Pain Management at SD IHS Emergency Departments
| Tracking # |
22-032 |
| Submitted | Nov. 23, 2021 |
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Communications
From: Cully Williams
To Whom It May Concern:
Pursuant to the Freedom of Information Act, I hereby request the following records:
For this request, I'm requesting data from all IHS Emergency Departments in South Dakota, and from the past 2 years, broken down by year.
I'm requesting a breakdown of (1) the total number of patients discharged from (or presented to, if easier) the Emergency Department, (2) number of patients discharged that presented with or were found to have a complaint of pain (either new or a chronic pain that is acutely worse) that was not believed to be cardiac related, (3) number of "pain patients" that were given IV pain management, and (4) number of pain patients that were discharged home with a new prescription for a pain management medication not available over-the-counter.
Loosely, the table I'm looking to fill in would have five columns: facility, annual volume, pain patient volume, pain medication given in-facility, prescription given for pain medication for after discharge. I'm familiar with SQL and data management techniques, so the data need not be structured in any specific way. So long as it is present, I'll make it work.
If the total patient population in (2) is too cumbersome to sort through, I will happily provide a list of ICD10 codes or similar at your request.
Ideally, I'd like to see a sixth column in that table, containing an associative array with the specific pain medications given and the number of patients that were given each medication in-house, but I'm not sure this data is accessible.
While this request is on my own behalf, I am employed by an IHS 638 contractor, and if a pathway exists for me to be able to access this data and other data like it without direct involvement and work on other individuals, I'd be more than happy to go that route instead.
The requested documents will be made available to the general public, and this request is not being made for commercial purposes.
In the event that there are fees, I would be grateful if you would inform me of the total charges in advance of fulfilling my request. I would prefer the request filled electronically, by e-mail attachment if available or CD-ROM if not.
Thank you in advance for your anticipated cooperation in this matter. I look forward to receiving your response to this request within 20 business days, as the statute requires.
Sincerely,
Cully Williams
From: Indian Health Service
Cully Williams,
Good morning!
We received your FOIA request and attached is our acknowledgment letter which includes your FOIA case number: 22-032.
I am the Government Information Specialist assigned to your FOIA case.
Please refer to your FOIA case number when checking on the status of your request. If you have any questions please contact me.
Thank you.
Respectfully,
David Meservey
Government Information Specialist/FOIA
Indian Health Service
5600 Fishers Lane
Rockville, MD 20857
IHSFOIAMailbox@ihs.gov<mailto:IHSFOIAMailbox@ihs.gov>
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Freedom of Information Act Request: Pain Management at SD IHS Emergency Departments
From: Muckrock Staff
To Whom It May Concern:
I wanted to follow up on the following Freedom of Information Act request, copied below, and originally submitted on Nov. 23, 2021. Please let me know when I can expect to receive a response.
Thanks for your help, and let me know if further clarification is needed.
From: Indian Health Service
Mr. Williams,
Good morning!
We are unable to provide an expected completion date at this time. This request requires additional clarification before we can collect the requested data. As you may already know, the information is not contained in one single document but rather in multiple electronic databases that are integrated with other patient care data elements. Nor is this a topic for which reports are currently generated. In order to extract this information, in the manner you requested, we would need to identify specific data elements (i.e. narrow the scope) to assist us in creating a database report. As you noted in your request, this may be a cumbersome report given the associated ICD-10 codes and other data elements, e.g. the number of pain medication currently available (see attached list). In addition, each facility will have its own database from which to extract the data.
Our Statistician has identified some additional needs for specific data elements to help design a report. In order to fulfill this request, we would need the following:
- (for #2) ICD-10 codes for "complaint of pain (either new or a chronic pain that is acutely worse)" and ICD-10 codes for exclusions for "cardiac related"
- (for #3) Determination of what is a "pain patient" to include diagnosis codes or a searchable criteria
- (for #3) medication list of IV pain medication
- (for #4) medication list to meet this criteria
Also, you stated you work for an IHS Service Unit and are familiar with the electronic database (RPMS-EHR) we use. We would like to request you provide a sample database report with the data elements you would like to review. Our Statistician has identified QMAN, VGEN or PGEN as sources for this report. If you are unable to provide a sample report then we will use the data elements you provide from those requested above to create and run the reports at each facility.
Please let me know if you have any questions or if you would like to discuss this topic via a telephone call. Thank you.
Respectfully,
David Meservey
Government Information Specialist/FOIA
Indian Health Service
5600 Fishers Lane
Rockville, MD 20857
IHSFOIAMailbox@ihs.gov<mailto:IHSFOIAMailbox@ihs.gov>
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Opioid Meds by NDC
From: Cully Williams
Mr. Meservey,
Thank you for your reply. In the process of developing the clarifications you need, I worked on a somewhat better way to make the request (in effect, the same request), and structure the data in a way that hopefully doesn't elicit your statistician into violent crimes. To that end, attached is "reference_book.xlsx" containing a few sheets to help clarify my request.
In my original request, I described a five-column table. I redid that, and sketched that up to illustrate what I'm going for. It is in the XLSX as "Example Results Table" and shows each column as a data point for each facility, as well as a descriptor for that data point. Annual ED Volume remains unchanged. A "pain patient" definition is provided as a sheet in the XLSX as "Inclusion Criteria". Note that I have ICD10 codes in there, but I also added a pain scale score of 8/10 or higher as I can imagine ICD10 diagnoses may leave out pain diagnoses when describing the ailment.
Getting back to the Example Results Table, you will find five columns, designed in a tiered system of sorts based around what medication was provided to the patient. Those five medication types are: OTC, oral non-narcotic, oral narcotic, IV non-narcotic, and IV narcotic. Each of these subsets of patients may have been prescribed some form of home medication, and this is the next column. The medications that qualify for each of these columns is described better below. The intent with this style of asking is to produce something similar to the attached PNG of a Sankey chart, dubbed the "sankey of pain". While the rightmost part of the Sankey would be cool, I don't think it's worth the time.
The final column of this table is IV narcotics given prior to arrival by EMS. The implication with this is that the other five columns are all medications administered by the Emergency Department. With the variability in EMS charting software and likely nonexistent integration with anything outside of EMS, I would suspect that prehospital med administration is found sitting in some narrative section of a health record. If that's the case, then skip this column. The variability behind identifying these administrations makes me feel like I couldn't trust the data. I've seen all those acronyms the nurses use, and I'm getting cold sweats just thinking about them.
With respect to breaking medications down by column, see the XLSX for a sheet called Pain Meds. This list originated from FDA's National Drug Code Directory, and the first column is the relevant NDC. All NDC in this list are unique. The next five columns are all mutually exclusive with each other. The logic being that somebody who is given an aspirin then later given IV fentanyl effectively got the IV narcotic pathway of care, and the prior levels wane in comparison. The sixth yellow column is that medications specific type. Same information as the five columns left of it. The "home pain medication" column is simply the sum of the "oral narcotics" and "oral non-narcotics" columns. The remaining columns are for reference.
I should clarify my employment. I work for a tribal ambulance service (RST) that has the local 638 contract, which means I don't use RPMS-EHR (I use the state-provided ImageTrend) and have no familiarity with it. I'd be willing to learn how to build the queries you want for this project, although I doubt there's a mechanism by which I could do that.
If you'd rather I call you to work out the finer points, I'm more than willing to do this if it'd be easier for you. Just say the word and give me a number to call.
I know changing horses mid-river is never a good idea, but hopefully this shift in request makes the querying easier to perform. Thank you to both you and the poor statistician for doing this work.
Cully
From: Indian Health Service
Mr. Williams,
Good morning!
This email is to acknowledge receipt of your email discussing clarification and narrowing of the scope. The IHS FOIA Office will meet with the respective Area and discuss potential options in creating a sample report that meets your request. We will follow-up with you should we have any additional questions.
Thank you.
Respectfully,
David Meservey
Government Information Specialist/FOIA
Indian Health Service
5600 Fishers Lane
Rockville, MD 20857
IHSFOIAMailbox@ihs.gov<mailto:IHSFOIAMailbox@ihs.gov>
From: Muckrock Staff
To Whom It May Concern:
I wanted to follow up on the following Freedom of Information Act request, copied below, and originally submitted on Nov. 23, 2021. Please let me know when I can expect to receive a response. You had assigned it reference number #22-032.
Thanks for your help, and let me know if further clarification is needed.
From: Indian Health Service
Mr. Williams,
Good afternoon!
Thank you for contacting the IHS FOIA Team regarding your FOIA request. Your FOIA request is number 131 in our queue and is listed in the complex processing track. We work requests in the order in which they are received (within each track). Unfortunately, IHS is experiencing a significant backlog at this time and providing a specific closure date or processing estimate in reviewing your case is unavailable.
Feel free to contact me if you have any additional questions about your request. Thank you.
Respectfully,
David Meservey
Government Information Specialist/FOIA
Indian Health Service
5600 Fishers Lane
Rockville, MD 20857
IHSFOIAMailbox@ihs.gov<mailto:IHSFOIAMailbox@ihs.gov>
From: Muckrock Staff
To Whom It May Concern:
I wanted to follow up on the following Freedom of Information Act request, copied below, and originally submitted on Nov. 23, 2021. Please let me know when I can expect to receive a response. You had assigned it reference number #22-032.
Thanks for your help, and let me know if further clarification is needed.
From: Indian Health Service
Mr. Williams,
Good morning!
Thank you for contacting the IHS FOIA Team regarding your FOIA request. Your FOIA request is number 127 in our queue and is listed in the complex processing track. We work requests in the order in which they are received (within each track). Unfortunately, IHS is experiencing a significant backlog at this time and providing a specific closure date or processing estimate in reviewing your case is unavailable. Note: The responsive program is reviewing the clarification information you provided and determining if there is a document that already exists OR if running additional system reports is necessary in order to fulfill your request.
Feel free to contact me if you have any additional questions about your request. Thank you.
Respectfully,
David Meservey
Government Information Specialist/FOIA
Indian Health Service
5600 Fishers Lane
Rockville, MD 20857
IHSFOIAMailbox@ihs.gov<mailto:IHSFOIAMailbox@ihs.gov>
From: Muckrock Staff
To Whom It May Concern:
I wanted to follow up on the following Freedom of Information Act request, copied below, and originally submitted on Nov. 23, 2021. Please let me know when I can expect to receive a response. You had assigned it reference number #22-032.
Thanks for your help, and let me know if further clarification is needed.
From: Indian Health Service
Good afternoon,
This is in response to Status request for FOIA request 22-032. Presently your request is number 123 in our queue to process.
v/r
Jim Souther
Government Information Specialist
Indian Health Service
5600 Fishers Lane, Mail stop: 09E47
Rockville, MD 20857
IHSFOIAMailbox@ihs.gov<mailto:IHSFOIAMailbox@ihs.gov>
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~WRD000
From: Muckrock Staff
To Whom It May Concern:
I wanted to follow up on the following Freedom of Information Act request, copied below, and originally submitted on Nov. 23, 2021. Please let me know when I can expect to receive a response. You had assigned it reference number #22-032.
Thanks for your help, and let me know if further clarification is needed.
From: Indian Health Service
Cully Williams,
Good afternoon!
Thank you for contacting the IHS FOIA Team regarding your FOIA request. The responsive program continues to search for the requested documents and therefore providing an estimated release date in unavailable.
Feel free to contact me if you have any additional questions about your request. Thank you.
Respectfully,
David Meservey
Government Information Specialist/FOIA
Indian Health Service
5600 Fishers Lane
Rockville, MD 20857
IHSFOIAMailbox@ihs.gov<mailto:IHSFOIAMailbox@ihs.gov>
From: Muckrock Staff
To Whom It May Concern:
I wanted to follow up on the following Freedom of Information Act request, copied below, and originally submitted on Nov. 23, 2021. Please let me know when I can expect to receive a response. You had assigned it reference number #22-032.
Thanks for your help, and let me know if further clarification is needed.
From: Indian Health Service
Cully Williams,
Good morning!
This is in response to status request for FOIA request 22-032. Presently your request is number 112 in our queue to process.
Feel free to contact me if you have any additional questions about your request. Thank you.
Respectfully,
David Meservey
Government Information Specialist/FOIA
Indian Health Service
5600 Fishers Lane
Rockville, MD 20857
IHSFOIAMailbox@ihs.gov<mailto:IHSFOIAMailbox@ihs.gov>
From: Indian Health Service
Cully Williams,
Good afternoon!
Please find our FOIA Office final response in regards to your Indian Health Service FOIA request 22-032. Attached to this e-mail is our final response letter and a responsive document. Your FOIA case is closed. Thank you.
Respectfully,
David Meservey
Government Information Specialist/FOIA
Indian Health Service
5600 Fishers Lane
Rockville, MD 20857
IHSFOIAMailbox@ihs.gov<mailto:IHSFOIAMailbox@ihs.gov>
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22-032 Emergency Department Patients with Pain Diagnosis
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11/26/2021
Freedom of Information Act Request: Pain Management at SD IHS Emergency Departments
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