Submitted by PACIO-Project on 2022-09-28
Support to Advance Encounter Identifier
- The PACIO (Post-Acute Care Interoperability) Project, established February 2019, is a collaborative effort between industry, government, and other stakeholders, with the goal of establishing a framework for the development of FHIR implementation guides to facilitate health information exchange.
- The PACIO Community has published a Re-Assessment Timepoints FHIR implementation guide (http://hl7.org/fhir/us/pacio-rt/) that profiles the US Core Encounter to support the representation of subsets of the longer encounters such as those found in post-acute care, behavioral health, and other residential settings. Because they represent parts of the larger encounter that is already a data class within USCDI, we believe that field-level requirements within that guide provide anecdotal support to proposed encounter data elements, including status, subject, identifier, participant, and reason for encounter. By providing real-world experience from implementations of the standard, we hope the Re-Assessment Timepoints implementation guide will help motivate the inclusion of these Encounter data elements within a future version of USCDI.
- The PACIO Community also believes that the concept of an encounter subset that is at the core of the Re-Assessment Timepoints implementation guide is a useful data element to include within USCDI and we will propose this as a new data element.
Submitted by Svellanky on 2022-09-29
CMS-CCSQ Continued Support for Encounter IdentifierCMS-CCSQ recommends reclassification of this data element to Level 2 and continues to find value in the addition of the data element to USCDI. This data element was previously identified as a CMS-CDC joint priority. Encounter identifiers are critical for providing context to other clinical data and supporting linking of data across care settings, distinguishing between encounters, as well as tracking of data, including between acute, post-acute and other care settings. All of these activities are important for supporting interoperability, quality measurement, and public health reporting. Furthermore, encounter identifiers (IDs) can support public health emergency activities, which is a stated ONC USCDI v4 priority. Maturity:
Current uses, exchange, and use cases: CMS recognizes that there may be variation in how encounter identifiers are formatted across facilities (i.e., there is not yet one, universal formatting standard), but the information provides context to the granular data exchanged – for example, did this data come from two distinct encounters or the same encounter – and enables linking those shared data with other relevant information. Encounter Identifiers are submitted for CMS eCQMs to support distinguishing between episodes of care when multiple episodes of care are submitted for a quality measure. This data element is also used for public health reporting.
- Current standards:
- HL7 FHIR US Core Implementation Guide STU4, STU5 based on FHIR R4, Encounter Profile must support an encounter identifier (https://www.hl7.org/fhir/us/core/StructureDefinition-us-core-encounter.html)
- Although there is no universal formatting standard for encounter IDs, the current state of “standardization” is sufficient to support the stated uses of linking and contextualizing data.