Encounter Information

Encounter Time Type

Add an element or attribute that can be associated with each instance of a date/time to indicate the semantic meaning of that date/time. In emergency medical services (ambulance calls), many date/time values are collected throughout an encounter, such as notification, en route, arrived on scene, arrived at patient, left scene, arrived at destination, back in service, etc.). This comment is submitted on behalf of the National Emergency Medical Services Information System (NEMSIS) Technical Assistance Center.

Response to Comment on Encounter Time

We would need to consider capturing this variable in order to support the following 6 domains related to Paul Coverdell National Acute Stroke Program/American Hospital Association’s (AHA) Get With The Guidelines (GTWG). • The goal is to reduce gaps in stroke care across the continuum of care in states with high burden populations. The information captured from stroke patients and those who encounter mobility related issues and are at risk of multiple hospitalizations due to post-discharge complications can help in reducing the gaps in care and to plan quality improvement efforts. # Domain # of Variables Variable Details Required or Optional 1 Hospital Discharge Date 1 1. date of hospital discharge Required 2 Hospital Admission Date 1 1. hospital admission date Optional 3 Follow-up 4 1. if follow-up phone call conducted, date 2. if in home follow up conducted, date 3. if chart review conducted, date 4. if follow-up conducted at a health facility, date Required 4 ED Visits 2 1. if patient seen in the ED since discharge, date information about ED visits gathered if before 30 days 2. if yes, Date of first ED visit Optional 5 Follow Up Appointment 1 1. date of first follow up appointment Optional 6 Readmissions 1 1. if readmitted, date of first readmission Optional Use-Case Justification: The most challenging part is capturing the information post-hospital discharge for acute stroke patients. A lot of the pre-hospital care is captured through National Emergency Medical Services Information System (NEMSIS), a national database that stores EMS data from the U.S. States and Territories). The follow-up elements proposed above have been developed as a part of the Paul Coverdell National Acute Stroke Program (link provided below) and captured within EHR for submission into American Heart Association’s (AHA) Get With The Guidelines (GTWG) module. The ability to extract the follow-up encounter related dates would help with the identification of gaps in post-hospital discharge date for stroke patients and plan strategies for Quality Improvement efforts. https://www.cdc.gov/dhdsp/programs/stroke_registry.htm This field is for general comments on this specific data element. To submit new USCDI data classes and/or data elements, please use the USCDI ONDEC system: https://healthit.gov/ONDEC USCDI_Version_2_Draft_Template for Comments_DHDSP_vFinal_04.14.2021.docx For encounter time, CMS's submission intended to recommend including an encounter date/time, or the date/time the encounter began (i.e. admission date/time for inpatient admissions, date/time for office visit) and date/time when the encounter ended (i.e. hospital encounter discharge date/time). We agree there are many date/times that could be defined, and that are important for different use cases.  

Response to Comment on Encounter Time

We recommend that ONC clarify “encounter” and “encounter time” and explain whether it applies to a daily visit (day/time/start and stop time) or an episode’s admission and discharge, which is comprised of numerous daily visits. In a facility setting, it is important to recognize that there can be many parallel encounters; for instance, numerous health care professionals conduct visits with a patient who is residing in long-term care facility; a patient may be admitted for 100 days, during which time a record is created each day (physical therapist treats in the morning, physical therapist assistant treats in the afternoon). Thus, is an encounter time representative of the patient’s entire stay in the skilled nursing facility, or each daily individual visit (which may be comprised of numerous visits by different health care professionals)? In the emergency department, a patient may be evaluated and treated by different clinicians, including a physical therapist. Thus, is encounter time admission and discharge from the hospital/emergency department, or the beginning and end of each clinician’s visit, and/or the beginning and end of a procedure? Other questions that must be resolved in the final USCDI: Is encounter date/time representative of the date and time of the encounter with the patient, or the date and time that the documentation is completed? Most clinicians do not collect start and stop times for an encounter. Moreover, is date and time intended to be reflected via a timestamp? Also, we question which timestamp would travel with the documentation, as a clinician may see a patient at one time during the day and complete their documentation at another time that day. Should the encounter time be the time the treatment occurred or the time the documentation entry occurred or both or neither? Does encounter time encompass duration? Requiring duration to be reported can create challenges between “duration” for a CPT code vs. duration of the entire session. In addition, the actual duration of the visit is not currently collected in all locations or by all practitioners. Finally, while the documentation itself may or may not include the duration, although the billing should reflect the time of each intervention and match the documentation. Is encounter time intended to reflect when the treating or evaluating clinician begins to provide skilled care for the patient, or is it more broadly the time of the scheduled appointment? Is it intended to capture time involved in direct one on one patient care or the overall visit? For instance, in a physical therapy office visit, frequently both the physical therapist and physical therapist assistant will treat the patient (at separate times). Would the start time of the physical therapist be captured, as well as the start time of the physical therapist assistant? Additional clarification is necessary. CMS's submission of the encounter time data element was intended to recommend inclusion of a patient encounter start and stop date/time. This would encompass the time the encounter began (i.e. admission date/time for inpatient admissions, date/time for office visit) and when appropriate (i.e. hospital encounters) a discharge date/time, or when the encounter ended. We did not intend to recommend start/stop times for daily visits/clinician treatment sessions that occur during an encounter.  

Response to Comment on Encounter Time

Is this intended to also capture duration or classification (long, short, regular, etc) of a visit for an office visit? Some of the content above make me think it might be. Is it meant to be the scheduled start time or the actual start time or the patient check-in time? There are comments about encounter diagnosis and encounter type above under applicable standards - is that intentional? CMS submitted several distinct encounter data elements for consideration in USCDI, including encounter time, encounter diagnosis, and encounter type. For encounter time, our submission intended to recommend including an encounter date/time, or the time the encounter began (i.e. admission date/time for inpatient admissions, date/time for office visit) and when appropriate (i.e. hospital encounters) a discharge date/time, or date/time when the encounter ended. 

Encounter Time

• We would need to consider capturing this variable in order to support the following 6 domains related to Paul Coverdell National Acute Stroke Program/American Hospital Association’s (AHA) Get With The Guidelines (GTWG). • The goal is to reduce gaps in stroke care across the continuum of care in states with high burden populations. The information captured from stroke patients and those who encounter mobility related issues and are at risk of multiple hospitalizations due to post-discharge complications can help in reducing the gaps in care and to plan quality improvement efforts. # Domain # of Variables Variable Details Required or Optional 1 Hospital Discharge Date 1 1. date of hospital discharge Required 2 Hospital Admission Date 1 1. hospital admission date Optional 3 Follow-up 4 1. if follow-up phone call conducted, date 2. if in home follow up conducted, date 3. if chart review conducted, date 4. if follow-up conducted at a health facility, date Required 4 ED Visits 2 1. if patient seen in the ED since discharge, date information about ED visits gathered if before 30 days 2. if yes, Date of first ED visit Optional 5 Follow Up Appointment 1 1. date of first follow up appointment Optional 6 Readmissions 1 1. if readmitted, date of first readmission Optional Use-Case Justification: The most challenging part is capturing the information post-hospital discharge for acute stroke patients. A lot of the pre-hospital care is captured through National Emergency Medical Services Information System (NEMSIS), a national database that stores EMS data from the U.S. States and Territories). The follow-up elements proposed above have been developed as a part of the Paul Coverdell National Acute Stroke Program (link provided below) and captured within EHR for submission into American Heart Association’s (AHA) Get With The Guidelines (GTWG) module. The ability to extract the follow-up encounter related dates would help with the identification of gaps in post-hospital discharge date for stroke patients and plan strategies for Quality Improvement efforts. https://www.cdc.gov/dhdsp/programs/stroke_registry.htm This field is for general comments on this specific data element. To submit new USCDI data classes and/or data elements, please use the USCDI ONDEC system: https://healthit.gov/ONDEC

USCDI_Version_2_Draft_Template for Comments_DHDSP_vFinal_04.14.2021.docx

Clarify encounter and encounter time

We recommend that ONC clarify “encounter” and “encounter time” and explain whether it applies to a daily visit (day/time/start and stop time) or an episode’s admission and discharge, which is comprised of numerous daily visits. In a facility setting, it is important to recognize that there can be many parallel encounters; for instance, numerous health care professionals conduct visits with a patient who is residing in long-term care facility; a patient may be admitted for 100 days, during which time a record is created each day (physical therapist treats in the morning, physical therapist assistant treats in the afternoon). Thus, is an encounter time representative of the patient’s entire stay in the skilled nursing facility, or each daily individual visit (which may be comprised of numerous visits by different health care professionals)? In the emergency department, a patient may be evaluated and treated by different clinicians, including a physical therapist. Thus, is encounter time admission and discharge from the hospital/emergency department, or the beginning and end of each clinician’s visit, and/or the beginning and end of a procedure? Other questions that must be resolved in the final USCDI:

1. Is encounter date/time representative of the date and time of the encounter with the patient, or the date and time that the documentation is completed? Most clinicians do not collect start and stop times for an encounter. Moreover, is date and time intended to be reflected via a timestamp? Also, we question which timestamp would travel with the documentation, as a clinician may see a patient at one time during the day and complete their documentation at another time that day. Should the encounter time be the time the treatment occurred or the time the documentation entry occurred or both or neither?
2. Does encounter time encompass duration? Requiring duration to be reported can create challenges between “duration” for a CPT code vs. duration of the entire session. In addition, the actual duration of the visit is not currently collected in all locations or by all practitioners. Finally, while the documentation itself may or may not include the duration, although the billing should reflect the time of each intervention and match the documentation.
3. Is encounter time intended to reflect when the treating or evaluating clinician begins to provide skilled care for the patient, or is it more broadly the time of the scheduled appointment?
4. Is it intended to capture time involved in direct one on one patient care or the overall visit? For instance, in a physical therapy office visit, frequently both the physical therapist and physical therapist assistant will treat the patient (at separate times).
5. Would the start time of the physical therapist be captured, as well as the start time of the physical therapist assistant?

Additional clarification is necessary.

Office visit clarifications - duration and meaning of start time

Is this intended to also capture duration or classification (long, short, regular, etc) of a visit for an office visit? Some of the content above make me think it might be. Is it meant to be the scheduled start time or the actual start time or the patient check-in time? There are comments about encounter diagnosis and encounter type above under applicable standards - is that intentional?

MedMorph's support of Encounter Timing

The MedMorph Project fully supports the addition of this element for USCDI v2. The encounter period is a necessary element for the MedMorph Healthcare Survey use case.