Data Element
Submitted By: Steven Lane / Sutter Health
Data Element Information
Rationale for Separate Consideration While most EHRs include a date field associated with each diagnosis, this field may be used variably to denote the date of entry, onset, diagnosis, etc. Having a specific field to specify the date that a given diagnosis was made would support the determination of disease prevalence and support research and public health activities.
Use Case Description(s)
Use Case Description Having a specific field to specify the date that a given diagnosis was made would support the determination of disease prevalence and support research into disease progression as well as public health activities. Knowing the amount of time that a patient has had a given disease can also support clinicians and those managing the health of populations to predict the timing/rate of the development of complications and/or disease progression.
Estimate the breadth of applicability of the use case(s) for this data element All clinicians could utilize this data to determine the duration of a disease process
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) N/A
Additional Specifications N/A
Current Use In limited use in production environments
Supporting Artifacts Cancer and some other disease registries capture date and often the manner of diagnosis for relevant conditions.
Extent of exchange 4
Supporting Artifacts Cancer registries receive this data from cancer registrars as part of routine reporting.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) N/A
Restrictions on Use (e.g. licensing, user fees) N/A
Privacy and Security Concerns N/A
Estimate of Overall Burden EHRs and other HIT systems likely all capture, at least in audit trail/metadata, the date that a diagnosis was entered into the active problem list and/or medical history list. This is quite different in meaning than the Date of Diagnosis so additional date fields would need to be added, the data stored in the database, data added to interoperability payloads for send, receive, ingestion, etc..
Other Implementation Challenges There would be a need to develop and maintain a clear definition of how this field is to be populated as well as a determination of what types of actors should be allowed to populate or update this data field. Would also need to define how to capture and maintain a provenance history for this data elements that could eventually travel with the data as it is transmitted between HIT systems.

Comment

Submitted by stevepostal on

Comments to Date of Diagnosis Data Element

As APTA noted previously, “diagnosis” needs to be better defined. For instance, will ONC allow more than one diagnosis to be reported? A physician may diagnose a patient with X, Y, and Z; the patient then sees a physical therapist, and the physical therapist identifies several musculoskeletal diagnoses. In this instance, are all diagnoses reported including all comorbidities?

APTA also suggest that ONC clarify that more than one clinician is eligible to populate this field.

ONC also should clarify how comorbidities should be tracked and whether these diagnoses/conditions are reported.

Finally, we suggest that ONC address how “errors” will be resolved, for instance, when the date of diagnosis may vary between the date of diagnosis in an EHR and the date that the patient reports that they were diagnosed.

Submitted by Kara Rose on

As noted elsewhere, …

As noted elsewhere, “diagnosis” needs to be better defined. For instance, will ONC allow more than one diagnosis to be reported? A physician may diagnose a patient with X, Y, and Z; the patient then sees a physical therapist, and the physical therapist identifies several musculoskeletal diagnoses. In this instance, are all diagnoses reported including all co-morbidities?

We also suggest that ONC clarify that more than one clinician is eligible to populate this field.

ONC also should clarify how comorbidities should be tracked and whether these diagnoses/conditions are reported.

Finally, we suggest that ONC address how “errors” will be resolved, for instance, when the date of diagnosis may vary between the date of diagnosis in an EHR and the date that the patient reports that they were diagnosed.

Submitted by Steven.Lane on

Suggested modification to metric definition

I also agree with MedMorph's suggestion.  Clinically the Date of Onset, often marked by the earliest date of symptoms, laboratory/imaging abnormalities, or morphologic changes, is distinct from the Date of Diagnosis, typically by a healthcare professional.

Submitted by maria.michaels… on

MedMorph's support of Date of Diagnosis

The MedMorph Project supports the addition of Date of Diagnosis, but requests slight tweaking of the definition.The current definition is very similar to the Date of Onset and includes extraneous information that should not be included in the definition.

Suggested definition:
The date of initial diagnosis by a recognized medical practitioner for the diagnosis, whether clinically or microscopically/laboratory confirmed.

Submitted by nedragarrett_CDC on

MedMorph's Date of Diagnosis

We agree with MedMorph's recommendations for the two mentioned data submissions, the two data elements mirror each other too closely and the definition should be revisited, based on the review of the submissions we've received.

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