PheDRS

Phenotype Detection Registry System (PheDRS) User Documentation

Overview

The Phenotype Detection Registry System (PheDRS) is a tool at UAB used to assist researchers and clinicians identify populations of interest at UAB matching clinical criteria from both structured data (billing codes, medications, labs) and unstructured documents using Natural Language Processing. The user documentation described here is intended for managers and users of the PheDRS system.

Additional documentation for PheDRS is found in the following locations:

1. Project specific information is found in the appropriate git repo wikis and markdown text

2. UAB specific developer documentation is found in the UAB_BioMedInformatics\PHEDRS Box directory

Installation / Setup

TODO

Currently this is very site specific and depends on various backend systems, EHR vendors, etc... UAB specific site setup can be found in the UAB_BioMedInformatics\PHEDRS Box directory

Roles

PheDRS supports the following user roles:

Manager

The manager of a registry. Full read and write access to the registry. Can add new users as registrars or managers to the registry.

Registrar

A user with read and write access to the registry.

Administrator

System administrator responsible for maintaining the entire PheDRS system including all registries.

Viewer

Read only access to the registry.

Inactive

Former registrars no longer active.

De-ID Viewer

Viewer allowed to view de-identified data (18 HIPAA Safe Harbor items removed) data.

Registry Configuration

The registry is configured by the registry manager, often in conjunction with the system administrator.

Registry Property Descriptions and Examples

Registry Configuration: Cvtermprop parameters

CV NAME	CV ID	Example of cvterm name for TYPE_ID	Meaning and Use of VALUE field for this type	Example of Value Field
UAB ICD-10-CM Codes	9	Panlobular emphysema	If patient has this billing code, assign as candidate to registry	UAB COPD Registry ICD-10-CM diagnosis criteria
UAB MS DRG Codes	12	COPD w CC	If patient has this DRG code, then add anchor cvterm property to this code	DRG Codes COPD Anchor Encounter criteria
		COPD w MCC	If patient has this DRG code, then add patient to the registry as "accepted"	UAB COPD Registry DRG Codes inclusion criteria
PHEDRS Data Loading Criteria	23	Default NLP Pipeline Collection	This is the ID# of the default pipeline for displaying documents in this registry. Unenforced Foreign Key to db_id=14	2
		Encounter Collection	Encounters matching the appended SQL criteria are added to the registry	AND (SRC_ADMIT_DT_TM >= (SYSDATE-730)) AND FORMATTED_MEDICAL_RECORD_NBR IN (SELECT FORMATTED_UAB_MRN FROM REGISTRY_PATIENT WHERE REGISTRY_ID=2861)
		Encounter Intervention	Encounters matching the appended SQL criteria are added to the registry AND candidate is flagged for review	AND SRC_ADMIT_DT_TM >= (SYSDATE-30) AND ( (reason_for_visit_txt LIKE '%COPD%') OR (UPPER(reason_for_visit_txt) LIKE '%BRONCHITIS%') OR (UPPER(reason_for_visit_txt) LIKE '%BRONCHIECTASIS%') OR (UPPER(reason_for_visit_txt) LIKE '%EMPHYSEMA%') )
PHEDRS MetaData CV	24	Patient Review Cutoff Date	Do not retrieve any data (codes, encounters, documents) from source system before this date	1/1/17
		Registry Application Title	Use this text here for the name of the registry	COPD Registry Control Panel
		Display Codes Database Identifier	DB_ID permissable to display in "Diagnoses and Drgs" Panel	8
PHEDRS Tab CV	25	REGISTRY_INPATIENT_REVIEW	Indicates that this tab should be displayed in this registry. Value indicates display order from LEFT to RIGHT (1 for leftmost tab)	1
Optum UAB APR DRG Codes 2017	26
UAB WH CLN REF Codeset 69	27

Developer Guide to PheDRS Data Loading Criteria

Data Loading Vocabulary

• Code - Structured data in the REGISTRY_PATIENT_CODES table including ICD-10-CM codes, DRG codes, MULTUM medication codes, etc...
• NLP - UMLS CUIs stored (currently) in the medics schema
• Encounter - Encounter data stored in REGISTRY_ENCOUNTER
• Detection - Indicates that detected patient will be added as candidates to a registry
• Intervention - Like detection, but the Intervention property will be set on the patient regardless of status
• Collection - The data type will be copied to the REGISTRY_PATIENT_CODES table or REGISTRY_ENCOUNTER from the appropriate ETL table

Data Loading Process

This table details how the PheDRS Data Loading Criteria ontology is used to by backend clients (controlled by loadAll.bsh) to set patient status and review status. Like other registry configuration criteria, the configuration information is stored in the cvterm and cvtermprop for that registry.

These scripts detect patients for the registry (updating status_id) and flag patients for review (updating review_status_id) when registry specific events occur based on registry configuration.

The server side process will never set the patient registry status to 'Under Review" or "Reviewed"

Criteria Name	Event Description	Input Patient Registry Status	Input Patient Review Status	Input REGISTRY _PATIENT _CVTERM	Output Patient Registry Status Change	Output Patient Review Status	Output REGISTRY _PATIENT _CVTERM	Action Description	Implementation Notes
Diagnosis (Code_Detection)	PATIENT_CODE entry hat matches diagnosis criteria in CVTERMPROP	NULL	NULL	NULL	CANDIDATE	NEVER REVIEWED	ANY	Add candidate	CVTERMs corresponding to codes have a CVTERMPROP set on them of type registry_name (from cv_id 11) with a value containing text "diagnosis criteria"
		Provisional	ANY	ANY	NO CHANGE	NEEDS REVIEW	ANY	Flag rejected and provisional candidates for review	Plan is to swap CVTERMs such that CVTERM_ID is the registry and the TYPE_ID is the code
		Candidate	ANY	ANY	NO CHANGE	NO CHANGE	ANY	Ignore diagnosis criteria on accepted patients
NLP_Detection	NLP_HITS_EXTENDED contains CUI with detection criteria	NULL	NULL	NULL	CANDIDATE	NEVER REVIEWED	ANY	Add candidate	CVTERMS corresponding to registries have a CVTERMPROP set on them with cvterm_id (registry_id), type_id (cvterm in NLP Pipeline Parameter Ontology) with value containing a UMLS CUI
		Provisional	ANY	ANY	NO CHANGE	NEEDS REVIEW	ANY	Flag rejected and provisional candidates for review	C98764323,C0012345,C0654321
		Candidate	ANY	ANY	NO CHANGE	NO CHANGE	ANY	Ignore detection criteria on accepted patients	Multiple CUIs are supported as additional rows in CVTERMPROP. Contextual CUIs are supported via commas
NLP_Intervention	NLP_HITS_EXTENDED	ANY	ANY	Requires Intervention	NO CHANGE (CANDIDATE IF NULL)	NO CHANGE	NO CHANGE		CVTERMS corresponding to registries have a CVTERMPROP set on them with cvterm_id (registry_id), type_id (cvterm in NLP Pipeline Parameter Ontology) with value containing a UMLS CUI
	contains CUI with	ANY	ANY	Intervention Complete < Encounter Date	NO CHANGE (CANDIDATE IF NULL)	NO CHANGE	Requires Intervention		C98764323,C0012345,C0654321
	intervention criteria	ANY	ANY	Any other current valid cvterms	NO CHANGE (CANDIDATE IF NULL)	NO CHANGE	Requires Intervention		Multiple CUIs are supported as additional rows in CVTERMPROP. Contextual CUIs are supported via commas
		ANY	ANY	Intervention Complete > Encounter Date	NO CHANGE (CANDIDATE IF NULL)	NO CHANGE	NO CHANGE		Compare date of code/encounter with the end(if not null) or start_date of the REGISTRY_PATIENT_CVTERM entry
Inclusion (Code Inclusion)	PATIENT_CODE entry that matches inclusion criteria in CVTERMPROP	All except Accepted	ANY	ANY	ACCEPTED	NEEDS REVIEW		DRG Codes generate automatic registry inclusion
		Accepted	ANY	ANY	NO CHANGE	NEEDS REVIEW
Eligibility	Custom	ANY	ANY	ANY	NO CHANGE	NO CHANGE	NO CHANGE	Machine learning of patient eligibility MACHINE_ACCEPTANCE_SCORE in REGISTRY_PATIENT is set to a non-zero value	Custom registry specific implementation that should result in a publication… :)
Code_Collection	None (daily)	Candidate	ANY	ANY	NO CHANGE	NO CHANGE	NO CHANGE	Specify data to collect for the registry	CVTERMPROP has cvterm_id (registry_id) and type_id (data source) and value which is a regular expression specifying code_values to collect from REGISTRY_PATIENT_CODES
		Accepted	ANY	ANY	NO CHANGE	NO CHANGE	NO CHANGE	Do not collect data unless patient is in registry
Encounter Collection	None (daily)	Candidate	ANY	ANY	NO CHANGE	NO CHANGE	NO CHANGE	Collect specified encounter data for people in the registry	CVTERMPROP has cvterm_id (registry_id) and type_id (sourcesystem_cd) and value in the format below
	Accepted	ANY	ANY	NO CHANGE	NO CHANGE	NO CHANGE		REGEX	REGEX….
Encounter Intervention	Encounter	ANY	ANY	Requires Intervention	NO CHANGE (CANDIDATE IF NULL)	NO CHANGE	NO CHANGE	Encounters matching criteria specified in CVTERM_PROP (which contains WHERE clause SQL) are loaded into REGISTRY_ENCOUNTERS	CVTERMPROP has cvterm_id (registry_id) and type_id (sourcesystem_cd) and value in SQL format
		ANY	ANY	Intervention Complete < Encounter Date	NO CHANGE (CANDIDATE IF NULL)	NO CHANGE	Requires Intervention
		ANY	ANY	Any other current valid cvterms	NO CHANGE (CANDIDATE IF NULL)	NO CHANGE	Requires Intervention
		ANY	ANY	Intervention Complete > Encounter Date	NO CHANGE (CANDIDATE IF NULL)	NO CHANGE	NO CHANGE	Flag patients for intervention
Encounter Detection	None	Encounter
Document Loading (deprecated)	Existence of documents	Accepted	ANY	ANY	NO CHANGE	NO CHANGE	NO CHANGE	Load NLP_DOCS from source systems for registry patients	Should be a default analysis type that is used for CVTERMPROP

Evidence Code Ontology

The evidence code ontology is used to describe how a patient's status in the registry (ACCEPTED, REJECTED, CANDIDATE OR PROVISIONAL) has been decided.

Evidence Code

Name	Short form	Interpretation
Referred	REF	Current patient registry status has been assigned manually
Algorithm Discovered Patient	ALG	Current patient registry status assigned by an algorithm
NLP Discovered Patient	NLP	Current patient registry status has been assigned on the basis of NLP processed text.
Code discovered patient	DIAG	Current patient registry status has been assigned on the basis of a structured code, ex) ICD-10-CM
Encounter Discovered Patient	ENC	Current patient registry status has been assigned on the basis of an encounter

Registry Cvtermprop Data Loading Values for Evidence Updating

Code Discovered Patients

• Registry cvtermprop value must end with "diagnosis criteria" or "inclusion criteria"

Encounter Discovered Patients

• Registry cvtermprop value must have criteria for "Encounter Intervention" or "Encounter Detection" and non-null SQL clause in the value field

NLP Discovered Patients

• Registry cvtermprop value must end with "NLP criteria" or "inclusion NLP criteria"

TODO - make separate CV for this