Submitted by nedragarrett_CDC on 2022-09-28
|Submitted By: Keith W. Boone / Audacious Inquiry|
|Data Element Information|
|Use Case Description(s)|
|Use Case Description||Facility level data is associated with laboratory tests (the testing facility), and health care provider locations, including hospitals, ambulatory providers, long-term and post acute care, and pharmacy providers.
Location data is used to support reporting of data for public health and emergency response (e.g., situation awareness reporting).
See https://build.fhir.org/ig/HL7/fhir-saner/ for details (note that (minus) - is a legal character in URLs, had to use a bit.ly link to get past validation errors in URL)
|Estimated number of stakeholders capturing, accessing using or exchanging||Hospitals in the US (Approximately 7000), Laboratories (260,000), pharmacies (88,000), ambulatory physicians (260,000).|
|Link to use case project page||https://bit.ly/SANERBUILD|
|Maturity of Use and Technical Specifications for Data Element|
FHIR DSTU2, 3 and 4, CDA Release 2.0, HL7 V2 PL Data Type
|Additional Specifications||V3.1.0: https://www.hl7.org/fhir/us/core/StructureDefinition-us-core-location.html
|Current Use||Extensively used in production environments|
Widely available within EHR Systems, but not necessarily searchable.
https://fhir.cerner.com/millennium/r4/encounters/encounter/ (Reference to a Location resource)
https://api.evident.com/dstu2/encounter (Location as an embedded resource)
https://www.questdiagnostics.com/dms/Documents/care360/Terms-Conditions/Quanum_EHR_FHIR_API.pdf (Quest only supports Location name in Immunizations)
|Number of organizations/individuals with which this data element has been electronically exchanged||5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.|
See US Core Connectathon report out: https://drive.google.com/file/d/1WNYWLEf28j8DPyDachC8jpk-QbkyuPxP/view
|Restrictions on Standardization (e.g. proprietary code)||None|
|Restrictions on Use (e.g. licensing, user fees)||None|
|Privacy and Security Concerns||Locations associated with Critical Access Hospitals, and single provider facilities may constitute PHI (in geographic locations with limited populations) and/or Individual Identifiable Information (e.g., for HCPs working from a combined home/office facility).|
|Estimate of Overall Burden||Most electronic systems provide the capacity to store location and organization information. Many EHRs already provide access to the Location resource via READ operations, some (e.g., Epic, AthentaHealth) provide search capabilities as well. This information is routinely communicated in HL7 V2 Messages, CDA Documents and some FHIR API transactions. To address gaps, implementers would need to modify interfaces (e.g., for CDA or HL7 V2), or add an endpoint. Estimated effort (based on past experience building EHR systems) is about one two-week sprint to implement the capability by a developer.|
|Other Implementation Challenges||Standards for location identifier may need flexibility depending on use of Location for reportiong, as there are a number of distinct location identifier systems which may be necessary for different reporting use cases. For example, CDC/NHSN assigns identifiers for HAI reporting, CLIA assigns identifiers to laboratories, CMS provides location identifiers, et cetera.|
Submitted by Svellanky on 2022-09-29
CMS-CCSQ Support for Facility/Organization Identifier: USCDI v4A facility, or organizational, identifier is critical for providing context for granular patient data and supports tracking data back to organizations—this type of contextual data element ensures usability of interoperable clinical data. Facility identifiers are used for billing, support data aggregation across sources, as well as attribution. They can also support exchange of data between hospitals and post-acute care providers. All of these activities are necessary for providing high quality care to patients, reducing healthcare inequities and disparities, and promoting interoperability and communication – all ONC stated priorities for the USCDI. Facility identifiers were also previously identified as a joint CMS-Centers for Disease Control and Prevention (CDC) priority as a critical element for public health reporting, surveillance and emergency response – an ONC stated priority for USCDI v4. For example, CDC and CMS rely on facility identifiers to measure the incidence of healthcare associated infections and other patient safety events in facilities, and to direct technical assistance and quality improvement support to underperforming facilities. Furthermore, the ISWG recommended this element for final USCDI v3, and received HITAC support, noting the need for an identifier combined with an assigning authority. Maturity: This element is classified as Level 2 by ONC and continues to have strong standardization and be in wide use.
Current uses, exchange, and use cases: CCN, PTAN, NPI, and CLIA numbers are exchanged across the nation for CMS reporting to appropriately attribute outcomes and measure results. They are used extensively for electronic clinical quality measure (eCQM) reporting, linking data sources for quality measurement, and for post-acute care reporting and payment purposes. Facility identifiers are also used extensively for electronic case reporting (eCR) and electronic lab reporting (ELR) and are critical for public health agencies ability to monitor the spread of reportable conditions. Exchange of organization identifiers supports facility-specific quality, prior authorization activities, and other assessments that are limited without this information. Additionally, there is active work underway to create an IG for healthcare directories (HL7.FHIR.US.DIRECTORY-EXCHANGE\Home - FHIR v4.0.1) as part of the FAST Da Vinci accelerator initiative, which includes the critical organization and provider identifiers necessary to appropriately use and attribute exchanged data. Among other purposes, organization identifiers are also used to support public health use cases, including electronic case reporting and emergency response activities. For instance, during the early COVID-19 pandemic phase, there was insufficient data tracking across organizations, further complicated by the need to track emergency response resources across individual facilities. Exchange of facility/organization identifiers can mitigate such delays in emergency response activities.
- Current standards:
- Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR) US Core Implementation Guide (IG) STU3-STU5 based on FHIR R4, Organization Profile must support an identifier (https://www.hl7.org/fhir/us/core/StructureDefinition-us-core-organization.html)
- Organization Profile is included in the HL7 FHIR US Core Capability Statement: https://www.hl7.org/fhir/us/core/CapabilityStatement-us-core-server.html; data included in this profile must be able to be exchanged, including the Organization Identifier