MIE's answers to the 24 WebChart data asks (billed visit code and mammogram results first)

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4/5
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3-5 giorni
Idoneità per principianti
35/100
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Documentazione
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Specificata chiaramente
Stato di attività
Attiva
Stack tecnologico
postgresql, typescript
Ambito
data, databases

Direzione di ricerca

Start with docs/OPEN_QUESTIONS.md and docs/WEBCHART_FHIR_MAPPING.md, then compare each listed ask with the WebChart proposals in this issue. Record each confirmed MIE answer in the relevant document and link it here, ticking the corresponding line. Done when the answers are documented and linked; many items depend on MIE replies, so this is a substantial coordination task.

Scritto dal modello di indicizzazione a partire dal testo della issue.

Descrizione

maui-pilot waiting webchart-convergence

On 2026-10-07 WorkWell sent MIE 24 questions about where WebChart stores what the five pilot measures read. On 2026-10-19 WorkWell added a proposed source for each, from the dev database. No MIE answer is recorded for any of them, and until now no issue tracked them. This issue is the place to record each answer as it comes in.

Each line gives the ask, then WorkWell's proposal (unconfirmed) or what is blocked. Tick a line when MIE answers it, and link where the answer is written down (usually docs/OPEN_QUESTIONS.md or docs/WEBCHART_FHIR_MAPPING.md).

First: these decide whether anyone enters a measure, or meets one

  • Billed visit code. Where office and outpatient visits (office, wellness, preventive, home health, telephone, virtual) record their billed visit code, finished status and dates, plus the practice's "Meaningful Use Visit Types" list. Proposal: encounters.visit_type and encounter_billing. Blocked: every trial encounter type is text with no code, so no patient enters any measure on WebChart data.
  • Where a mammogram result is charted (CMS125), and where CT colonography is (CMS130). Proposal: mammo_tracking, scanned MAMMO documents, or the procedure row; nothing found for CT colonography. Since 2026-11-05 a billed mammogram (CPT 77067 / HCPCS G0202) no longer counts as a result, so this answer decides whether live CMS125 can find anyone screened. Related: may a mapper supply Observation.category = imaging from a mammogram LOINC code? The shim and the dev-DB export emit observation rows with no category, and official CMS125 requires it (docs/OPEN_QUESTIONS.md 4.6).

The rest

  • Birth date and sex (all measures). Proposal: patients.birth_date, patients.sex; confirm the sex values.
  • Race and ethnicity (OMB category, detailed code). Proposal: patients.race plus the CDC Race and Ethnicity observations.
  • Measure-specific visits (nutrition for CMS122; depression-screen visits for CMS2; ESRD monthly and ED/inpatient stays for CMS165), with encounter class and discharge disposition.
  • How a visit's diagnosis is linked to the visit. Proposal: encounters_link to patient_conditions, or the encounter or billing diagnosis columns.
  • Inclusion diagnoses (diabetes, essential hypertension) with code, clinical and verification status, onset and end. Proposal: patient_conditions.
  • Exclusion diagnoses (hospice, palliative care Z51.5, frailty, advanced illness, mastectomy with side, colon cancer, pregnancy, ESRD, CKD 5, kidney transplant, bipolar). Proposal: patient_conditions; mastectomy from patient_procedures.
  • HbA1c or GMI results with value, status and date (CMS122). Proposal: observations by LOINC 4548-4.
  • FOBT/FIT and FIT-DNA results (CMS130). Proposal: observations by LOINC 2335-8 and related; no FIT-DNA code found. Most trial observations carry no code.
  • Procedures (colonoscopy, sigmoidoscopy, mastectomy, colectomy, kidney transplant, dialysis, hospice and palliative procedures, depression follow-up) with code, completed status and date. Proposal: patient_procedures.
  • How blood pressure is stored (CMS165). FHIR serves a panel with status: unknown, which the measure rejects (#591).
  • How a depression screening result is stored as coded positive or negative (CMS2). PHQ-2/PHQ-9 are free-text observations with no LOINC.
  • Depression follow-up within 2 days of the visit: referral, follow-up procedure or antidepressant order (CMS2). Proposal: encounter_orders, order_requests, rxlist.
  • How a screening not done, with its reason, is recorded (CMS2). No dedicated field found.
  • Where hospice is recorded (visit, order, procedure, the "hospice: yes" assessment 45755-6, diagnosis, discharge to hospice). Proposal: the "Hospice Care" observation and hospice care-team roles.
  • Where palliative care is recorded (FACIT-Pal assessment, Z51.5, visit, intervention). Proposal: Z51.5 in patient_conditions only.
  • Medications with RxNorm code, status, dates and supply. Proposal: rxlist, which has no RxNorm or days-supply column; trial medications are coded in FDDC.
  • Frailty (walker, wheelchair or oxygen orders, assessment 98181-1, frailty diagnoses, home-aide visits, symptoms). No device orders found.
  • Long-term nursing-home residence (housing status 71802-3). The question exists, but it has no nursing-home answer.
  • Coverage and payer type (Source of Payment Typology) and its period. Proposal: insurance_policy and insurance_plans.insurance_type_code. See #893.
  • Things that make the two systems' numbers differ although no measure reads them: the "Exclude from Quality Care" flag (what is it called?), scanned screening documents, and the PCP (proposal: user_patients role 290).
  • Which version of WebChart's CMS measure reports the practice runs (the trial instance has NQF-era v4/v5), and whether its per-patient results table measure_calc can be read.
  • Whether WebChart deliberately skips the hospice, palliative care, frailty, nursing-home, medication and coverage exclusions. None of its five CMS reports reads them, so rates will differ by design.

The CMS137-only parts of the original asks (detox, inpatient and ED visits; substance-use diagnoses and drug orders) are dropped: CMS137 was retired on Maui on 2026-11-05 (#889).

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