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List: openmrs-implementers
Subject: Re: Incomplete ICD-10 Diagnostic codes, and other known standards/vocabularies
From: Raymonde Uy <demonray () gmail ! com>
Date: 2014-08-22 18:15:57
Message-ID: c3c8287e-a471-47bf-96ef-c8532b6c5a75 () openmrs ! org
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Darius,
Thank you for your reply! I really want to test this out, and possibly have
some clinicians test it in their settings.
Currently the latest concept dictionary is saved in the CIEL dropbox, which
if I may politely ask Dr. Kanter if I could possible get access? :)
Lots of thanks and appreciation.
Sincerely,
Raymonde
On Thursday, August 21, 2014 8:16:59 PM UTC-4, Darius Jazayeri wrote:
>
> Hi Raymonde,
>
> I didn't record the video, Burke did, and he's a clinician. :-)
>
> The search mostly works as you say: when you type more words it filters
> down, and it's limited to 50 total results (or something like that) for
> performance reasons.
>
> If you want to test it out yourself, it should be enough to:
> 1. Install OpenMRS 2.0
> 2. Install the CIEL dictionary on top of that (by running the SQL script)
> 3. Install the modified version
> <https://issues.openmrs.org/secure/attachment/41823/coreapps-1.2.1.omod>
> of the coreapps module that's attached to the RA-332 ticket
>
> And voila.
>
> I agree that this is a completely solvable problem, we just need to decide
> how to approach it from the perspective of (a) what to include with OpenMRS
> 2.x out of the box, and (b) how to improve the search UI. And someone needs
> to do the work. :-)
>
> -Darius
>
>
> On Thu, Aug 21, 2014 at 4:57 PM, Raymonde Uy <demo...@gmail.com
> <javascript:>> wrote:
>
> > Darius,
> >
> > The video that you linked is actually pretty ok! It's a lot better than
> > not having any coded diagnosis! :)
> >
> > Have you tried narrowing the search terms down, so that it does not yield
> > that many results?
> > For example: instead of just using "diabetes", how about "Diabetes
> > Mellitus type II".
> > "Malignant hypertension" instead of just "hypertension"
> >
> > Do the search results get smaller?
> > How about a way to order the search results by category?
> >
> > When a physician decides on his or her primary diagnostic impression,
> > they usually have it narrowed down anyway. It's all about the search terms,
> > and their familiarity with how ICD codes are named. Placing your diagnosis
> > as just "diabetes mellitus" instead of a more complete diagnosis which
> > indicates for "controlled/uncontrolled" / "insulin-dependent/independent"
> > is lazy on the physician's part.
> >
> > When a physician does type in a general term, and not a specific term,
> > having a manageable amount of search results (20-50?) may also help in
> > assisting the physician in considering the other more specific diagnosis,
> > which then helps in learning ICD-10 codes through experience, and may be
> > value adding in formulating their differential diagnosis.
> >
> > Thanks for all the hard work! Tell me what you guys think.
> >
> > I will try to incorporate the full CIEL dictionary in my current
> > work-in-progress.
> >
> > Thank you also for the response Andy regarding what "fully specified"
> > meant, and it was my mistake of not being clear about it in my first post.
> > I fully understand that the parent category cannot be used as the coded
> > diagnosis if there are more specific, child diagnosis under them. I just
> > really want the stand-alone OpenMRS 2.0 to have a bigger concept
> > dictionary. As it stands, physicians in rural communities who want to try
> > OpenMRS in their small clinic will not be able to find the coded diagnosis
> > in writing their visit notes.
> >
> > Thank you for your time!
> >
> > Sincerely Yours,
> > Raymonde
> >
> >
> >
> > On Thursday, August 21, 2014 6:23:28 PM UTC-4, Darius Jazayeri wrote:
> >
> > > The reference application (currently) makes available as visit diagnoses
> > > concepts that are in a concept set of concept sets.
> > >
> > > This code is contributed from Mirebalais, where the clinical teams
> > > wanted to define their own sets of available diagnoses, and didn't want the
> > > noise of lots of other diagnoses creeping in.
> > >
> > > Out of the box in OpenMRS 2.0 this is the ICPC diagnoses, but there's a
> > > global property (emr.concept.diagnosisSetOfSets) you could use to point
> > > to a different set-of-sets if you created one.
> > >
> > > It would be a trivially small change in the code to search diagnoses
> > > based on concept class of diagnosis, symptom, finding, or symptom/finding (
> > > RA-332 <https://issues.openmrs.org/browse/RA-332> is about testing
> > > this) but per our research the user experience if we do this with the full
> > > CIEL dictionary is quite bad (this video <http://youtu.be/GkKAGgwfATo>,
> > > which you Andy already commented on).
> > >
> > > We're supposed to discuss this on an upcoming design call, but this
> > > didn't get scheduled. I will email you, Burke, and Jonathan separately to
> > > find a date we can all make it, and then we can communicate it more broadly.
> > >
> > > -Darius
> > >
> > >
> > >
> > > On Thu, Aug 21, 2014 at 2:31 PM, Andrew Kanter <andy_...@yahoo.com>
> > > wrote:
> > >
> > > > Raymonde,
> > > > I think your major problem is that the current version of the reference
> > > > application is not accessing the full CIEL dictionary... but to answer your
> > > > other question:
> > > >
> > > > Fully-specified code is one where all digits are provided. In ICD, if a
> > > > code exists with another digit, then you cannot use the code without that
> > > > digit. Since there are E14.x codes, you cannot use E14. If there is an
> > > > E14.8x you would not be able to use E14.8. These intermediate codes (E14
> > > > and E14.8 in my examples) are navigational or categorical only and should
> > > > not be used to capture information.
> > > >
> > > > Darius, I don't think I understood that the reference app could not
> > > > take advantage of the full CIEL dictionary for diagnoses at this time. Is
> > > > that because the UI is only leveraging the ICPC list of diagnoses? Do we
> > > > need to have folks add dx to a set to show, or should the reference app
> > > > search all concepts with a finding/diagnosis category?
> > > >
> > > > Andy
> > > >
> > > >
> > > >
> > > >
> > > > *-------------------- Andrew S. Kanter, MD MPH FACMI*
> > > > Asst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology
> > > > Columbia University
> > > > Email: andrew...@dbmi.columbia.edu
> > > > Mobile: +1 (646) 469-2421
> > > > Office: +1 (212) 305-4842
> > > > Skype: akanter-ippnw
> > > > Yahoo: andy_kanter
> > > >
> > > >
> > > > On Thursday, August 21, 2014 2:08 PM, Raymonde Uy <demo...@gmail.com>
> > > > wrote:
> > > >
> > > >
> > > >
> > > > Dear Dr. Kanter,
> > > >
> > > > Thank you very much for your very swift reply!
> > > >
> > > > What does it mean when you say fully-specified? I'm assuming that these
> > > > are codes that do not have "unspecified" in the code, or are vague.
> > > >
> > > > About Diabetes Mellitus, the ICD-10 code *E14.9* is in the parent code
> > > > E14 *Unspecified diabetes mellitus *with E14.9 *Unspecified diabetes
> > > > mellitus without complications*
> > > >
> > > > Doesn't this mean that it is not fully-specified?
> > > > Diagnosis of Diabetes Mellitus is usually specified as insulin
> > > > dependent (type I) or non-insulin dependent (type II), which are fully
> > > > specified codes E10 Insulin-dependent diabetes mellitus and E11
> > > > Non-insulin-dependent diabetes mellitus; with appropriate CIEL codes in
> > > > http://maternalconceptlab.com
> > > >
> > > > Lastly, in the demo and downloaded standalone versions of OpenMRS 2.0,
> > > > this is what shows up in placing Diabetes as a diagnosis. Why isn't it
> > > > showing up with an appropriate ICD code? It only has a SNOMED code in the
> > > > concepts dictionary.
> > > >
> > > > <https://lh5.googleusercontent.com/-Kyyhiqn1DAw/U_ZCipZ8f8I/AAAAAAAALVs/2wv7-sDdm98/s1600/DM.JPG>
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > > Is it possible to use the full dictionary in the current version?
> > > >
> > > > Again, thank you so much for the hard work and support you and your
> > > > team have given in support of OpenMRS!
> > > >
> > > > Very Truly Yours,
> > > > Raymonde
> > > >
> > > > ---
> > > >
> > > > Raymonde C. Y. Uy, MD/MBA
> > > > Postdoctoral Research Fellow
> > > > Medical Informatics Training Program
> > > > Office of High Performance Computing and Communications
> > > > Lister Hill National Center for Biomedical Communications
> > > > U.S. National Library of Medicine, National Institutes of Health
> > > > 8600 Rockville Pike
> > > > Bldg. 38A, Room B1N30A18
> > > > Bethesda, MD, 20894
> > > > +1 (301) 402-4100 [Main]
> > > > +1 (301) 402-7851 [Direct]
> > > > +1 (301) 402-4080 [Fax]
> > > > RaymondeC...@nih.gov
> > > >
> > > >
> > > >
> > > >
> > > > On Wednesday, August 20, 2014 5:39:59 PM UTC-4, Andrew Kanter wrote:
> > > >
> > > > Raymonde,
> > > > Only fully-specified, valid ICD-10 codes are included mapped to
> > > > diagnoses in the full CIEL dictionary. Prefix codes, or code ranges will
> > > > not be included. In addition, it depends whether you are using the full
> > > > dictionary or only the minimal data as part of the reference application.
> > > >
> > > > For Diabetes Mellitus, the correct ICD-10 code is E14.9.
> > > >
> > > > If you go to maternalconceptlab.com
> > > > <http://www.google.com/url?q=http%3A%2F%2Fmaternalconceptlab.com&sa=D&sntz=1&usg=AFQjCNHvu0aBLziJMx90USJWXWKMrY2U8g> \
> > > > and type in the ICD-10 codes you will find the terms.
> > > >
> > > > Andy
> > > >
> > > >
> > > >
> > > > *-------------------- Andrew S. Kanter, MD MPH FACMI*
> > > > Asst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology
> > > > Columbia University
> > > > Email: andrew...@dbmi.columbia. edu
> > > > Mobile: +1 (646) 469-2421
> > > > Office: +1 (212) 305-4842
> > > > Skype: akanter-ippnw
> > > > Yahoo: andy_kanter
> > > >
> > > >
> > > > On Wednesday, August 20, 2014 4:21 PM, Raymonde Uy <
> > > > demo...@gmail.com> wrote:
> > > >
> > > >
> > > >
> > > > Greetings of Peace!
> > > >
> > > > I currently installed OpenMRS 2.0, and have also been playing around
> > > > the online demo version.
> > > >
> > > > I have been exploring the concept dictionaries. It was mentioned that
> > > > the vocabularies such as LOINC, SNOMED, ICD-9, ICD10 and RxNORM have been
> > > > added to OpenMRS.
> > > >
> > > > Strangely, I tried creating a Visit Note, and could not find an ICD
> > > > coded "Diabetes Mellitus", which is supposed to be mapped in ICD-10 as E10 \
> > > > (http://apps.who.int/ classifications/icd10/browse/ 2010/en#/E10-E14
> > > > <http://www.google.com/url?q=http%3A%2F%2Fapps.who.int%2Fclassifications%2Ficd \
> > > > 10%2Fbrowse%2F2010%2Fen%23%2FE10-E14&sa=D&sntz=1&usg=AFQjCNGRIi4M5dCUbtBqqbnjW8SeAxJwyg>
> > > > )
> > > >
> > > > When I try to place a diagnosis of Hypertension, the appropriate ICD
> > > > code shows up for it. Unfortunately, many other diagnosis are not showing
> > > > up like Glaucoma, and Renal diagnoses.
> > > >
> > > > Is OpenMRS using an incomplete, non-comprehensive list of ICD codes? Is
> > > > it the task of the physician to add each and every concept here \
> > > > http://apps.who.int/ classifications/icd10/browse/ 2010/en
> > > > <http://www.google.com/url?q=http%3A%2F%2Fapps.who.int%2Fclassifications%2Ficd10%2Fbrowse%2F2010%2Fen&sa=D&sntz=1&usg=AFQjCNHC-1EWqjc8yKmsQAJ3Xpg3GLhX7A> \
> > > > ?
> > > >
> > > >
> > > > As a physician, I feel that this may be a limitation. I could not find
> > > > any way to integrate or add the full ICD-10 to the visit note, or the
> > > > concept dictionary (which I downloaded, and saw that it only had less than
> > > > 300 entries)
> > > >
> > > > Thank you for your time and efforts! I do hope that there is an answer
> > > > to this, and my lack of experience is the root of the problem.
> > > >
> > > > Very truly yours,
> > > > Raymonde Uy, MD/MBA
> > > > --
> > > > OpenMRS Implementers: http://go.openmrs.org/ implementers
> > > > <http://go.openmrs.org/implementers>
> > > > Post: implem...@openmrs.org
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> > > >
> > > >
> > > >
> > > > --
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> > > >
> > > >
> > > >
> > > --
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> > Post: implem...@openmrs.org <javascript:>
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> >
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> >
>
>
--
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Unsubscribe: implementers+unsubscribe@openmrs.org
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[Attachment #3 (text/html)]
<div dir="ltr">Darius,<div><br></div><div>Thank you for your reply! I really want to \
test this out, and possibly have some clinicians test it in their \
settings.</div><div><br></div><div><span style="color: rgb(51, 51, 51); font-family: \
Arial, sans-serif; font-size: 14.399999618530273px; line-height: 16px;">Currently the \
latest concept dictionary is saved in the CIEL dropbox, which if I may politely ask \
Dr. Kanter if I could possible get access? :)</span></div><div><br></div><div>Lots of \
thanks and appreciation.</div><div><br></div><div>Sincerely,</div><div>Raymonde</div><div><br></div><div><br>On \
Thursday, August 21, 2014 8:16:59 PM UTC-4, Darius Jazayeri wrote:<blockquote \
class="gmail_quote" style="margin: 0;margin-left: 0.8ex;border-left: 1px #ccc \
solid;padding-left: 1ex;"><div dir="ltr">Hi Raymonde,<div><br></div><div>I didn't \
record the video, Burke did, and he's a clinician. :-)</div><div><br></div><div>The \
search mostly works as you say: when you type more words it filters down, and it's \
limited to 50 total results (or something like that) for performance reasons.</div>
<div><br></div><div>If you want to test it out yourself, it should be enough \
to:</div><div>1. Install OpenMRS 2.0</div><div>2. Install the CIEL dictionary on top \
of that (by running the SQL script)</div><div>3. Install the <a \
href="https://issues.openmrs.org/secure/attachment/41823/coreapps-1.2.1.omod" \
target="_blank" onmousedown="this.href='https://www.google.com/url?q\75https%3A%2F%2Fi \
ssues.openmrs.org%2Fsecure%2Fattachment%2F41823%2Fcoreapps-1.2.1.omod\46sa\75D\46sntz\0751\46usg\75AFQjCNHdsyTge8W39t1WBkKotODtSv3FmQ';return \
true;" onclick="this.href='https://www.google.com/url?q\75https%3A%2F%2Fissues.openmrs \
.org%2Fsecure%2Fattachment%2F41823%2Fcoreapps-1.2.1.omod\46sa\75D\46sntz\0751\46usg\75AFQjCNHdsyTge8W39t1WBkKotODtSv3FmQ';return \
true;">modified version</a> of the coreapps module that's attached to the RA-332 \
ticket</div>
<div><br></div><div>And voila.</div><div><br></div><div>I agree that this is a \
completely solvable problem, we just need to decide how to approach it from the \
perspective of (a) what to include with OpenMRS 2.x out of the box, and (b) how to \
improve the search UI. And someone needs to do the work. :-)</div>
<div><br></div><div>-Darius</div></div><div><br><br><div class="gmail_quote">On Thu, \
Aug 21, 2014 at 4:57 PM, Raymonde Uy <span dir="ltr"><<a href="javascript:" \
target="_blank" gdf-obfuscated-mailto="j9VpLvlslTYJ" \
onmousedown="this.href='javascript:';return true;" \
onclick="this.href='javascript:';return true;">demo...@gmail.com</a>></span> \
wrote:<br>
<blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc \
solid;padding-left:1ex"><div dir="ltr">Darius,<br><br>The video that you linked is \
actually pretty ok! It's a lot better than not having any coded diagnosis! :)<br>
<br>Have you tried narrowing the search terms down, so that it does not yield that \
many results?<br>For example: instead of just using "diabetes", how about "Diabetes \
Mellitus type II".<br>"Malignant hypertension" instead of just "hypertension"<br>
<br>Do the search results get smaller?<br>How about a way to order the search results \
by category?<br><br>When a physician decides on his or her primary diagnostic \
impression, they usually have it narrowed down anyway. It's all about the search \
terms, and their familiarity with how ICD codes are named. Placing your diagnosis as \
just "diabetes mellitus" instead of a more complete diagnosis which indicates for \
"controlled/uncontrolled" / "insulin-dependent/<wbr>independent" is lazy on the \
physician's part.<br>
<br>When a physician does type in a general term, and not a specific term, having a \
manageable amount of search results (20-50?) may also help in assisting the physician \
in considering the other more specific diagnosis, which then helps in learning ICD-10 \
codes through experience, and may be value adding in formulating their differential \
diagnosis.<br>
<br>Thanks for all the hard work! Tell me what you guys think.<br><br>I will try to \
incorporate the full CIEL dictionary in my current work-in-progress.<br><br>Thank you \
also for the response Andy regarding what "fully specified" meant, and it was my \
mistake of not being clear about it in my first post. I fully understand that the \
parent category cannot be used as the coded diagnosis if there are more specific, \
child diagnosis under them. I just really want the stand-alone OpenMRS 2.0 to have a \
bigger concept dictionary. As it stands, physicians in rural communities who want to \
try OpenMRS in their small clinic will not be able to find the coded diagnosis in \
writing their visit notes.<br>
<br>Thank you for your time!<br><br>Sincerely Yours,<br>Raymonde<div><br><br><br>On \
Thursday, August 21, 2014 6:23:28 PM UTC-4, Darius Jazayeri wrote:</div><blockquote \
class="gmail_quote" style="margin:0;margin-left:0.8ex;border-left:1px #ccc \
solid;padding-left:1ex">
<div><div dir="ltr">The reference application (currently) makes available as visit \
diagnoses concepts that are in a concept set of concept \
sets. <div><br></div><div>This code is contributed from Mirebalais, where the \
clinical teams wanted to define their own sets of available diagnoses, and didn't \
want the noise of lots of other diagnoses creeping in.</div>
<div><br></div><div>Out of the box in OpenMRS 2.0 this is the ICPC diagnoses, but \
there's a global property (emr.concept.<u></u>diagnosisSetOfSet<wbr>s) you could use \
to point to a different set-of-sets if you created one.</div>
<div>
<br></div><div>It would be a trivially small change in the code to search diagnoses \
based on concept class of diagnosis, symptom, finding, or symptom/finding (<a \
href="https://issues.openmrs.org/browse/RA-332" target="_blank" \
onmousedown="this.href='https://www.google.com/url?q\75https%3A%2F%2Fissues.openmrs.or \
g%2Fbrowse%2FRA-332\46sa\75D\46sntz\0751\46usg\75AFQjCNE1FkXsmGhYp_S1lINWvsZr15RkVw';return \
true;" onclick="this.href='https://www.google.com/url?q\75https%3A%2F%2Fissues.openmrs \
.org%2Fbrowse%2FRA-332\46sa\75D\46sntz\0751\46usg\75AFQjCNE1FkXsmGhYp_S1lINWvsZr15RkVw';return \
true;">RA-332</a> is about testing this) but per our research the user experience if \
we do this with the full CIEL dictionary is quite bad (<a \
href="http://youtu.be/GkKAGgwfATo" target="_blank" \
onmousedown="this.href='http://youtu.be/GkKAGgwfATo';return true;" \
onclick="this.href='http://youtu.be/GkKAGgwfATo';return true;">this video</a>, which \
you Andy already commented on).</div>
<div><br></div><div>We're supposed to discuss this on an upcoming design call, but \
this didn't get scheduled. I will email you, Burke, and Jonathan separately to find a \
date we can all make it, and then we can communicate it more broadly.</div>
<div><br></div><div>-Darius</div><div><div><br></div></div></div></div><div><br><br><div \
class="gmail_quote"><div>On Thu, Aug 21, 2014 at 2:31 PM, Andrew Kanter <span \
dir="ltr"><<a>andy_...@yahoo.com</a>></span> wrote:<br>
</div><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc \
solid;padding-left:1ex"><div><div \
style="color:#000;background-color:#fff;font-family:HelveticaNeue,Helvetica \
Neue,Helvetica,Arial,Lucida Grande,sans-serif;font-size:14pt">
<div>
<div><span>Raymonde, </span></div><div \
style="color:rgb(0,0,0);font-size:19px;font-family:HelveticaNeue,'Helvetica \
Neue',Helvetica,Arial,'Lucida \
Grande',sans-serif;background-color:transparent;font-style:normal">
<span>I think your major problem is that the current version of the reference \
application is not accessing the full CIEL dictionary... but to answer your other \
question:</span></div><div \
style="color:rgb(0,0,0);font-size:19px;font-family:HelveticaNeue,'Helvetica \
Neue',Helvetica,Arial,'Lucida \
Grande',sans-serif;background-color:transparent;font-style:normal">
<span><br></span></div><div \
style="color:rgb(0,0,0);font-size:19px;font-family:HelveticaNeue,'Helvetica \
Neue',Helvetica,Arial,'Lucida \
Grande',sans-serif;background-color:transparent;font-style:normal">Fully-specified \
code is one where all digits are provided. In ICD, if a code exists with another \
digit, then you cannot use the code without that digit. Since there are E14.x codes, \
you cannot use E14. If there is an E14.8x you would not be able to use E14.8. These \
intermediate codes (E14 and E14.8 in my examples) are navigational or categorical \
only and should not be used to capture information.</div>
<div style="color:rgb(0,0,0);font-size:19px;font-family:HelveticaNeue,'Helvetica \
Neue',Helvetica,Arial,'Lucida \
Grande',sans-serif;background-color:transparent;font-style:normal"><br></div><div \
style="color:rgb(0,0,0);font-size:19px;font-family:HelveticaNeue,'Helvetica \
Neue',Helvetica,Arial,'Lucida \
Grande',sans-serif;background-color:transparent;font-style:normal">
<span style="font-weight:bold">Darius</span>, I don't think I understood that the \
reference app could not take advantage of the full CIEL dictionary for diagnoses at \
this time. Is that because the UI is only leveraging the ICPC list of diagnoses? Do \
we need to have folks add dx to a set to show, or should the reference app search all \
concepts with a finding/diagnosis category?</div>
<div><div style="color:rgb(0,0,0);font-size:19px;font-family:HelveticaNeue,'Helvetica \
Neue',Helvetica,Arial,'Lucida \
Grande',sans-serif;background-color:transparent;font-style:normal"><br></div><div \
style="color:rgb(0,0,0);font-size:19px;font-family:HelveticaNeue,'Helvetica \
Neue',Helvetica,Arial,'Lucida \
Grande',sans-serif;background-color:transparent;font-style:normal">
Andy</div><div></div><div> </div><div><b>-------------------- <br>Andrew S. \
Kanter, MD MPH FACMI<br><span \
style="font-weight:normal"><b><br></b></span></b></div><div \
style="color:rgb(0,0,0);font-size:13px;font-family:arial,helvetica,clean,sans-serif;background-color:transparent;font-style:normal">
Asst. Prof. of Clinical Biomedical Informatics and Clinical \
Epidemiology<br></div></div></div><div \
style="color:rgb(0,0,0);font-size:13px;background-color:transparent;font-style:normal;font-family:arial,helvetica,clean,sans-serif">
Columbia University<br>Email: <a>andrew...@dbmi.columbia.<u></u>edu</a> \
<br><div><div>Mobile: <a value="+16464692421">+1 (646) 469-2421</a><br>
Office: <a value="+12123054842">+1 (212) 305-4842</a><br>Skype: \
akanter-ippnw<br>Yahoo: andy_kanter</div></div></div> <div><br><br></div><div \
style="display:block"> <div style="font-family:HelveticaNeue,'Helvetica \
Neue',Helvetica,Arial,'Lucida Grande',sans-serif;font-size:14pt">
<div style="font-family:HelveticaNeue,'Helvetica Neue',Helvetica,Arial,'Lucida \
Grande',sans-serif;font-size:12pt"><div><div><div><div> <div dir="ltr"> <font \
face="Arial"> On Thursday, August 21, 2014 2:08 PM, Raymonde Uy \
<<a>demo...@gmail.com</a>> wrote:<br>
</font> </div> </div></div></div></div><blockquote style="border-left:2px solid \
rgb(16,16,255);margin-left:5px;margin-top:5px;padding-left:5px"> <br><br> \
<div><div><div><div dir="ltr"><div><div><div><div><font size="4">Dear Dr. \
Kanter, </font><div>
<font size="4"><br clear="none"></font></div><div><font size="4">Thank you very much \
for your very swift reply! </font></div><div><font size="4"><br \
clear="none"></font></div><div><font size="4">What does it mean when you say \
fully-specified? I'm assuming that these are codes that do not have "unspecified" in \
the code, or are vague.</font></div>
<div><font size="4"><br clear="none"></font></div><div><font size="4">About Diabetes \
Mellitus, the ICD-10 code <b>E14.9</b> is in the parent code E14 <b><u>Unspecified \
</u>diabetes mellitus </b>with E14.9 <b><u>Unspecified </u>diabetes mellitus \
without complications</b></font></div>
<div><font size="4"><br clear="none"></font></div><div><font size="4">Doesn't this \
mean that it is not fully-specified?</font></div><div><font size="4">Diagnosis of \
Diabetes Mellitus is usually specified as insulin dependent (type I) or non-insulin \
dependent (type II), which are fully specified codes E10 Insulin-dependent diabetes \
mellitus and E11 Non-insulin-dependent diabetes mellitus; with appropriate CIEL codes \
in <a href="http://maternalconceptlab.com" target="_blank" \
onmousedown="this.href='http://www.google.com/url?q\75http%3A%2F%2Fmaternalconceptlab.com\46sa\75D\46sntz\0751\46usg\75AFQjCNHvu0aBLziJMx90USJWXWKMrY2U8g';return \
true;" onclick="this.href='http://www.google.com/url?q\75http%3A%2F%2Fmaternalconceptlab.com\46sa\75D\46sntz\0751\46usg\75AFQjCNHvu0aBLziJMx90USJWXWKMrY2U8g';return \
true;">http://maternalconceptlab.<u></u>c<wbr>om</a> </font></div>
<div><font size="4"><br clear="none"></font></div><div><font size="4">Lastly, in the \
demo and downloaded standalone versions of OpenMRS 2.0, this is what shows up in \
placing Diabetes as a diagnosis. Why isn't it showing up with an appropriate ICD \
code? It only has a SNOMED code in the concepts dictionary.</font></div>
<div style="text-align:center;clear:both"><a rel="nofollow" shape="rect" \
href="https://lh5.googleusercontent.com/-Kyyhiqn1DAw/U_ZCipZ8f8I/AAAAAAAALVs/2wv7-sDdm98/s1600/DM.JPG" \
style="clear:left;margin-bottom:1em;float:left;margin-right:1em" target="_blank" \
onmousedown="this.href='https://lh5.googleusercontent.com/-Kyyhiqn1DAw/U_ZCipZ8f8I/AAAAAAAALVs/2wv7-sDdm98/s1600/DM.JPG';return \
true;" onclick="this.href='https://lh5.googleusercontent.com/-Kyyhiqn1DAw/U_ZCipZ8f8I/AAAAAAAALVs/2wv7-sDdm98/s1600/DM.JPG';return \
true;"><font size="4"><img border="0"></font></a></div>
<div><font size="4"><br clear="none"></font></div><div><font size="4"><br \
clear="none"></font></div><div><font size="4"><br \
clear="none"></font></div><div><font size="4"><br \
clear="none"></font></div><div><font size="4"><br clear="none">
</font></div><div><font size="4"><br clear="none"></font></div><div><font \
size="4"><br clear="none"></font></div><div><font size="4"><br \
clear="none"></font></div><div><font size="4"><br \
clear="none"></font></div><div><font size="4"><br clear="none">
</font></div><div><font size="4"><br clear="none"></font></div><div><font \
size="4"><br clear="none"></font></div><div><font size="4"><br \
clear="none"></font></div><div><span style="font-size:large">Is it possible to use \
the full dictionary in the current version?</span><br clear="none"></div><div><font \
size="4"><br clear="none"></font></div><div><font size="4">Again, thank you so much \
for the hard work and support you and your team have given in support of \
OpenMRS!</font></div>
<div><font size="4"><br clear="none"></font></div><div><font size="4">Very Truly \
Yours,</font></div><div><font size="4">Raymonde</font></div><div><br \
clear="none"></div><div>---</div><div><br clear="none"></div></div></div>
</div></div><div><div><div><div><div><div>Raymonde C. Y. Uy, \
MD/MBA</div><div>Postdoctoral Research Fellow</div><div>Medical Informatics Training \
Program</div><div>Office of High Performance Computing and Communications</div>
<div>Lister Hill National Center for Biomedical Communications</div>
<div>U.S. National Library of Medicine, National Institutes of Health</div><div>8600 \
Rockville Pike</div><div>Bldg. 38A, Room B1N30A18</div><div>Bethesda, MD, \
20894</div><div><a value="+13014024100">+1 (301) 402-4100</a> [Main]</div>
<div><a value="+13014027851">+1 (301) 402-7851</a> [Direct]</div><div><a \
value="+13014024080">+1 (301) 402-4080</a> \
[Fax]</div></div></div><div><a>RaymondeC...@nih.gov</a></div><div><div><div><br \
clear="none"></div><div><br clear="none"></div><div><br clear="none"></div><br \
clear="none">On Wednesday, August 20, 2014 5:39:59 PM UTC-4, Andrew Kanter \
wrote:</div>
</div></div>
</div><div><div><blockquote style="margin:0;margin-left:0.8ex;border-left:1px #ccc \
solid;padding-left:1ex"><div><div \
style="color:rgb(0,0,0);background-color:rgb(255,255,255);font-family:HelveticaNeue,'Helvetica \
Neue',Helvetica,Arial,'Lucida Grande',sans-serif;font-size:14pt">
<div><div><div><span style="font-size:14pt">Raymonde,</span><br \
clear="none"></div><div>Only fully-specified, valid ICD-10 codes are included mapped \
to diagnoses in the full CIEL dictionary. Prefix codes, or code ranges will not be \
included. In addition, it depends whether you are using the full dictionary or only \
the minimal data as part of the reference application. </div>
<div><br clear="none"></div><div>For Diabetes Mellitus, the
correct ICD-10 code is E14.9.</div><div><br clear="none"></div><div>If you go to <a \
rel="nofollow" shape="rect" \
href="http://www.google.com/url?q=http%3A%2F%2Fmaternalconceptlab.com&sa=D&sntz=1&usg=AFQjCNHvu0aBLziJMx90USJWXWKMrY2U8g" \
target="_blank" onmousedown="this.href='http://www.google.com/url?q\75http%3A%2F%2Fmat \
ernalconceptlab.com\46sa\75D\46sntz\0751\46usg\75AFQjCNHvu0aBLziJMx90USJWXWKMrY2U8g';return \
true;" onclick="this.href='http://www.google.com/url?q\75http%3A%2F%2Fmaternalconceptlab.com\46sa\75D\46sntz\0751\46usg\75AFQjCNHvu0aBLziJMx90USJWXWKMrY2U8g';return \
true;">maternalconceptlab.com</a> and type in the ICD-10 codes you will find the \
terms.</div>
<div><br clear="none"></div><div>Andy</div><div><b>-------------------- <br \
clear="none">Andrew S. Kanter, MD MPH FACMI<br clear="none"><span \
style="font-weight:normal"><b><br clear="none"></b></span></b></div><div \
style="color:rgb(0,0,0);font-size:13px;font-family:arial,helvetica,clean,sans-serif;background-color:transparent;font-style:normal">
Asst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology<br \
clear="none"></div><div \
style="color:rgb(0,0,0);font-size:13px;background-color:transparent;font-style:normal;font-family:arial,helvetica,clean,sans-serif">
Columbia
University<br clear="none">Email: <a rel="nofollow" \
shape="rect">andrew...@dbmi.columbia. edu</a> <br clear="none">Mobile: <a \
value="+16464692421">+1 (646) 469-2421</a><br clear="none">
Office: <a value="+12123054842">+1 (212) 305-4842</a><br clear="none">Skype: \
akanter-ippnw<br clear="none">Yahoo: andy_kanter</div> <div><br clear="none"><br \
clear="none">
</div></div></div><div style="display:block"> <div \
style="font-family:HelveticaNeue,'Helvetica Neue',Helvetica,Arial,'Lucida \
Grande',sans-serif;font-size:14pt"> <div style="font-family:HelveticaNeue,'Helvetica \
Neue',Helvetica,Arial,'Lucida Grande',sans-serif;font-size:12pt">
<div><div> <div dir="ltr"> <font face="Arial"> On Wednesday, August 20, 2014 4:21 PM, \
Raymonde Uy <<a rel="nofollow" shape="rect">demo...@gmail.com</a>> wrote:<br \
clear="none"> </font> </div> </div></div><blockquote style="border-left:2px solid \
rgb(16,16,255);margin-left:5px;margin-top:5px;padding-left:5px"> <br \
clear="none"><br clear="none"> <div><div><div dir="ltr"><div>
<div>Greetings of Peace!<br clear="none"><br clear="none">I currently installed \
OpenMRS 2.0, and have also been playing around the online demo version.<br \
clear="none"><br clear="none">I have been exploring the concept dictionaries. It was \
mentioned that the vocabularies such as LOINC, SNOMED, ICD-9, ICD10 and RxNORM have \
been added to OpenMRS.<br clear="none">
<br clear="none">Strangely, I tried creating a Visit Note, and could not find an ICD \
coded "Diabetes Mellitus", which is supposed to be mapped in ICD-10 as E10 (<a \
rel="nofollow" shape="rect" \
href="http://www.google.com/url?q=http%3A%2F%2Fapps.who.int%2Fclassifications%2Ficd10% \
2Fbrowse%2F2010%2Fen%23%2FE10-E14&sa=D&sntz=1&usg=AFQjCNGRIi4M5dCUbtBqqbnjW8SeAxJwyg" \
target="_blank" onmousedown="this.href='http://www.google.com/url?q\75http%3A%2F%2Fapp \
s.who.int%2Fclassifications%2Ficd10%2Fbrowse%2F2010%2Fen%23%2FE10-E14\46sa\75D\46sntz\0751\46usg\75AFQjCNGRIi4M5dCUbtBqqbnjW8SeAxJwyg';return \
true;" onclick="this.href='http://www.google.com/url?q\75http%3A%2F%2Fapps.who.int%2Fc \
lassifications%2Ficd10%2Fbrowse%2F2010%2Fen%23%2FE10-E14\46sa\75D\46sntz\0751\46usg\75AFQjCNGRIi4M5dCUbtBqqbnjW8SeAxJwyg';return \
true;">http://apps.who.int/ classifications/icd10/browse/ 2010/en#/E10-E14</a>)<br \
clear="none">
<br clear="none">When I try to place a diagnosis of Hypertension, the appropriate ICD \
code shows up for it. Unfortunately, many other diagnosis are not showing up like \
Glaucoma, and Renal diagnoses.<br clear="none"><br clear="none">
</div></div>Is OpenMRS using an incomplete,
non-comprehensive list of ICD codes? Is it the task of the physician to add each and \
every concept here <a rel="nofollow" shape="rect" \
href="http://www.google.com/url?q=http%3A%2F%2Fapps.who.int%2Fclassifications%2Ficd10% \
2Fbrowse%2F2010%2Fen&sa=D&sntz=1&usg=AFQjCNHC-1EWqjc8yKmsQAJ3Xpg3GLhX7A" \
target="_blank" onmousedown="this.href='http://www.google.com/url?q\75http%3A%2F%2Fapp \
s.who.int%2Fclassifications%2Ficd10%2Fbrowse%2F2010%2Fen\46sa\75D\46sntz\0751\46usg\75AFQjCNHC-1EWqjc8yKmsQAJ3Xpg3GLhX7A';return \
true;" onclick="this.href='http://www.google.com/url?q\75http%3A%2F%2Fapps.who.int%2Fc \
lassifications%2Ficd10%2Fbrowse%2F2010%2Fen\46sa\75D\46sntz\0751\46usg\75AFQjCNHC-1EWqjc8yKmsQAJ3Xpg3GLhX7A';return \
true;">http://apps.who.int/ classifications/icd10/browse/ 2010/en</a> ?<div>
<br clear="none"><br clear="none">As a physician, I feel that this may be a \
limitation. I could not find any way to integrate or add the full ICD-10 to the visit \
note, or the concept dictionary (which I downloaded, and saw that it only had less \
than 300 entries)<br clear="none">
<br clear="none">Thank you for your time and efforts! I do hope that there is an \
answer to this, and my lack of experience is the root of the problem.<br \
clear="none"><br clear="none">Very truly yours,<br clear="none">Raymonde Uy, \
MD/MBA<br clear="none">
</div></div><div>
-- <br clear="none">
OpenMRS Implementers: <a rel="nofollow" shape="rect" \
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onmousedown="this.href='http://www.google.com/url?q\75http%3A%2F%2Fgo.openmrs.org%2Fim \
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</div></div><div> </div></blockquote><div> </div></div><div> </div></div><div> \
</div></div><div> </div></div></div></blockquote></div></div></div></div><div><div><div><div>
-- <br clear="none">
OpenMRS Implementers: <a rel="nofollow" shape="rect" \
href="http://go.openmrs.org/implementers" target="_blank" \
onmousedown="this.href='http://www.google.com/url?q\75http%3A%2F%2Fgo.openmrs.org%2Fim \
plementers\46sa\75D\46sntz\0751\46usg\75AFQjCNExD4m2DMk0LRbCq6o9tLI1fOekoQ';return \
true;" onclick="this.href='http://www.google.com/url?q\75http%3A%2F%2Fgo.openmrs.org%2 \
Fimplementers\46sa\75D\46sntz\0751\46usg\75AFQjCNExD4m2DMk0LRbCq6o9tLI1fOekoQ';return \
true;">http://go.openmrs.org/<u></u>implemen<wbr>ters</a><br \
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Post: <a>implem...@openmrs.org</a><br clear="none">
Unsubscribe: <a>implementers...@<u></u>openmrs.org</a><div><br clear="none">
Manage your OpenMRS subscriptions at <a rel="nofollow" shape="rect" \
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</div></div></div></div></div><br><br></div> </blockquote> </div> </div> </div> \
</div></div></blockquote></div><br></div> </blockquote></div><div><div>
<p></p>
-- <br>
OpenMRS Implementers: <a href="http://go.openmrs.org/implementers" target="_blank" \
onmousedown="this.href='http://www.google.com/url?q\75http%3A%2F%2Fgo.openmrs.org%2Fim \
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Fimplementers\46sa\75D\46sntz\0751\46usg\75AFQjCNExD4m2DMk0LRbCq6o9tLI1fOekoQ';return \
true;">http://go.openmrs.org/<wbr>implementers</a><br>
Post: <a href="javascript:" target="_blank" gdf-obfuscated-mailto="j9VpLvlslTYJ" \
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<a href="https://id.openmrs.org/" target="_blank" \
onmousedown="this.href='https://www.google.com/url?q\75https%3A%2F%2Fid.openmrs.org%2F\46sa\75D\46sntz\0751\46usg\75AFQjCNGIvNkgnYKpjHWVydfcrUw7yKtiPA';return \
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</div></div></blockquote></div><br></div> </blockquote></div></div>
<p></p>
-- <br />
OpenMRS Implementers: <a \
href="http://go.openmrs.org/implementers">http://go.openmrs.org/implementers</a><br \
/>
Post: implementers@openmrs.org<br />
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