Clinical data

Clinical data includes allergy, condition, laboratory test, medication data, observation, and risk data. The tables show the available data, whether the data is mandatory, and the differences when the data is manually created or received from integrated systems.

Clinical data conforms with standard coding systems for clinical data. Clinical data codes are displayed in the Reporting application for the purposes of creating reports when received from integrated systems. However, clinical data codes are not displayed in the Care Team application.

After a client is registered, you can add new Clinical data, with the exception of Coverage and Observation data.

Important: Clinical data from integrated systems refreshes overnight in Watson Care Manager and cannot be modified.

Allergy data

Allergy data conforms with standard coding systems for allergy data. Manual data entry for the allergy name is supported by a terminology search (SNOMED). Allergy data from integrated systems might be associated with different coding systems than manually created allergy records.

The table lists the fields that are displayed on an allergy record.

Field	Mandatory	When manually created	When received from integrated systems
Allergy Name	Yes	Displays the allergy name that was selected by using the terminology search (SNOMED). If the allergy name was manually recorded by using the Record other allergy option, this field displays the name that was entered.	Displays the allergy name that was received from the integrated system. When the record is received electronically, the allergy name that is displayed might be different to the names of manually created allergy records
Status	Yes	Displays one of the following statuses: Active Inactive Duplicate Invalid Unknown	As per manually created records. Displays Active, Inactive, Duplicate, Invalid, or Unknown, depending on the status that is received from the integrated system.
Allergy Type	No	Displays the allergy type that was selected from a preconfigured coded list when the record was manually created.	Displays the allergy type that was received from the integrated system.
Start Date	No
End Date	No
Reactions/Severities	No	Up to three symptoms of the allergic reaction and the severity of each symptom are displayed in a comma-separated list. Each symptom and severity can be selected from a preconfigured coded list when the record is manually created.	As per manually created records. When the record is received electronically, the reactions and severities that are displayed might be different to those of manually created allergy records. The text (Unknown), is appended to each reaction that does not have an associated severity value.
Currently Active		Displays Yes, No, Unknown, or is blank.	Not applicable. A client's confirmed allergy status is not received from integrated systems. You can manually specify whether a client has explicitly confirmed that an allergy is currently active, if needed.
Comments	No
Source	Yes	Displays the source of the allergy data that was selected from a configured list. The following default sources are available for selection: Chart Encounter Lab Self Reported	Not applicable. Displays EMR to indicate that the record came from an integrated system. This field is automatically populated by Watson Care Manager.
Original Source System	No	Displays the original source system where the allergy data originated that was selected from a configured list. The following default values are available for selection: Watson Care Manager Other	Not applicable.

Condition data

Condition data conforms with standard coding systems for condition data. Manual data entry for the condition name is supported by a terminology search (SNOMED). Condition data from integrated systems might be associated with different coding systems than manually created condition records. Condition codes from integrated systems are not displayed.

Note: Problem List records in the IBM Explorys EPM Registry display as Condition records in Watson Care Manager.

If a condition is associated with more than one coding system in IBM Explorys EPM Registry, a separate condition record is displayed in Watson Care Manager for each coding system that the condition is associated with.

The table lists the fields that are displayed on a condition record.

Field	Mandatory	When manually created	When received from integrated systems
Condition Name	Yes	Displays the condition name that was selected by using the terminology search (SNOMED). If the condition name was manually recorded by using the Record other condition option, this field displays the name that was entered.	Displays the condition name that was received from the integrated system. When a record is received electronically, the condition name that is displayed might be different to the name for manually created condition records.
Status	Yes	Displays one of the following statuses: Active Inactive Resolved Duplicate Invalid	Displays one of the following statuses: Active Inactive Resolved Invalid Unknown If the integrated system has different statuses, Watson Care Manager maps each status to one of the above statuses.
Start Date	No
End Date	No
Classification	No	Displays Primary, Secondary, or is blank.	Not applicable. Condition classifications are not received from integrated systems. You can manually classify conditions from integrated systems, if needed.
Comments	No
Source	Yes	Displays the source of the condition data that was selected from a configured list. The following default values are available for selection: Self-Reported Chart Encounter Lab	Not applicable. Displays EMR to indicate that the record came from an integrated system. This field is automatically populated by Watson Care Manager.
Original Source System	No	Displays the original source system where the condition data originated that was selected from a configured list. The following default values are available for selection: Watson Care Manager Other	Not applicable

Coverage data

Coverage data is received from IBM Explorys products and is read-only. Coverage data cannot be manually created or modified. Coverage data conforms to the Fast Healthcare Interoperability Resources (FHIR) standard. The coverage data type is visible in the Clinical data category on the Data page when one or more records are received from the integrated system.

The table lists the fields that are displayed on a coverage record.

Field	Mandatory	When manually created	When received from integrated systems
Group	No	Not applicable	Displays the name of the group that includes the medical or insurance plan.
Plan	Yes	Not applicable	Displays the name of the medical or insurance plan.
Type	No	Not applicable	Not applicable A type is not received from integrated systems.
Subgroup	No	Not applicable	Displays the name of the sub group or subsection of the plan.
Precedence	No	Not applicable	Not applicable A precedence is not received from integrated systems.
Status	No	Not applicable	Displays one of the following statuses: Active Canceled Entered in error Draft
Start Date	No	Not applicable
End Date	No	Not applicable
Comments	No	Not applicable
Source	No	Not applicable	Not applicable This field is automatically populated by Watson Care Manager. Displays Eligibility System to indicate that the record came from an integrated system.
Original Source System	Yes	Not applicable	Not applicable.

Laboratory test data

Laboratory test data conforms to the Fast Healthcare Interoperability Resources (FHIR) standard. Manual data entry for the laboratory test name is supported by a coded list of laboratory tests (LOINC). Laboratory test data from integrated systems might be associated with different coding systems than manually created laboratory test records.

When Watson Care Manager receives laboratory test data from the IBM Explorys EPM Registry, there is a two-step mapping process.

Watson Care Manager checks that the data contains a LOINC code, based on an internal reference list.
If the LOINC code maps to a code on the list, a laboratory test record is created by Watson Care Manager. If the data contains no LOINC code, or if the LOINC code received does not match a code in the list, an observation record is created.

When Watson Care Manager receives laboratory test data from IBM Phytel products, the following mapping steps occur.

Watson Care Manager checks that the data is classified as a laboratory test.
Watson Care Manager creates a laboratory test record. Otherwise, an observation is record is created.

Note: Laboratory tests that are up to two years old are displayed when the records come from IBM Explorys EPM Registry.

Laboratory test records that are up to two years old are also displayed when the records come from IBM Phytel products. However if the last laboratory test record received is older than two years, Watson Care Manager displays that record.

The table lists the fields that are displayed on a laboratory test record.

Field	Mandatory	When manually created	When received from integrated systems
Laboratory Test Name	Yes	Displays the laboratory test name that was selected from the preconfigured coded list when the record was manually created (LOINC).	Displays the laboratory test name that was received from the integrated system. When the record is received electronically, the laboratory test name that is displayed might be different to the name for manually created laboratory test records.
Value	No	Displays the value that was added to the record.	Displays the data that is received from the integrated system. This could be one or any combination of the following: Comparator (< > =) Value Unit Value String If the record from the integrated system has no comparator, value, unit, or value string, the Value field is blank. For example, if a record has a comparator (`<),` a value (`1.5`) and a unit (`mEq/L`). The Value field displays `<1.5 mEq/L`. If WCM receives a value without a unit, the Value field displays only the value. For example, `1.5`.
Units	No	Displays units added to manually created laboratory test records only.	Not applicable
Service Date	Yes
Status	Yes	Displays one of the following values: Registered Preliminary Correction to Results Final Results Procedure Incomplete Valid Invalid Unknown Completed Order Cancelled Entered-in-error Results stored; Not Verified Procedure Scheduled, but not done No order on Record No Record of this Patient Duplicate	Displays one of the following values: Registered (Maps to the Registered status FHIR standard). Preliminary (Maps to the Unknown status FHIR standard) Final (Maps to the Final status FHIR standard) Amended (Maps to the Correction to Result status FHIR standard). Valid (Maps to the Valid status FHIR standard. Unknown (Maps to the Unknown status in FHIR). Corrected (Maps to the Correction to Result status FHIR standard. Cancelled (Maps to the Order Cancelled status FHIR standard). Entered-in-error (Maps to the Invalid status FHIR standard).
Comments	No
Source	Yes	Displays the source of the laboratory test data that was selected from a configured list. The following default values are available for selection: Self-Reported Chart Encounter Lab	Not applicable. Displays EMR to indicate that the record came from an integrated system. This field is automatically populated by Watson Care Manager.
Original Source System	No	Displays the original source system where the laboratory test data originated that was selected from a configured list. The following default values are available for selection: Watson Care Manager Other	Not applicable

Medication data

Medication data conforms with standard coding systems for medication data. Medications from integrated systems might be associated with different coding systems than manually created medication records.

Note: Medication data that comes from integrated systems is read-only. Users can manually indicate whether a client is currently taking a particular medication.

The table lists the fields that are displayed on a medication record.

Field	Mandatory	When manually created	When received from integrated systems
Medication Name	Yes	Displays the medication name that was selected by using the terminology search (NDC-11 digit). If the medication name was manually recorded by using the Record other medication option, this field displays the name that was entered.	Displays the medication name that was received from the integrated system. When a record is received electronically, the medication name that is displayed might be different to the name for manually created medication records.
Status	Yes	Displays one of the following statuses: Active Inactive Self Refused Refused for medical reasons Unknown	Displays one of the following statuses: Active Inactive Duplicate Invalid Unknown If the integrated system has different statuses, Watson Care Manager maps each status to one of the above statuses.
Type	No	Displays one of the following types: OTC Prescribed Other blank	Displays the medication type from the integrated system. When a record is received electronically, the type that is displayed might be different to the type for manually created medication records.
SIG	No	Displays the values that were entered in the following fields, in this order: Quantity Strength Dose Form Route Frequency Duration	Displays the values that were received from the integrated system in the following fields, in this order: Quantity (The text `(quantityEMR)` is appended to the quantity value.) Strength (The text `(strength)` is appended to the strength value.) Dose Form (The text `(doseFormEMR)`is appended to the dose form value.) Route (The text `(routeFormEMR)` is appended to the Route value.) Frequency (The text `(frequencyEMR)` is appended to the Frequency value.) Duration (The text `(duration)` is appended to the Duration value.)
Classes		Not applicable Medication classes cannot be manually created.	Displays a comma-separated list of medication classes that are received from the integrated system.
Date	Not applicable	Watson Care Manager automatically populates this field based on which date is available in the record. In the following order, the date might be the medication start date, ordered date, prescribed date, fill date, or last refill date, depending on which date is entered. If no date is available, the date is the record creation date.	As per manually created records.
Strength	No	If the medication was selected by using the terminology search, displays the medication strength that was selected from the list of valid medication strengths, based on the search. If the medication was manually recorded by using the Record other medication option, displays the medication strength that was entered.	Displays a numeric value and unit of measurement that was received from the integrated system. The text `(strength)` is appended to the duration value. When a record is received electronically, the medication strength that is displayed might be different to the strength for manually created medication records.
Dose Form	No	Displays the form of medication that was selected from the list of forms.	Displays the dose form that was received from the integrated system. The text `(doseFormEMR)` is appended to the dose form value. When a record is received electronically, the dose form that is displayed might be different to the dose form for manually created medication records.
Route	No	Displays the path that the medication entered the client's body that was selected from the list of routes.	Displays the route that was received from the integrated system. The text `(routeFormEMR)` is appended to the route value. When a record is received electronically, the medication route value that is displayed might be different to the value for manually created medication records.
Quantity	No		Displays the quantity that was received from the integrated system. The text `(quantityEMR)` is appended to the dose form value. When a record is received electronically, the medication route that is displayed might be different to the route for manually created medication records.
Frequency	No	Displays the frequency value that was selected from a preconfigured coded list when the record was manually created.	Displays the frequency that was received from the integrated system. The text `(frequencyEMR)` is appended to the frequency value. When a record is received electronically, the frequency that is displayed might be different to the frequency for manually created medication records.
Duration	No	Displays the duration that was selected from a preconfigured coded list when the record was manually created.	Displays the duration that was received from the integrated system. The text `(duration)` is appended to the duration value. When a record is received electronically, the duration that is displayed might be different to the duration for manually created medication records.
Start Date	No
End Date	No
Ordered By	No
Ordered Date	No
Prescription Number	No
Prescribed Date	No
Prescribed By	No
Fill Date	No
Pharmacy	No
Review	No	Displays one of the following values: Duplicate Needs Review Verified Unknown	Not applicable
Dispensed Quantity	No
Last Refill Date	No
Refills	No
Instructions	No
Reason	No
Refused Reason	No
Comments	No
Source	No	Displays the source of the medication data that was selected from a configured list. The following default values are available for selection: Chart Encounter Lab Self Reported	Not applicable. Displays EMR to indicate that the record came from an integrated system. This field is automatically populated by Watson Care Manager.
Original Source System	No	Displays the original source system where the medication data originated that was selected from a configured list. The following default values are available for selection: Watson Care Manager Other	Not applicable

Observation data

Observation data is received from integrated systems and is read-only. Observation data is visible in the Clinical data category on the Data page when one or more records are received from the integrated system.

When Watson Care Manager receives observation data, it maps the data to an appropriate data type, typically a Watson Care Manager Laboratory Test or a Vital type. If Watson Care Manager cannot map the data to an appropriate data type, an Observation record in created in the Clinical data category. Observation data from integrated systems can be vitals data, laboratory test data, or any other data that cannot be mapped to a Watson Care Manager data type.

When observation data comes from the IBM Explorys EPM Registry, Watson Care Manager maps the data to an appropriate data type based on its associated LOINC code. For example, if blood pressure data is received that contains a LOINC code that maps to the Blood Pressure LOINC code in an internal reference list, a blood pressure record is created in the Vitals data category. If the data is not associated with a LOINC code, or the LOINC code received does not map to a LOINC code in the list, an Observation record is created.

When observation data comes from IBM Phytel products, Watson Care Manager maps the data to an appropriate data type, based on whether the data is classified in the integrated system. For example, if the data is classified as a laboratory test, a Laboratory Test record is created in the Clinical data category. If the data is classified as a vitals-sign and specified as Height data, Watson Care Manager creates a Height record in the Vitals data category. Otherwise, Watson Care Manager creates an observation record.

The table lists the fields that are displayed on an observation record.

Field	Mandatory	When manually created	When received from integrated systems
Name	Yes	Not applicable	Displays the name that was received from the integrated system.
Type	No	Not applicable	Not applicable This field is not populated by Watson Care Manager.
Value	No	No applicable	Displays the data that is received from the integrated system. This could be one or any combination of the following: Comparator (< > =) Value Unit Value String If the record from the integrated system has no comparator, value, unit, or value string, the Value field is blank. For example, if a record has a comparator (`<),` a value (`1.5`) and a unit (`mEq/L`). The Value field displays `<1.5 mEq/L`. If WCM receives a value without a unit, the Value field displays only the value. For example, `1.5`.
Date	Yes	Not applicable	Displays the date that the observation measurement was created.
Status	Yes	Not applicable	Displays one of the following statuses, depending on the status that is received from the integrated system: Registered Preliminary Final Amended Valid Unknown Correction to Result Canceled Invalid If the integrated system has different statuses, Watson Care Manager maps each status to one of the above statuses.
Measurement Method	No	Not applicable	Displays the method used to perform the observation that was received from the integrated system.
Observation Site	No	Not applicable	Displays the site of the client's body where the observation was made.
Source	Not applicable	Not applicable	Not applicable This field is automatically populated by Watson Care Manager. Displays EMR to indicate that the record came from an integrated system.
Original Source System	No	Not applicable	Not applicable

Risk data

Clinical risk data can be manually created and received from integrated systems. For example, Watson Care Manager can receive the following risks from integrated systems:

ERM (Medicare/Concurrent/Commercial/Prospective)
HCC-Billing
HCC-Clinical
LACE
Charlson Deyo

Administrators can configure the risks that are applicable to the organization so they are available for selection when they are manually created in the care team application.

The table lists the fields that are displayed on a risk record.

Field	Mandatory	When manually created	When received from integrated systems
Name	Yes	Displays the risk name that was selected from the configured list when the record was manually created.	Displays the risk name from the integrated system. When the record is received electronically, the risk name that is displayed might be different to the name of manually created risk records.
Date	Yes
Score	Yes
Category	No	Displays the configured category that the risk score falls into.	Displays the risk category from the integrated system. When the record is received electronically, the risk category that is displayed might be different to the category for manually created risk records.
Comments	No
Source	Yes	Displays the source of the risk data that was selected from a configured list. The following default values are available for selection: Analytics (External) Analytics (Internal) Hospital Information System Other Outside Provider Payer Practive Management System Self Reported	Not applicable. Displays EMR to indicate that the record came from an integrated system. This field is automatically populated by Watson Care Manager.
Original Source System	No	Displays the original source system where the risk data originated that was selected from a configured list. The following default values are available for selection: Watson Care Manager Other	Not applicable