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eCR/RCKMS Community of Practice

The purpose of the eCR/RCKMS Community of Practice Basecamp is to provide staff from state, local, territorial, and tribal public health agencies with a venue to participate in peer-to-peer discussions pertaining to using RCKMS. This Basecamp is not intended for formal communications about RCKMS or eCR and will not be moderated by CSTE staff. For technical issues or assistance with RCKMS, please visit www.rckms.org to submit a ticket. Disclaimer: The statements and responses posted on the eCR/RCKMS Community of Practice are solely the views of the authors and do not necessarily represent the official views of CDC or CSTE.
Becky Lampkins, Manager, Surveillance/Informatics Program at CSTEMeredith Lichtenstein, CSTELaura ErhartNancy Barrett, Epi 4/PH Informatics SpecialistRita Altamore, EpidemiologistDavid DiCesareWalter Kemper, ELR Coordinator, NC DHHS Div of Public HealthAmanda Payne, Senior Consultant at J Michael ConsultingJohn Satre, Informatician at Iowa Department of Public HealthShaily Krishan, Program Manager at CSTEJudie HyunKathy Turner, Deputy State Epidemiologist at IDSara Robinson, ID Epi Program Director at Maine CDCMisty Johnson, Informatician, WI DHSCrystal Snare +376 others
Posted by Shaily Krishan ·

Diagnosis/ Active Problem Criteria in RCKMS

Hello RCKMS users,

Recently, the RCKMS Content Team received requests from jurisdictions to separate Diagnosis/ Active Problem Criteria for COVID-19 in RCKMS. Below is a summary of the issue and our response:

Summary of Issue:
  • Currently diagnosis & problem are combined into one “sufficient” clinical criterion in RCKMS
  • Jurisdictions are receiving eICRS with data for older problems or chronic conditions (in the “active problem list”) because providers do not close out/ update problems within the EHR consistently. 
    • Note: In the current EHR, Problem List management is a known issue, and we might not be able to change the provider workflow easily. Timepoints related to problem list—e.g., date problem opened, date problem closed, whether problem is truly active during the current encounter—are not always updated depending on how this information is documented in EHRs by providers.
  • The RCKMS team has received requests to separate “diagnosis” and “problem” logic, so that jurisdictions could choose not to author “problem” criteria in the hopes that this would eliminate the ‘old diagnoses’ issue. 
  • If diagnosis/ problem criteria were available separately, jurisdictions could only author “diagnosis” criteria, and only choose to receive diagnoses 
RCKMS Response:
The RCKMS Content team and national eCR team discussed this issue at length. While we realize receiving old data is problematic for PHAs, the issue is caused by entrenched provider workflow and documentation issues. The issue is well-known and problematic for HCO data sharing in many contexts and is very provider dependent (it depends on how someone was trained and how they use problem and diagnoses differently, depending on that training). Because of this, and considered in the context of condition triggering, we do not recommend separating the Diagnosis/ Active Problem Criteria for COVID-19. Below are some considerations related to the issue:  
  • Problems are usually entered into the EHR during the encounter, by the provider.  
  • Diagnoses are usually entered later, mostly for billing purposes. Often these are added by billing personnel, not the provider. 
  • If relying on diagnosis only for COVID, jurisdictions might not receive reports of COVID-19 as quickly as desired as diagnoses might wait for the case to go through billing to trigger.  
  • Some EHRs trigger on the problem list, and if a jurisdiction has not authored rules for problem list, this might result in missed case reports. 
If you would like more information on this issue or have any questions, please contact Shaily Krishan (skrishan@cste.org).

If you’d like to discuss possible workarounds/ filtering options, please contact the eCR-info mailbox (eCR-Info@aimsplatform.org) for technical assistance.