this is especially useful because simple count data shows up at the bottom of the page 2 Counts A how many cells contain a value or value over a certain number such as everyone who has received more than one macrolide COUNT IF countif range gt 2 ex 2 B If you want to categorize this further beyond a value count IF cell gt 3 YES ex greater than 2 YES C Count the number of non empty cells in a range if cells are coded as blank or have missing values COUNTA range 3 If then statements A If you want to know how many values meet exceed or fall below a criteria IF THEN IF cell gt X Yes IF cell gt 2 No 4 Basic formulas A Sun min max average st dev median sqrt are all easy functions that can be completed by before the function you can drag the bottom right hand square across rows or down columns to auto populate information Ex sqrt Ex SUM B Standard error stdev range sart range 5 Concatenate 1 CONCATENATE cell cell 50 6 If you have two columns B and C and you have blanks in some of the rows in c that you want filled with the values in B the following is the process you should follow An image of the challenge B C Inpatient date time outpatient date time 1 8 02 9 58 AM 3 11 02 3 41 AM 3 6 04 12 00 AM 3 10 03 3 45 PM B 3
32. splay the Menu bar alternatively right click the Address bar and then select Menu bar Click Tools and the click Compatibility View settings Favorites lnc Delete browsing history Ctrl Shitt Del InPrivate Browsing Ctrl Shitt P Tracking Protection Actives Filtering Diagnose connection problems Reopen last browsing session Add site to Start menu Imin istrative Dept View downloads Ctrl J SmartScreen Filter Manage add ons Compatibility View Compatibility View settings Subscribe to this feed Feed discovery Windows Update F12 developer tools OneNote Linked Notes Lyne Click to Call Send to OneNote Internet options MIDAS Occurrence Reporting A CUAL Arte If it is not already in the list of websites add emerginghealthit com into the form field Click Add 56 Compatibility View Settings You can add and remove websites to be displayed in ory Compatibility View Add this website Websites you ve added to Compatibility View Remove Indude updated website lists from Microsoft Display intranet sites in Compatibility View Display all websites in Compatibility View Note This method should be used with the awareness that certain later versions of Internet Explorer i e will reset and thus lose compatibility mode once the cache is cleared If you are using version 11 or greater compatibility mode will need
33. static Solid Tumor AIDS HIV Charlson Score Age Related Risk ICD9Count OOOO OC O O 00 O O 0 Oo O QI O amp O o QI N O O O O The relevant Charlson Adjuster is the Combined Score which takes age and diagnoses into consideration You can use this score to compare two cohorts for comparability at baseline AE Estimated 10 yr survival 98 3 95 9 21 4 95 9 98 3 0 21 4 95 9 27 Text search use video and reference manual Tutorial 31 Text Search https www youtube com watch Pv zUyTE7de81w Must learn on own with video and with manual 1 Orders with text 2 Lab with text mw 29 15 Spm Manual 28 Use CLG User Guide 4 3 1 Text search include Chapter 11 Searching Text Based information p 317 368 Look for the phrase pancreatic cancer in 2014 What are the types in orders with text that have Pancreatic cancer in them Steps Use 1 event collection approach 2 event type orders with text condition is a order Note Contains Pancreatic Cancer Edit Options Name orders with text Pancreatic Ca Event Orders With Text ww Type Event Definition Options E Definition ie x Order Note Contains Pancreatic Cancer LJ NOT Order Note ______ CONTAINS _ V Update Update and Close Close ____ Ee ES CINOT orders with text Pancreatic Ca OrdersWithText Y Name EC JB INDEX EVEN
34. thing called phq9 which is a finding type v Description Agitated depression Notice in the program in the drop down for event type something called PHq9 score cemr You got a hint that such a thing existed from the search function https clg emerginghealthit com CLGNET Modules EventDefinitionBuilder Eventl Name pha Event Findings Ww Type ____ Unuduie Event Definition Options EA Definition Undefined Condition SROIAC INDE CARDIAC OUTPUT A CLOSE SUPERVISION COGNITIVE IMPAIRMENT COHB COLONOSCOPY CEMR CONSULT PHARMACY CONTRACTION DURATION CPP CVP DC HOUR NITRIC OXIDE T Findi DC MIN NITRIC OXIDE Update Update and Close DEPRESSION SCREENING PHQ2 CEMR DEPRESSION SCREENING PHQ9 CEMR L usnsnsn nnn DEVICE TEMPERATURE C DEXTROSE STICK 35 Nama heli Type Event Definition Options H So METE ARR Selected BUILD Csave As ae Tx x ji Name phq9 in January 2014 E ii ec hi INDEX EVENT All of Any And bane nls phq9 All of phq9 FindingDate WHEN IN January 2014 36 N 695 695 measures of depression in the month of January 2014 using the phq9 Now consider how many episodes of screening phq2 in the same time period Name haz Findings a Event Definition Options E4 Definition DELTA P DEPRESSION SCREENING
35. to be manually restored If the error message persists even upon computer restart please contact the IT Service Desk itservicedesk montefiore org with a screenshot of the error message A complete or limited CLG server reboot may be needed 57
36. udedtrue End Date Inchided false There are about 96 different order types that have within them the full phrase pancreatic cancer sort ordered them and provide them as output 31 Row Labels l Count of GROUP 1 INDEX Pancreatic Cancer 1Order Type 2 4 Attending Progress Note 5 Discharge Summary 6 Intern Progress Note ch 7 Attending Admit H amp P 8 Longitudinal Patient History k Intern Admit H amp P f Phys Asst Admit H amp P CT ABDOMEN amp PELVIS W CONTRAST 12 Resident Admit H amp P 13 CT THORAX WITH CONTRAST 14 Phys Asst Progress Note 15 Brief Note 16 Resident Progress Note 17 CT Thorax Abdomen amp Pelvis with contrast 18 Chest XR PA Lat 19 GYN Ultrasound 20 Attending Pre Op Evaluation 21 Surg Path Case 22 MRI ABD W O CONT FOLBY CONTR amp FURTH 23 MRCP Abdomen w amp w 0 contrast 24 CT ABDOMEN amp PELVIS W O CONTRAST 25 CHEST PORTABLE 26 CT THORAX WITHOUT CONTRAST 27 PET CT SCAN BASE SKULL TO MID THIGH MM Count of Order types with the phrase Pancreatic Cancer in them The spreadsheet has a column with the full text 641 244 216 186 139 116 115 32 Event Search Which event do want to use to answer my clinical question Tutorial 31 Event Search Which event do want to use to answer my clinical question https www youtube com watch v msTS6YPEVrl Use event manual to find 1 blood pressure Systolic diastolic 2 Peak flow 3 Bmi 4 Depression Or Use Search Events and
37. y clinical QUESTION Mh kk eke 33 Search Events and At DI L Si ys yn s 0y0a5555ky N k n W N WEN 2 32y anni tee d n Awan M AN day EN W KENA NANNA 33 RO ee 2 ee 38 Oye oye ONON e de a D e 39 Tutorial 35 Counting Previous Hospitalizations in Wide List View 40 How to turn a multiplicity into a singularity using only the count attribute and no other fields from an Analysis Definition usne AR eee ae ea dan a es ec ec 40 SO i 018 TOP COUN a D a de nee a 0 46 Take th Combe EKI or 47 Steps to Obtain NDI Mortality Data for CLG Users kek keke keke k KK K 48 Methods Section for Use in Citing Clinical Looking Glass Work 49 TOME WICKS WA EXC MO CLG US OVS scr a aa at ae a 50 Common CLG Error Message site casunscecesecciecscrsntevedesasensiunetuvavsauhbencusetesieveanvecdinoatesevedqieancasatuendeanteaadwoatedeseunenes 52 Custom Exception RAR de eases 52 Browser Compatibility REStrictiONS ccccccccssseccccesececceseccecesececeunececsunececsensecessusecessuaecessenseeesauaeeetseneses 56 Guidance After today s class you will have completed the curriculum for basic competency will be able to pass the basic competency exam and will be ready to undertake your own education CLG Information is both broad and deep The manuals cover most of its capability but can be daunting without a guide have collected in this section Special Topics those topics most c
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