Add logic to account for more than 1 biopsy result from the same procedure, eg. Colposcopy or LEAP

[gmmeadows]

Sharon has added logic to the L2 to acommodate this.

[mickohanlon23]

@gmmeadows @ssebast2 Can you point me towards where this added logic lives in the L2?

[ssebast2]

It is tentatively in two areas:

1. as a new variable titled 'most severe' (at the bottom of page 12)
2. in the very first LP5 logic clause (at the bottom of page 41)

[ssebast2]

@mickohanlon23 - This update is a smaller scope than the issue is labelled (i.e., mention of LEAPs). This update is should be confined to: IF there is >1 result documented for a given procedure (i.e., colposcopy OR colpo +ECC performed on the same dateTime) THEN reason over the most severe of the documented results.

Of note, Ginny blessed the logic in the L2. I will go ahead and add it throughout the rest of the LP5 logic.

I will create a separate issue to how to accommodate biopsies from: 1) excisions alone, 2) excisions and ECCs on the same dateTime, and 3) ECCs alone. To Ginny and I, this is not a 'must have' prior to the first go live. Dr. Guido may object, but there is only so much we can do.

[mickohanlon23]

See 'most severe' logic in L2

[mrnosal]

This issue also affects how to interpret multiple biopsy rankings, for example, if there are two Cervix Pathology biopsy reports with the same date. If one has a conclusion code of CIN 2, and the other is Unspecified HSIL, the HSIL is not recognized as an option. The code defaults to treating these as two separate screening tests, rather than one test which produced two results. Unspecified HSIL is not in the recognized list of BiopsyInterpretation.
We need a ranked list of all biopsy results, so that we may properly handle coincident biopsy reports from a single procedure. And confirm that identifying the most severe result is consistent with additional result conclusionCodes, and does not regress either risk table lookup or most severe biopsy result.

[ssebast2]

This definition is from the top of page 12 in the L2:

Define ‘most severe’:
o Use the most severe cervical histology result obtained during a colposcopy procedure OR colposcopy and endocervical curettage (ECC) procedures that are performed on the same dateTime

WHERE Histologic cancer is > (i.e., more severe) Histologic AIS > Histologic HSIL (CIN3) > Histologic HSIL, unspecified > Histologic HSIL (CIN2) > Histologic LSIL (CIN1) > ‘<CIN1’

[ssebast2]

Ugh these issues are overlapping.

We need to:

1. recognize biopsy results from colpos, ECCs, and excisions
2. identify the most severe result from each of these procedures
3. follow logic in the L2 (i.e., reason over most severe result from a colpo procedure OR a colpo with an ECC procedure) OR follow logic outlined in the "Go Live CDS Updates for July Start Date_v2" spreadsheet. Note: all logic in the spreadsheet has been added into github issues.

[mickohanlon23]

PR #99 adds HSIL, Unspecified to Biopsy Interpretation list