Information related to interactions between healthcare providers and a patient.

Data Element

Additional Information

Encounter Identifier
Description
Sequence of characters by which an encounter is known.

Comment

CMS-CCSQ Continued Support for Encounter Identifier

CMS-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 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.
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.

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.

CDC's comment on behalf of CSTE

CSTE Comment:
  • CSTE strongly recommends inclusion of encounter identifier in USCDI v4. This field would be exceedingly helpful in matching eCR data back to the encounter from which it derived. This will be critical for data quality improvement and troubleshooting as eCR implementation scales up across the US.

CDC-CMS Shared Priority

Encounter identifier is CDC-CMS shared priority to be included in V3.

CDC's comment on behalf of CSTE

CSTE strongly recommends inclusion of encounter identifier in USCDI v3. This field would be exceedingly helpful in matching eCR data back to the encounter from which it derived. This will be critical for data quality improvement and troubleshooting as eCR implementation scales up across the US.

CDC's Consolidated Comment

Importance: The Encounter Identifier helps narrow the patient’s health information to a particular encounter so that only relevant information is sent from the patient’s record. Facilitates accurate linking of data across encounters. This is important for at least two reasons: (1) unnecessary information from the patient’s health record should not be sent, (2) extra information sent requires a lot of effort to process to get to the necessary information. This is not ideal for the data sender or the data receiver. Feasibility: Since Encounter Identifier is required in HL7 CCD and C-CDA documents (as a “SHALL” and “SHOULD”), EHRs likely already support this data element. Examples of program use: CDC Division of Healthcare Quality Promotion (DHQP) Hypoglycemia Measure Additional Technical Specifications: HL7 FHIR Health Care Surveys Content Implementation Guide (http://hl7.org/fhir/us/health-care-surveys-reporting/2022Jan/); HL7 FHIR Central Cancer Registry Reporting Content Implementation Guide (http://hl7.org/fhir/us/central-cancer-registry-reporting/2022Jan/).

CMS-CCSQ Support for Encounter Identifier

CMS-CCSQ recommends reclassification of this data element to Level 2. Encounter identifiers are critical for linking data, distinguishing between encounters, as well as tracking of data. Encounter identifiers provide important contextual information to support interoperability, quality measure reporting, and public health reporting. Maturity:
  • Current standards:
  • Current uses, exchange, and use cases: CMS recognize 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.

Unified Comment from CDC

  • Data element description: Encounter Identifier is defined by HL7 US Core as the identifier(s) by which this encounter is known and US Core notes that this is a business identifier, not a resource identifier (http://hl7.org/fhir/us/core/StructureDefinition-us-core-encounter-definitions.html#Encounter.identifier).  
  • General Comment: Encounter Identifier is a Must Support data element in the US Core Encounter Profile. Encounter identifier is a fundamental and critically important data element for the MedMorph use case of Health Care Surveys. Cancer Registries and we suspect many other use cases use Encounter Identifier to resolve duplicate records, among other uses.  
  • Estimate the number of stakeholders who capture, access, use or exchange this data element or data class: The encounter identifier is generated by all EHRs that this commenter is aware of including all major EHR products that together comprise over 80% of inpatient and ambulatory EHR US market share.  
  • Additional Use Cases: Among many other clinical and payment related use cases, Da Vinci Payer Data Exchange 1.0.0 - STU1 (http://hl7.org/fhir/us/davinci-pdex/USCoreEncounter.html) uses Encounter Identifier.  
  • Additional Applicable Standards: Da Vinci Payer Data Exchange http://hl7.org/fhir/us/davinci-pdex/STU1/

Log in or register to post comments