Health centers have been turned upside down by the coronavirus pandemic. They’re canceling many non-urgent visits and shifting to telehealth where possible – while also transforming into testing facilities for a highly contagious disease. They’re in dire need of tests, PPE, and emergency funding.

Several of the health centers we work with have asked for a way to identify patients who may be at high risk of developing severe illness as a result of COVID-19. Over the past week, we’ve built a new risk model in our analytics platform to address this need.

Our risk model is based on CDC's current guidance regarding COVID-19 and underlying conditions. At this time there isn't enough data available to validate this model (or, really, any similar model), and CDC's guidance may change over time. Despite these uncertainties, we hope this model can help inform clinical risk assessment and outreach efforts.

To simplify and speed implementation, we rely on data that can be easily extracted from EHRs, such as diagnosis codes. Other potential risk factors, such as prolonged use of immunosuppressive therapies or living in a long-term care facility, are not included. We also do not include pregnancy as a risk factor, due to lack of evidence demonstrating increased risk, although CDC stresses the importance of monitoring pregnant women.

Please feel free to incorporate this risk model into your workflow, and reach out to [email protected] with any questions, feedback, or requests. We're wishing safety to all health center staff, their patients, and their communities.

COVID-19 Risk Model Details

Patients are assigned a single risk score based on the sum of risk factor weights.

Risk Factor Standard Population Weight
Between 65 and 74 Patients between 65 and 74* 1
75 or older Patients 75 or older* 2
BMI >= 40 Patients with BMI >= 40* 1
Hypertension Patients with Hypertension 1
Cardiovascular Disease Patients with Cardiovascular Disease* 1
Lung Disease Patients with Lung Disease* 1
Diabetes without End Organ Damage Patients with Diabetes without End Organ Damage 1
Diabetes with End Organ Damage Patients with Diabetes with End Organ Damage 2
Renal Disease Patients with Renal Disease 1
Moderate or Severe Liver Disease Patients with Moderate or Severe Liver Disease 1
Immunodeficiency Patients with Immunodeficiency* 1
Cancer Patients with Cancer 1
Metastatic Solid Tumor Patients with Metastatic Solid Tumor 1

*Indicates a new Standard Population.

Standard populations include the following criteria:

Patients with Cardiovascular Disease are those with:

  • Diagnosis codes in the following value sets:

    Value Set Name Value Set OID(s)
    Atherosclerosis and Peripheral Arterial Disease 2.16.840.1.113762.1.4.1047.21
    Cerebrovascular disease, Stroke, TIA 2.16.840.1.113762.1.4.1047.44
    Ischemic heart disease or coronary occlusion, rupture, or thrombosis 2.16.840.1.113762.1.4.1047.46
    Stable and Unstable Angina 2.16.840.1.113762.1.4.1047.47
    Myocardial Infarction 2.16.840.1.113883.3.464.1003.104.12.1001, 2.16.840.1.113883.3.666.5.3011, 2.16.840.1.113883.3.526.3.403
    Ischemic Vascular Disease 2.16.840.1.113883.3.464.1003.104.12.1003
    Valvular Heart Disease 2.16.840.1.113883.3.464.1003.104.12.1017
    Coronary Artery Disease No MI 2.16.840.1.113883.3.526.3.369
  • OR a record on the importers Carotid Interventions, Percutaneous Coronary Interventions, Coronary Artery Bypass Grafts, or Cardiac Surgeries

Patients with Lung Disease are those with:

  • Diagnosis codes in the following value sets:

    Value Set Name Value Set OID(s)
    Asthma 2.16.840.1.113883., 2.16.840.1.113883.3.526.3.362, 2.16.840.1.113883.3.464.1003.102.12.1023
    Emphysema 2.16.840.1.113883.3.464.1003.102.12.1004
    COPD 2.16.840.1.113883.3.464.1003.102.12.1007
    Restrictive lung disease 2.16.840.1.113883.3.666.5.2160
    Structural lung disease 2.16.840.1.113883.3.666.5.774
    Interstitial lung disease 2.16.840.1.113883.3.666.5.777
    Cystic Fibrosis 2.16.840.1.113883.3.464.1003.102.12.1002
  • OR a record on the importers Asthma Cases, Chronic Obstructive Pulmonary Disease Cases, or Cystic Fibrosis Cases

Patients with Immunodeficiency are those with:

  • Diagnosis codes in the following value sets:

    Value Set Name Value Set OID(s)
    Conditions Due To Human Immunodeficiency Virus (HIV) 2.16.840.1.113762.1.4.1056.54
    Severe Combined Immunodeficiency 2.16.840.1.113883.3.464.1003.120.12.1007
    Immunodeficient Conditions 2.16.840.1.113883.3.666.5.1726
    Immunocompromised Conditions 2.16.840.1.113883.3.666.5.1940

Patients with BMI >= 40 are calculated based on patient's most recent BMI measurements (as mapped on the BMI Measurements importer)

Patients between 65 and 74 and Patients 75 and older are based on the patient's date of birth and the current date.