Data Element

Comment

NCPDP Comment

NCPDP recommends modifying the data element description to “Category of health care service defining the reason and class of service. Examples include but are not limited to office visits, telephone assessment and home visit”.

Support to Advance Encounter Type

This comment is in support of the advancement of encounter type for inclusion in the United States Core Data for Interoperability.

Emergency Medical Services Encounter Types

If USCDI defines or adopts a value list, please ensure that it includes the types of encounters that emergency medical services (ambulance) providers have with patients. An example reference list might be the NEMSIS data element eResponse.05 - Type of Service Requested: https://nemsis.org/media/nemsis_v3/release-3.5.0/DataDictionary/PDFHTML/EMSDEMSTATE/sections/elements/eResponse.05.xml .

This comment is submitted on behalf of the National Emergency Medical Services Information System (NEMSIS) Technical Assistance Center.

Response to Comment on Encounter Type

ONC should define the terminology standard and value set of allowed concepts to which this data element is bound. Without it, this data element will result in differing interpretations. Also, ONC must clarify how it characterizes encounter types: by care settings; what was done; how long it lasted, etc. Other questions include:
Does encounter type include a telehealth encounter, when both the patient and the clinician are in their respective homes/ offices?
Will audio-only interactions be included?
Many physical therapist visits with patients occur in the skilled nursing facility, assisted living facility, patient’s home, school, emergency department, and other settings. Is encounter type, as currently defined, broad enough to encompass these situations?
How will a consulting visit be identified?
How would tests such as Functional Capacity Evaluations be classified, or would such test be considered an office visit? 
How is preventive care/wellness denoted?

CMS supports associating terminology standards with this data element. In our submission, we note the following standards often used to represent Encounter Type: SNOMED CT, HCPCS, CPT. Note that Implementation Guides (i.e. FHIR US Core) also provides additional context around this data element. 

 

ONC should define the…

ONC should define the terminology standard and value set of allowed concepts to which this data element is bound. Without it, this data element will result in differing interpretations.

Also, ONC must clarify how it characterizes encounter types: by care settings; what was done; how long it lasted, etc.

Other questions include:

  • Does encounter type include a telehealth encounter, when both the patient and the clinician are in their respective homes/ offices?
  • Will audio-only interactions be included?
  • Many physical therapist visits with patients occur in the skilled nursing facility, assisted living facility, patient’s home, school, emergency department, and other settings. Is encounter type, as currently defined, broad enough to encompass these situations?
  • How will a consulting visit be identified?
  • How would tests such as Functional Capacity Evaluations be classified, or would such test be considered an office visit? 
  • How is preventive care/wellness denoted?

MedMorph's Support of Encounter Type

Support for this element is submitted on behalf of MedMorph project which includes relevant specifications and supporting artifacts.

Classification of Encounter can be representing using the V3 Value SetActEncounterCode.

Relevant technical specifications include the following:
HL7 CDA ® Release 2 Implementation Guide: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1, DSTU Release 1.1 – US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=398

HL7 CDA® R2 Implementation Guide: National Health Care Surveys (NHCS), R1 STU Release 3 - US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=385

HL7 CDA® R2 Implementation Guide: Consolidated CDA Templates for Clinical Notes - US Realm: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492

HL7 FHIR® US Core Implementation Guide STU3 Release 3.1.1: https://www.hl7.org/fhir/us/core/index.html

HL7 FHIR US Core Encounter: http://hl7.org/fhir/us/core/StructureDefinition-us-core-encounter.html. MustSupport for the following elements: Encounter status, Classification of Encounter, Encounter type, Encounter subject, Encounter Identifier, Encounter period, Encounter participant type, Participant overseeing the encounter, Primary participant responsible for encounter, Encounter participant individual, Encounter primary performer NPI, Encounter primary performer name, Encounter primary performer professional role, Time period participant participated in the encounter, Reason for the visit, Hospital encounter discharge disposition, Encounter location address                                                                                                                                                                                                                                                                                                                             

HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm: http://hl7.org/fhir/us/ecr/STU1/Electronic_Initial_Case_Report_(eICR)_Transaction_and_Profiles.html

HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 2 - US Realm - the Electronic Initial Case Report (eICR): https://www.hl7.org/implement/standards/product_brief.cfm?product_id=436

Vital Records Birth and Fetal Death Reporting FHIR - US Realm: https://build.fhir.org/ig/HL7/fhir-bfdr/index.html

HL7 Version 2.6 Implementation Guide: Vital Records Birth and Fetal Death Reporting, Release 1 STU Release 2 - US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=320

HL7 CDA® R2 Implementation Guide: Birth and Fetal Death Reporting, Release 1, STU (Release 2 - US Realm): https://www.hl7.org/implement/standards/product_brief.cfm?product_id=387

IHE Quality, Research and Public Health Technical Framework Supplement: Birth and Fetal Death Reporting-Enhanced (BFDR-E) Revision 3.1: (https://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf)

Support to Advance Encounter Type in USCDI

This comment is in support of the advancement of encounter type for inclusion in the United States Core Data for Interoperability.

As part of a research project sponsored by the National Committee of Quality Assurance (NCQA) and a regional health information exchange in New York, Diameter Health was requested to examine data included in clinical documents, such as C-CDA, for 474 distinct facilities in 2020. These clinical documents are shared through health information exchange with other healthcare organizations routinely, in part to fulfill requirements for use of certified health information technology to record and transmit data related to USCDI. These facilities represented a mix of ambulatory care, inpatient and post-acute settings in New York. The project was sponsored as part of the emerging program for Data Aggregator Validation (DAV) launched by NCQA (https://www.ncqa.org/programs/data-and-information-technology/hit-and-data-certification/hedis-compliance-audit-certification/data-aggregator-validation/). These comments represent the perspective of Diameter Health and are not meant to represent the opinions, perspectives or policy of any other organization.

Over the data analysis of 474 organizations having sampled 100 clinical documents from each, Diameter Health found that vast majority of organizations recorded and transmitted encounter data. For the 47,400 records, over 300,000 encounters were recorded within C-CDA documents, either through the inclusion of an “encounters section” or “encompassingEncounter” portion of a clinical document. Encounters were routinely structured with machine readable entries that could be parsed by software and human readable content that could be read by clinicians. Clinical documents included encounter information on over 75% of sampled records. Over 90% of the 474 organizations were sending encounter information for at least some patient records.

The most common way that these encounters were encoded was through the usage of CPT (codeSystem OID 2.16.840.1.113883.6.12), although some records used HCPCS (OID 2.16.840.1.113883.6.14), HL7 (OID 2.16.840.1.113883.5.4) and SNOMED (OID 2.16.840.1.113883.6.96) terminologies in addition to locally developed or vendor provided codes.

Diameter Health works with over 20 health information exchanges nationally as well as an array of health plans, health information technology vendors and governmental entities. The findings shared as part of this research supports observations from other clients and data modalities, such as HL7v2 messages.

Encounter information is important for patient care as part of care transitions, the performance of quality reporting and other population health analyses. The role in quality reporting is paramount, since patients only qualify for denominators in most electronic clinical quality measures based on encounter type. Diameter Health strongly supports the continued elevation of encounter type information in the USCDI and we believe that the data from the field shows that this information is already widely recorded and exchanged among healthcare organizations. Please feel welcome to reach out if it would be helpful to share more details or to answer questions regarding this comment.

Thank you for your comment…

Thank you for your comment in support of Encounter Type data element.  ONC has received multiple submissions in support of Encounter Type, and have designated it Level 2 and will be considered for addition to USCDI version 2.

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