Special Topics - Clinical Looking Glass from Montefiore Medical
Contents
1. y order Account Type bk Vlorder Facility order y Order Provider Open up excel and insert Pivot table focused on Oder types I want to know what sort of texts at Montefiore had the word Pancreatic Cancer in it 34 Name Pancreatic Cancer Faahi Created ebelin Modified On 2015 05 05 2034 00 Modified 2015 05 057203400 Number of Records 4513 EventCollection Created On 2015 05 0512034 00 INDEX EVENT All Of Any Pancreatic Cancer All Of orders with text Pancreatic Ca OrdersWithText WHEN IN 2014 Definitions list orders with text Pancreatic Ca OrdersWithText Event Type OrdersWithText Order Note Contains Pancreatic Cancer StartDate 0 1 01 2014 12 00 EndDate 01 01 2015 12 00 Start Date Includedtrue End Date Includedfalse There are about 96 different order types that have within them the full phrase pancreatic cancer sort ordered them and provide them as output 35 3 Row Labels Count of GROUP 1 INDEX Pancreatic Cancer Order Type 4 Attending Progress 5 Discharge Summary 6 Intern Progress Note m 7 Attending Admit H amp P 8 Longitudinal Patient History F Admit H amp P Phys Asst Admit H amp P ABDOMEN amp PELVIS W CONTRAST 12 Resident Admit H amp P 13 THORAX WITH CONTRAST 14 Phys Asst Progre2. Findings Edit Selected Condition 9 __ phag FindingDate WHEN IN January 2014 Y WITH No Demographics Y 11D Dsave As Name pha9 in January 2014 Event canvas INDEX EVENT All of Any And of FindingDate WHEN IN January 20141 1 40 N 695 695 measures of depression in the month of January 2014 using the Now consider how many episodes of screening phq2 in the same time period Event E Type eee 3 emm iS EEJ Finds Type Equal PHQ SCORE CEMR pee Diabetic Eye Exam Diabetic Foot Check Diastolic Blood Pressure Diastolic Blood Pressure Initial DIASTOLIC PA DILATION DILTIAZEM MGIHR DILTIAZEM DOBUTAMINE MCG KG NIN DOBUTAMINE MUHR m Findings T DOPAMINE Ft PRA 1 Event x ha Findin vi Name pha Type 7777773 Bi onsen on onton ings Type Eval DEPRES With a final result on the event canvas of ANIM JILD Save ss SS ee Name phq2 in January 2014 qmm J INDEX EVENT All of Any And 458 pha All of phq2 FindingDate WHEN IN January
3. CLG rat Lp Encarte Detal EH ires evene ral EE Show Loba LE snow medications lao Ann fere Ad Hoe Vapor ace anraturesecone f n rapor E cordc coth HE cone Ted Report Viewer 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 29 Criteria Summary Methods Define Patients select a Cohort select an Event Collection Select Cohort USR Pneumonia 2010 Female admits dc alive E M Risk Window 180 O After Index Date 9 Before Index Date O Before and After Index Date Cohort End Date j Calendar Start Date Eje Colendor End Date 0 include Left Endpoint CI Include Right Endpoint E Event Type V Inpatient Visits V Outpatient Visits V Emergency Room Visits Calculator Spreadsheet csv file charison Charlson Detall Elixhauser AHRQ Web Elixhauser AHRQ Web Detail Labs Non Lab Covariate 1 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 3 Comorbidity applied the methodology only to the hospitalization related to
4. The EC is now green Buse Pneumonia 2010 Male admits dc alive310b 17 The original cohort had 762 people So this means in 2010 there were 762 unique males who were admitted with pneumonia 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 18 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 v flZckS9Jm4A Watch Streaming video 19 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 20 Self Teaching Exercise Learn how to create medication sets and use them to solve a question Tutorial 28 Medication Set building Find Explore 2 Watch Streaming vi
5. 62 6 pa sEventDotenime eventoatenme 49 0 1 1 39 Admit Referral Agency outcomes moor 5 Resulting in 53 roupNo 00 Patient 0 2 6 0 3 EventDaterime 0 1 1 4 EventDateTime 0 1 1 29 Referral Agency Now run the method and note the resulting spreadsheet IsAdmissionFromSNF snf admit Analysis Instance Count You also have access to the actual SNF names in another field 54 Outcome qual isAdmissionFromSNF snf admit 1Admit Referral Agency Other Nursing Home Morningside House Other Nursing Home Kings Hrbr Multicare Morningside House 55 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 v EoM7XXaeWBYlist PLf7raPnmlLOeAWU2cNf2jIMDRqQuUTCum 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 va
6. 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 orderNote Contains Pancreatic Cancer Name orders wih t Event Type Event Definition Options Ee order Contains Pancreat cancer Order Note 5 v Sc THEN Edit Selected Condition Pancreatic Cancer CONOT Allof __ orders with text Pancreatic Ca OrderswithText WHEN IN 2014 WITH No Demographics Y Y Bt M save As Name Pancreatic Cancer INDEX EVENT All of Any And EE Pancreatic Cancer All of orders with text Pancreatic Ca OrdersWithText WHEN IN 2014 33 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 4 t Types List Attributes Select Analysis Definition optional Please Select an Analysis 1 Pancreatic Cancer Description Select Events and Attributes y Eventname
7. 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 E Bfaport List 00 CLG Ht eure Fetowup encounter Dott Evert Ti sron inte LE sron nocens H Admin Reports Hoc Reports HE ace ae raure Bacr anorauresecond 8 antibiogram E come can E carai teno Heroes raport olabetosPhysPerlormance Report Viewer 24 Diagnosis Summary Smart Reports E neports List Summary Methods prp Define Patients eG Admin Reports Hoe Reports select a Cohort O select an Event Collection fS ACE ARB Failure 2 ACE ARBFaliureSecond T Tg Birth Report Risk Window 180 After Index Date Before Index Date O Before end Alter Index Date 28 cardiac cath E cardiac Echo E comorbidity E comorbidity T consuittion Report continuity oF Care Diabetesphyspertormance i Diagnosis Codes ET Orco codes O cera codes Both registry Output infection Exposur Spreadsheet O csv rie Report O Index Event O Follow up Follow up including Index Event select Cohort nDischarge With Pneumonia Primary de AliveFemales E M Use C
8. an Analysis Definition using All Use of Box for Security Take the Competency Exam Steps to Obtain NDI Mortality Data for CLG Users Methods Section for Use in Citing Clinical Looking Glass Work Quick Tricks in Excel for CLG Users Common CLG Error Message and First Pass Solution 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 1 have collected in this section Special Topics those topics most commonly 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
9. and First Pass Solution This is a common server error that you may come across during use of CLG z 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 P3 68 Zoom 90 Safety Add site to Start menu View downloads Manage add ons 12 Developer Tools Go to pinned sites Compatibility View settings Report website problems Internet options About Internet Ex Left click on Internet options An Internet Option palette opens 69 General Security Privacy Content Connections Programs Advanced Home page To create home page tabs type each address on its own line http go microsoft com fwlink p Linkld 255141 2 Use current Use defauit new tab Startup Start with tabs from the last session Start with home page Tabs Change how webpages are displayed in tabs Tabs Browsing history Delete temporary files history cookies saved passwords and web form information Delete Appearance Colors _ Languages Fons Accessiblity Click on the General tab in Internet options and click Del
10. 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 Of course we could always build the event collection from scratch But you can not change the index line from earliest to all So 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 14 L Event Collection Edit J USR Dc2010AgeGe65 Delete Pneumonia 7 Make Copy kc B USR Pneumonia 2010 Male discharg View Summary Browse Share Pneumonia 2010 Female discha USR Pneumonia 2010 Male discharge Pneumonia 2010 Male discharae Cc B USR Pneumonia 2010 Female discha USR Pneumonia 2010 Female admits USR Pneumonia 2010 Male admits 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 15 Management 2 03 Event Collection C Rhematoid Arth
11. if the patient was admitted from a nursing facility For this AD we build the atest admission event within 0 to 10 days before the cohort s admission This tricks CLG to be looking at the very admission that is the cohort member s admission The nearest admission is the admission at zero days away from the index admission so we are functionally looking at whether the index admission came from a nursing home https clg emerginghealthit com CLGNET Modules EventDefinitionBuilder EventDefinitionBuilder Event End Point T z Type Event 5 Referral Build set by lefi clicking on Three aoned buons APR DRG Average LOS APR DRG Went APR Mortality Risk TZ Discharge Referal Agency Dischargs Nursing Staton Re Click on the three dotted button Clinical Looking Glass will open a window to build a set for the Admission Referral Agency 48 Mem code ie am Dern Dorging hierarchy rames Dey Pen onre Eston dren values erly C Show berries Assigned it nurse Hospice 2 b ating Nase Hospice ut Boy Peer WE Sae ae Eer worcester bed ctr ern abran Home care White Plans Hosp E Feb cir ener tain Hom Moreras detras Skilled Nursing Facilities Bainbridge Nu
12. 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 3SsOlwu7G8M 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 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 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
13. 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 Folder Cohort An event collection opens up on the event canvas Bf it Selected Osave as 2 New EventCollection 46d 2 erm EE Winoex EVENT A of Any Anc Eventi tron WHEN IN 111 Training Cohorts Cass 1 2 5g Evert colection CEEB USR New EvertColection cid T SE md nona Bus Pneumonia 2010 discharge dc aive USR Pneumonia 2010 Female charge de v USR Pneumonia 2010 Female admis dalve USR 2010 Male adritsdcave USR Pointing to Original Valve CE Bust fect Selected Condition vent 4 USR Diabetic EE Alot Event Def ursbischarge Usk 2012 WHEN IN WITH No Demographics v e cras jn Se CE 1 the management pane you see an event collection appear in yellow Note the EC as opposed to the C of th
14. the discharge The steps follow 1 Hover over the index event line 2 Right click to get the menu 3 Leftclick on add condition within Ex Ec J INDEX EVENT All of Any Fro discharges All of dischat jent 2010 WITH age 65 4 This now results in the following on the event canvas and gui editor below EHCEC BJ INDEX EVENT All of Any And 1 1 discharges All of discharges InpatientDischargeDate WHEN IN 2010 WITH age ge 65 AND iem Eventi New Event Definition within 0 to 0 select time units select time direction New Abstract Event Definition Bl Edit Selected Condition Eventi All of v New Event Def WITHIN 0 Days After Event discharges TY 5 Putin the requirements the condition line First Admit post dischargeNew Event Definiiton Inpatient admit b Change the all in the gui to earliest as I want the first readmission not all the downstream readmissions Within 0 to 30 days The gui editor now looks like this BUD Dlsmeas 5 Name Dc2010AgeGe65 ECB INDEX EVENT All of Any ES discharges of discharges InpatientDischargeDate WHEN IN 2010 WITH age ge 65 AND Eventi New Event Definition within 0 to 0 select ti
15. 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 6 Define Patients i Select Cohort 8 Select Cohort USR Pneumonia 2010 Female admits de alive E 9 E Cohort uU Header 3 Me Pneumorie 2010 Female admits de alive 5 Last Saved 3 26 2015 10 27 48 PM 7 pes belo tn Summary Comorbidity Multiple Paget E and now look at spreadsheet 30 x Y z AC Moderate or Severe Liver Disease Metastatic Sold Tumor AIDS HIV Charison Score Related Risk ICD9Count Estimated 10 yr survival 0 0 o o 383 o 0 o 1 559 o o 4 1 214 0 o 1 0 5 959 o 0 o 9 1 pr o 0 o 5 2 25 o n 0 o o 5 na o 0 1 12 959 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 31 Text search use video and reference manual Tutorial 31 Text Search https www youtube com watch v zUyTE7de81w Must learn on own with video and with manual 1 Orders with text 2 Lab with text Manual 32 Use CLG User Guide 4 3 1 Text search include Chapter 11
16. two cohorts of pneumonia patients from 2010 discharged alive from the hospital based upon an inpatient admission event One cohort was male and one was female You built this before so this should be easy Name the study Pneumonia detail 1 Let s build list method called IsDiabeticInPastSYears 2 Goto advanced Method 3 Build an indicator variable for HemoglobinA1c greater than or equal to 6 5 in the preceding five years You only care about the existence yes no and really do not care which one so you can chose Earliest 4 Eliminate in the list populator attributes selected all the attributes selected This is just for ease of seeing the results 44 5 Click on three dotted button to open an Analysis Definition builder canvas m rame sDiabeicirPast 5 years ja Analy of Any And HabatcGas s Eariest of hamoglctinA2cGeb 5 LabTestDate wehin 0 te 1825 Days Before Cchort Colecton Data HabateGe6 5 INOT Eariest of vv hemoglobinAtcces s LabTestDate Y WITHIN 1025 Days Date v Using this AD will find the earliest value but more importantly the count variable to be shown in the list populator when applied to an AD with a singularity Earliest or Late
17. 2014 41 N 17 532 So there were 17 352 times that 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 begins phq 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 42 Upload cohort Tutorial 33 Upload Cohort https www youtube com watch v ubnZoAgx6A8 When you have a list of medical record numbers and index dates and want to enroll this list as a cohort or event collection in CLG you will use this feature See video 5 25 24 43 List Method When you want to Create an Indicator variable 0 1 Using an Analysis Definition to Create an Indicator variable Tutorial 34 List Method How to create an indicator variable for continuous or categoric Variables https www youtube com watch v i3hEdgb05ag Background Sometimes when you have a cohort of patients you want to build a spreadsheet with an indicator variable yes 1 and no 0 For example Did the patient have in the year prior to the admission a Hemoglobin A1c greater than or equal to 6 5 Or was the patient admitted from a nursing home yes No The cohort was built and now you want to know whether these questions are true or not The list method provides a good way to solve this problem Let s create a new study with the
18. CLINICAL LOOKING Special Topics Version 11 Eran Bellin M D 8 13 2015 Contents Guidance Review with Students Event Collection How to convert a cohort to an Event Collection Useful Trick with a warning 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 19 Self Teaching Exercise Learn how to create medication sets and use them to solve a question Additional Topics of Interest Find All the hospitalizations ED visits and Outpatient Visits in a temporal window post index Use smart Report Diagnosis Summary Smart Report with Charlson Comorbidity 2 Charlson extension Adjust for Severity using administrative data collected over a prolonged time Text search use video and reference manual Event Search Which event do want to use to answer my clinical question Search Events and Attributes Exercise Upload cohort List Method When you want to Create an Indicator variable 0 1 Using an Analysis Definition to Create an Indicator variable Indicator Variable for a Categoric Variable Value set 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
19. Discharges All of Discharges InpatientDischargeDate within 0 to 180 Days Before Cohort Collection Dato Now we also want an AD with ED triage but disposition not admit Name Etage Event o ue vi Yat fl Esere pennon oons undefincd Condition MINOT Disposition Inpatient Admission w 7727208 cc Selected Condition ED ENOT Alof w EDtriage ErTriagedDate WITHIN 0 180 Days Before Cohort Collection Date gt Please Select an Event Definition 57 EEI ne 5 Name EDAIIO_180dBefore ADB EpAllo 180dBefore All of Any And ED All of EDtriage ErTrlagedDate within 0 to 180 Days Before Cohort Collection Date Analysis definition USR DischargesAllo 180dBefore _ v Start Blackout 0 Days E 4 0 0 Common Event Attributes 6 0 1 GroupNo 5 9 0 0 1 EventName 0 0 2 EventDateTime 3 n 2 MRN 5 2 EventID 0 1 1 4 EventDatetime 8 0 0 4 5 e Remove from 3 4 8 0 1 DischargesAll0_180dBefore selected attributes 8 0 1 1 Discharges 5 E 0 1 1 1 Count 3 Bring count to selected attributes 9 0 1 1 3 Eve
20. amp Rehab Williamsbridge Manor Nursing Home Workmen s Circle MultiCare Center Build the set and then save Now Update and save We have an admission event with a referral agency equal to a set of nursing homes jEvent J End Point ame CDI Namel 5 Event Agency SUS Update and Close You have now populated the event in the gui for the analysis canvas seve as Name IsAdmissionFromSNF New Analysis flesff4 All of Any And BEE Eventi New Event Definition within 0 to 0 select time units select time direction New Abstract Event Definition Condition snf admit WITHIN 0 12 Days Before Cohort Collection Date CC Now Update and close Edit the Index Event line of the analysis canvas Analysis Definition AD seve as ix 1x Name isAdmissionFromSNF Dmm i CAD New Analysis 4 All of Any andy sra snf Latest of admission from LG sslonDate within 0 to 2 Days Before Cohort Callecton Date Change Latest so you have a singularity 0 1 no yes Update and close 51 APSE cues Name IsAdmissionFromSNF CAD B 1sAdmissionrromSNr Latest of Any And 1 s
21. deo Help streaming Videos CLG Modules Hierachical Set Medication Watch Video Hierarchical Set medications so you can build a set with medications Then find the number of children age LT 18 in year 2012 at Montefiore who are prescribed in the outpatient an aerosol steroid in 2012 Build the cohort See 1 2 below for helpful clues 21 Hints demographic is age less than 18 event type is Prescription Note prescriptions are medications in the outpatient med orders are medications that have been ordered in the hospital InternMedAdmin Date are the actual meds that were administered in hospital All three events can use the same medication sets Read in Event Definition manual volume 3 Chapter 8 P 89 97 Medication Prescription In the process of the build you will be building on the event definition canvas 22 https cia emerginghealthit com CLGNET Modules EventDefinitionBuilder EventDefinitionBuilder aspx Def Type EVENTA SelMenuOption Name Bis Event Sart ENA Poit aca Seer pe Event CO rm y Med Type nt U ctii tori a recon its set usr toon Your final cohort will have n 280 Make sure you have the same results 3 Review CLG User Guide Version 4 31 Manual Look through Table of Contents b P 17 25 Introduction and Core Concepts c Inthe reading below notice the style of question and answer d Pp 25 167 23 Additional Topics of
22. der view objects view fies History Specify how many days Internet Explorer should save the list of websites you have visited Days to keep pages in history Coe Restart your computer if the same error message appears during your next session in CLG If the error message persists even upon computer restart please contact Ray Gonzalez raygonza emerginghealthit com with a screenshot of the error message Acomplete or limited CLG server reboot may be needed 72
23. e ED Analysis Instance Count _ 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 61 Use of Box for Security Box creates a virtual drive on your computer In the configuration we have prepared for you no information 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 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 62 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 The Orders
24. e cohort 2 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 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 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 Agroup called cohort has an mrn only once Agroup called an event collection can have the same mrn multiple times What is u
25. erage 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 sqrt range 5 Concatenate 1 CONCATENATE cell cell 66 6 If you have two columns 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 Inpatient date time outpatient datetime 8 3 02 12 40 PI 3 19 04 8 34 PI 2 13 04 6 28 Pi 5 28 05 2 25 lt move column b data to column c when column c is blank Select the whole range of Column C Press control G goto Press button Special Press blanks or select blank from the radial buttons Press Enter OK Press the equals sign Press the left arrow on the keyboard Press control enter TA M OO Pp 1 8 02 9 58 3 11 02 9 41 3 8 04 12 00 3 10 03 3 45 2 11 02 9 36 2 15 02 2 45 12 13 04 11 19 AM 4 14 08 12 00 7 11 03 8 30 AM 6 28 02 1 04 PM 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 3 Review how to use Pivot Table capability of Excel 67 Common CLG Error Message
26. esidence 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 1 did as well 9 If you are 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 64 Methods Section for Use in Citing Clinical Looking Glass Work CLINICAL 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 app
27. ete browsing history on exit Click Apply and OK when done 70 You may also want to update your settings to delete temporary internet files automatically This is accomplished by clicking settings General Security Privacy Content Connections Programs Advanced Home page To create home page tabs type each address on its own line http go microsoft com fwlink p LinkId 255141 _Usecurrent Usedefeut Usenew tab Startup Start with tabs from the last session 6 Start with home Tabs Change how webpages are displayed in tabs Browsing history Delete temporary files history cookies saved passwords and web form information Colors Languages Fonts Accessibilty Which will open the Temporary Internet Files and History Settings Palette and then check automatically Click OK when done Temporary Internet Files and History Settings Temporary Internet Files Internet Explorer stores copies of webpages images and media for faster viewing later Check for newer versions of stored pages Every time 1 visit the webpage C Every time I start Internet Explorer ded 50 250MB Current location C Users stahi AppData Vocal Microsoft Windows Temporary Internet Files Disk space to use 8 1024MB 250 Recommen m Move fol
28. 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 mmm BNDEX EVENT All of Any ENG discharges of disch AND Ra First Admit post discharge Earliest of Inpatier A menu appears choose edit left click edit A gui editor for the index event line appears below the event canvas TEZIE EventCollection All of Any Operator Wy es CS Now modify the all of any to be all of discharges Edit Selected Condition EventCollection All of Root Operator AND Event discharges Event First Admit post discharge 11 Edit Selected Condition EventCollection Event discharges Root Operator AND Update and close The event canvas would have looked like this EE Dee Name Dc2010AgeGe65 Hever conve c Bioeceveur Al af discharges And T CER discharges of discharges InpatientDischargeDate WHEN IN 2010 WITH age ge 65 1 HAND First Admit post discharge Earliest of Inpatient Admit InpatientAdmissionDate within 0 to 30 Days After Event discharges Now b
29. ion 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 38 Search Events and Attributes Matching search 122 which is a finding type we see something called phq9 Death In House Death Date Cause of Death Y Findings the vertical arrow is now horizontal showing that data is hidden gt Findings Text v Findings Type DEPRESSION SCREENING PHO2 CEMR DEPRESSION SCREENING PHO9 CEMR v Problem List Close Date 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 Event Name Type ig al 8501 undefined rdum 4 EIE E E MN ANI ERE EAD a Findings Type DEAE Eee Coe EPRESSION SCREENING PHQ2 CEMR DEPRESSION SCREENING FT DEXTROSE STICK 39 Name pha9 CO
30. lication 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 65 Quick Tricks in Excel for CLG Users 1 Filter your lists click on upper right hand arrow can delete additional unneeded information keep pertinent information 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 2 B If you want to categorize this further beyond a value count IF cell gt 3 YES ex greater than 2 YES 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 av
31. me units select time direction New Abstract Event Definition Edit Selected Condition E First Admit post discharge CNOT Earliest of v Inpatient Admit InpatientAdmissionDate WITHIN 0 TO 30 Days Event discharges ee Now Update and Close and the conditions in the GUI editor are painted onto the Event Canvas A 010 Save As xix Name Discharges2010AliveGe65 CEE B INDEX EVENT All of any And 1 Discharges alive All of Discharges Alive InpatientDischargeDate WHEN IN 2010 WITH age ge 65 inpatient admit Earliest of inaptient admit InpatientAdmissionDate within 0 to 30 Days After Event Discharges Alive CLG Message Box Webpage Dialog hittpsi cig emerginghealthit com CLGNET Modules MessageBox M B 10 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
32. nf admi Latest of admission from SNF InpabentAdmissionDate within 0 to 2 Days Before Cohary Collecton Date Now save You have created your indicator analysis Defin indicator was used ion that can be used exactly as the previous ENTE EES EE M sDiabetictnpastsyears FromANursingHome X 2 Run Method 2 EXE Analysts defino 5 start r 3 ashresth TSH all a ashresth TSH all USR WBC30_210befLast B Method Name Fror ashresth Xray spine DID Method Descnption List USR IsAdmissionFromSNr Choose the AD in the Advanced Method IsAdmissionfromSNF analysis definitio PII usn IsAdmissionFromSNF USR WbcAllWhenInCohartDuration USR WocFirstWhentnCohartouration ashresth Xray spine 020 575 52 Maximize the image of the list populator by left clicking Resulting in a Goor evere1sme Q oina vectis poe rooster 45 issanssooeroast 4 Sioa count 1 outcomes Demographics Now drag count over to the selected attributes Available Attributes 4 oa common Event Atributs 5 0 04 0 0 2 EventDateTime 0 0 3 Evento 0 0 EventType 4 IsAdmissionFromSNF X 4 BR isnf admit o vul nero oaaaibertoaeTe mt feral
33. nique in the event collection is not the mrn but rather the mrn date time combination The dyad of and date time is unique in the event collection Now let Let s continue our build 2 the event collection Dc2010AgeGe65 3 Build the event collection a Event discharges i Discharged alive meaning disposition not equal to expired b Duration 1 1 10 1 1 11 not included on right Age gt 65 The gui editor now looks like this I Edit Selected Condition discharges AIl of discharges InpatientDischargeDate WHEN IN 2010 v WITH age 65 v CO NC CNN When you update and close the event canvas looks like this Edit Selected Select O save as Name Dc2010AgeGe65 pu E Ec MiNDEx EVENT of Any And discharges All of discharges InpatientDischargeDate WHEN IN 2010 WITH age ge 65 Retain the all in the index event line 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
34. ntID You must remove any variable from outcome event discharges that have a multiplicity Count isa 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 The result of these moves 58 View wide Long Selected Attributes G 0 1 GroupNo 0 1 MRN Q 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 c ep s o 4 0 2 EDAN0_180dBefore X 30 2 MRN 4 en EventID 9 02 13 EventIype Outcomes Bemographics Group 0 2 15 Eventname 49 02 16 End EventDaterime Arrival Mode Bring over this singleton for display Remove the multipli Wide O Long ies from the outcomes which include both EventDateTime and Disposition 59 Vew 0 Wide O lars pg E Grup PES A coa iEventDsteTime Resulting in View Wide C Long n 6 0 1 GroupNo 0 D 1 PatientiD 02 6 0 3 EventDateTime 0 1 1 1 Count 4 0 2 1 1 Count Now run in wide view i 60 DischargesAll0_180dBefore Discharges Analysis Instance Count EDAIIO 180dBefor
35. ohort End Date Calendar start Date calendar End Date Event Type inpatient visits E Outpatient visits emergency Wists Ambulatory Surgery mnh tts CLINICAL Diagnosis Summary LOOKING GLASS Sam see cotati tet cna d ec E 2 Er incon one pe 25 File Format Crystal Reports RPT pager Prista Kadans RPT 23 fy SROI Microsoft Excel 972003 Microsoft Excel 97 2003 Data Only Microsoft Excel Workbook Data only Microsoft Word 97 2003 Microsoft Word 97 2003 Editable Rich Text Format RTF Character Seoarated Values CSV xport 26 GE SPATS MRN agan set at index Date 57 index Date Jan 112010 STP PCP Huang ma 27 Smart Report with Charlson Tutorial 30 Charlson Comborbidity 2 The Charlson comorbidity report looks at a single 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 28 Comorbidity 2 Charlson extension Adjust for Severity using administrative data collected over a prolonged time See video
36. riable 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 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 ETE Discharges v Discharges InpatientDischargeDate Y wirHIN D ro t ___ EET Cohort Collection Date update EN CEN 56 Edit Selected Save As Name DischargesAll0_180dBefore mm AD B Dischargesallo_180dBefore All of Any And 1 Lira
37. ritis USR RheumatoidArthritisAdmissions B USR RheuratoidArthritisPatientsadmitoo CJ TDiabetes B usa Bad Diabetes with RepeatHgbAic usn Bad Diabetes 8 USR Dc2010AgeGe65 Pneumonia EC USR Pneumonia 2010 Male discharge dc alive amp fds B USR Pneumonia 2010 Female discharge dc alive Use admit pneumonia 2010 discharge dc alive Use admit FC usn Pneumonia 2010 Male discharge dc alive Pneumonia 2010 Female discharge dc alive B USR Pneumonia 2010 Female admits dc alive Ec USR Pneumonia 2010 Male admits dc alive310b lt B USR Pneumonia 2010 Male admits digital Diabetics gt 16 Notice how the Event Collection object is yellow in the management pane EC USR Pneumonia 2010 Male admits dc alive3 10b Let s edit the Event Collection and see what it looks like ca Emm 15 Name Pneumonia 2010 Male admits de alive310b EC INDEX EVENT All of Any And 1 L EB 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
38. rsing amp Rehab Center Bay Park Center for Nursing amp Rehab Beth Abraham Health Services PARTNER 5 Bronx Center for Rehab amp Healthcare Bronx Lebanon Special Care Center Bronx Park Rehab amp Nursing Center Casa Promesa Concourse Rehab amp Nursing Center Daughters of Jacob Nursing Home East Haven Nursing amp Rehab Center Eastchester Rehab amp Health Care Center Fieldston Lodge Care Center Gold Crest Care Center Grand Manor Nursing amp Rehab Center Hebrew at Riverdale Partner 5 Highbridge Woodycrest Center Hudson Pointe at Riverdale Center for Nursing amp Rehab Jewish Home Lifecare Partner 5 Kings Harbor Multicare Center PARTNER 5 Kingsbridge Heights Rehab amp Care Center Laconia Nursing Home Manhattanville Rehab amp Health Care Center Methodist Home for Nursing amp Rehab 49 Morningside House Morris Park Nursing Home Mosholu Parkway Nursing amp Rehab Center Park Gardens Rehab amp Nursing Center Pelham Parkway Nursing Care amp Rehab Facility Providence Rest Nursing Home Rebekah Rehab amp Extended Care Center Regeis Care Center Riverdale Nursing Home Schervier Nursing Care Center PARTNER 5 Split Rock Rehab amp Health Care Center St Barnabas Rehab amp Continuing Care Center St Patrick s Home for the Aged amp Infirm St Vincent de Paul Rehab amp Nursing Center Terrace Healthcare Center Throgs Neck Extended Care University Nursing Home Wayne Center for Nursing
39. ss Note 15 Brief Note 16 Resident Progress Note 17 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 o contrast 24 CT ABDOMEN 8 PELVIS W O CONTRAST 25 CHEST PORTABLE 26 CT THORAX WITHOUT CONTRAST 27 PET CT SCAN BASE SKULL TO MID THIGH Count of Order types with the phrase Pancreatic Cancer in them The spreadsheet has a column with the full text 641 244 216 186 139 116 115 115 97 58 4T 46 19 18 7 7 16 14 13 12 11 10 10 9 36 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 msTSGYPEVrI Use event manual to find blood pressure Systolic diastolic Peak flow Bmi Depression Pe Or Use Search Events and Attributes eS oe Eon Type in depression Events and Attributes 37 Now left click on v Death In House Death Date Search Cause of Death Gas ea Cardiac Arrest CAD HTN HLD Depression GERD Aortic Aneurysm Cardiopulmonary Arrest CHF EHTN Depression Anxiety COPD mE Cardiopulmonary Arrest UTI Escherichia Coli HTN DM Depression Complications of Alzheimer s Disease CHF PUD HTN Depression Hemorrhagic Stroke EHTN Dementia Depress
40. st will produce a zero when no record was found and a one when at least one value was found in the column for the count variable in the list method spreadsheet The image below shows us invoking the AD called IsDiabeticInPastSYears and then dragging the count variable in the list populator from available attributes to selected attributes 45 Fe Rum all save as X Du toni Y NEP pom nals Methods m rb acinis fist 4 o0 Common Fe Ribes 2 js cocer 4 RM saine ya bitumen Resulting in Selected Attributes that look like this Vion Wes tera pg Selected Attributes Greuplio Joa man Event ste me 0 1 1 4 i rentDeteTime tab Test Type oat Count 13 tab Test value Run the study Exporting the resulting spreadsheet shows a count field with the required 0 1 46 1eDiabeticinPaet 5 years HgbaleGe6 5 Analysis Instance Count have therefore demonstrated how to use a numeric based AD to generate a 0 1 dummy 47 Indicator Variable for Categoric Variable Value set We also want an indicator variable for the categoric variable SNF Skilled Nursing Facility We want to know
41. uild N 6 200 There were 6 200 admissions of 65 year olds or older who had 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 12 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 Root Operator AND And 1 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 13 How to convert a cohort to an Event Collection Useful Trick with a warning Suppose you start with a familiar cohort O Save as neumonia 2010 Male admits dc alive TE admits All of Pneumonia InpatientAdmissionDate WHEN IN 2010 WITH Male This is a cohort so we have the
42. with Text event 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 event or a specific attribute Congratulations on becoming an analytically empowered participant in modern Healthcare 63 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 before 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 r
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