Archive for the tag 'TouchWorks Problem'

Administrative ICD9 Diagnoses to Clinical Medcin Problem Conversion

Drawing on our past experience and expertise with data conversions, we recently assisted one of our clients with a conversion of administrative ICD9 diagnostic data extracted from their Practice Management system to clinical Medcin-based  problem data within the EHR. The project ultimately saved a tremendous amount of data entry time. Upon completion of the data-conversion, clinicians were then able to review the problem list in “Past Medical History” section of the patient chart within the EHR and categorize by either choosing to make the problem “active” or mark redundant or resolved problems as “Entered in Error”.

As with any data conversion, one must be cautious in terms of negative implications. For instance, administrative data has its limitations, and an example or where the process can go wrong is the highly-publicized case of e-Patient Dave.  Ultimately, problem conversions can be useful, but the data needs to be reviewed, and almost treated as suspect.  The value in the conversion is saving the entry of the problems that are accurate – say 80-90%.  Any that are incorrect, will be reviewed with the patient and can easily be marked EIE.


  • 1,007,238 problems were loaded to the EHR for 205,831 patients via the interface engine, taking about 11 hours to process totally.
  • PM Extract file statistics:
    • Total matchups of ICD9s to patients: 5,405,874
    • Total Unique ICD9s: 8346
    • ICD9s that only match up with 1 patient:1295
    • ICD9s that match up with 100 or more patients: 2027

Approach and Components:

  • Master approved “ICD9” list provided by client
  • Extract of ICD9 data from PM system provided by PM vendor
  • Automated macro that attempts to match ICD9 to Medcin. Potential matches include the following:
    • 1 to 1
    • One to many (20 or less)
    • One to many (20 plus)
    • One to none
    • Each of the different flavors of matches were marked with an annotation (highlighted via an asterisk) to identify to clinicians the logic that was used in importing the problems:

    • Once the translation was finalized, it was loaded into the interface engine and mapping logic loaded problems into the patient chart in the EHR via the API (existing stored procedure).

    Known Issues Mitigated:

    • Due to incorrect logic, some ICD9s were linked to patient profiles improperly. To mitigate this, a script was run to mark these problems as “entered in error”
    • Problems were loaded to the “Past Medical History” section of the patient chart with a status of active. However, given this status, it didn’t facilitate providers to easily change the problem to be an active problem linked to a note.

    Lessons Learned:

    • Execute a proof-of-concept and as with any technical project, get clinician feedback. The client had a pilot group of 5 clinicians to vet out issues and bless the data before the live conversion was run.
    • Do NOT use spreadsheets to track the cross-walk between administrative ICD9 diagnoses and clinical Medcin problems. Rather utilize a staging DB to serve as a single repository in developing ICD9 to Medcin translations. Also, the data from flat-file export from PM can be loaded into a staging environment via SSIS such that it can be analyzed and summarized while facilitating persistence.
    • Make sure to tie the problem conversion load to a specific provider, that way if side effects or issues are identified after the fact, there is a clear way to identify which problems were loaded in the conversion via the provider they are tied to. The interface log should also have a record of this, but most organizations set the retention time to 90 days.
    • Workflow validation – ensure that the workflow to move problems from PMH to Active will not be a barrier to use.

    If your organization is looking for assistance in data conversion, please contact and visit our website for more information regarding our technical service offerings.

    Fun with Problems

    I worked with a large group who had been using TouchWorks for a year or so, after converting data from their previous EHR (a predecessor of TouchWorks). The conversion brought their Problems into TouchWorks; however, the problems were viewed differently and were now also viewed and managed by physicians, rather than only the nursing staff. While these changes were generally fine, the personal and family history that they had captured on paper, then showed in their old EHR, now cluttered patients’ problem lists – they had 10 copies of “Coffee Consumption” or “Denies Drug Use”. They also commonly had patients with duplicates of other problems as these didn’t appear as duplicates in the previous EHR.

    We spent a few weeks designing a neat de-duplication process. I’ll spare you the details, but it went along the lines of finding problems of the same type, status, category and view. We’d take the oldest entry and keep it. We’d mark the rest as Entered in Error; however, we didn’t toss them away completely – we’d store each problem entry as an assessment on the first problem entry so you could always view the problem details to see the Audit/History.

    We also took out some other attributes of the converted problems, such as the category of History Of for every problem and comments that the physician group thought might be useful.

    Before I continue, I have to say – both the physician group and those assisting with the conversion (at Allscripts) did a great job of converting the 12 years of electronic charts (about 2MM patients). I think the biggest issue was the group not having a year’s experience using TouchWorks to make some of the decisions – hindsight is 20/20.

    Luckily, we had the ability to make corrections as we went. We were able to convert millions of problems, removing duplicates (while maintaining their history!) and saving the clinicians a great amount of time and frustration. An internal medicine doc remarked that it saved him somewhere in the area of 100 hours of effort (not to mention the gray hairs).

    I wouldn’t say we did anything extraordinary, but just had the luck to work on a fun project that helped out a couple hundred nurses and physicians. And hopefully make their transition to a (full) EHR a little more pleasant.