Data Element

Types of orders for medical care/services

Order or a Service Request represents a request for a procedure, diagnostic service, intervention, laboratory test, follow-up care, or other planned service for a patient. This concept may be used to share relevant information required to support a referral or a transfer of care request from one practitioner or organization to another when a patient is required to be referred to another provider for a consultation /second opinion and/or for short term or longer-term management of one or more health issues or problems.


CDC-CMS Joint Priority Data Element for USCDI v4

CDC continues to recommend inclusion of this high priority data element in USCDI v4.  This element is also shared high priority item for CMS/CDC as outlined in our joint letter

PACIO update re: Level 2 data element Types of Orders

The PACIO Community (Post-Acute Care Interoperability) leadership wishes to update the ONC/USCDI with current efforts relating to the concept of Advance Directives and portable clinician authored orders in that domain. The PACIO Community continues to test FHIR interoperability of Advance Directive Information (ADI) during HL7 and CMS Connectathons (September 2021, May 2022, and July 2022) and resolve HL7 balloting comments in preparation for publication in upcoming months of a FHIR based Advance Directive Information Implementation Guide (IG) as Standard for Trial Use-1 (STU1).  As part of the work, PACIO completed an environmental scan across states and other jurisdictions to inform a design that could work on a national level while allowing for jurisdictional differences. PACIO’s focus has been on “model of meaning” of ADI concepts as opposed to “model of use” where only specific narrative or forms are used. A benefit of exchanging semantic meaning recognizes the current reality of diverse state and local jurisdictional processes present as the nation moves towards standards-based data exchange. The PACIO ADI Community has been working with external national organizations on the concept of practitioner authored information and orders that includes all types of advance directive concepts, including during emergency situations, end of life situations, and whenever an individual is unable to express for themselves their wishes and desires. The PACIO Community is working with external stakeholders both within the interoperability and clinical ecosystems to tease out how the concepts of clinician/practitioner authored orders (including portable non-location-based orders) in the domain of “Advance Directive” would differ from other “Types of orders for medical care/services” as currently in USCDI level 2 and/or “Orders for End-of-Life Care” in USCDI Level 1.

Unified Comment from CDC

CDC considers this element to be high priority and strongly recommends its inclusion in the USCDI V3

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