Multiple Provider Specialities

[clairblacketer]

TYPE	NOTES
ITEM	How do we handle providers with multiple specialties?
FORUM POST	http://forums.ohdsi.org/t/new-comprehensive-hierarchy-for-providers-visits-and-place-of-service-specialty-care-site/5633
SOLUTION	Currently there is a convention: A single Provider cannot be listed twice (be duplicated) in the table. If a Provider has more than one Specialty, the main or most often exerted specialty should be recorded.
NEXT STEPS	Understand from @cgreich how this should be working given what is now in the Vocabulary. Supposedly there is a hierarchy now.

[cgreich]

And how do we know if two records are the same guy?

[clairblacketer]

Same NPI or SOURCE_PROVIDER_ID?

[cgreich]

Ugly. We have the same NPI, but a different provider_id? Half of the folks will get confused.

[don-torok]

It would be nice to see an example. How is the provider defined in the medical encounters? Do you have both provider id and specialty or just a provider id? If the latter, then ETL will again have the problem of having to choose one or the other provider.
If it is necessary to maintain multiple provider specialties add a table provider_specialty (provider_id, specialty_concept_id, rank). You will still have the problem of choosing the primary specialty (which should also go into the provider table) but will as least be able to maintain the source information that provider has more that one specialty.

[cgreich]

Friends:

Here is what I will do. I will pull the list of these multiple-specialty docs and check it against the specialty hierarchy we are building. Because in the real world there are almost no true double-specialty docs. Trust me. It takes a lot of time, and a lot of training, and a lot of examinations, a lot of lost income to get there. What's happening a lot is like a "cardiologist" will also call himself "internist" in another circumstance. But of course cardiology is a subspecialty of internal medicine.

I will report back how bad the situation really is.

[stephanieshong]

a provider with a NPI number can be a care_site, a hospital, with multiple specialty associated with it. (i.e. outpatient specialty clinic, hospital and a hospice.)
a provider as a physician who took care of a patient can be medpeds in US, who is both internal medicine and pediatric specialty doctor.
Not being able to add specialty value associated with the same NPI is causing a problem both in provider and the care_site table.

[cgreich]

@stephanieshong:

• NPI: That is correct. In the CDM, we only collect Entity Type 1 providers: Individuals, including sole proprietors. And, to be honest, I think even that is TMI.
• Specialty of organizations: We do not model those. We had debates about that. It wouldn't work.
• Medical pediatrics: No problem adding that as a concept, as descendant of both Pediatric Medicine and Internal Medicine. Strangely, there is no such thing, even though we have tons of mixed pediatric specialties (look under "Subsumes").

[MelaniePhilofsky]

Closing this issue. Vocabulary and CDM conventions were updated.