Activity performed for or on a patient as part of the provision of care.

Data Element

Information from the submission form
Procedure Timing
Description

This submission has been added to Draft USCDI v4 as Procedures/Time of Procedure.

Time and/or date a procedure or other action is performed.

Submitted By: Sheila Abner / CDC/NHSN
Data Element Information
Use Case Description(s)
Use Case Description Surgical site infections are reported to NHSN as part of nationwide healthcare-associated infections surveillance. Data reported to NHSN on surgical site infections associated with colon and abdominal hysterectomy operative procedures are submitted to CMS.

Data elements associated with orders for isolation / transmission precautions (status of patient on the following types of isolation precautions: contact, airborne, droplet) are needed for public health reporting on patients with suspected cases of contagious diseases. Feedback is requested regarding the most appropriate class for these data elements. Another option might be Encounter or possibly part of a new class such as Service Request.
Estimated number of stakeholders capturing, accessing using or exchanging Beginning 15 years ago with 300 hospitals, NHSN now serves approximately 25,000 medical facilities tracking HAIs. Current participants include acute care hospitals, long-term acute care hospitals, psychiatric hospitals, rehabilitation hospitals, outpatient dialysis centers, ambulatory surgery centers, and nursing homes, with hospitals and dialysis facilities representing the majority of facilities reporting data. Participation among the other facility types is expected to continue to grow in coming years.
Link to use case project page https://www.cdc.gov/nhsn/index.html
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) Location of Procedure: HSLOC (https://www.cdc.gov/nhsn/cdaportal/terminology/codesystem/hsloc.html)

Transmission-based precautions: SNOMED CT
Additional Specifications CDA IG: HL7 CDA® R2 Implementation Guide: Healthcare Associated Infection (HAI) Reports, Release 3 - US Realm (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=426)
FHIR IG: Healthcare Associated Infection Reports Implementation Guide CI Build (http://hl7.org/fhir/us/hai/)
Current Use Extensively used in production environments
Number of organizations/individuals with which this data element has been electronically exchanged 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) none known
Restrictions on Use (e.g. licensing, user fees) none known
Privacy and Security Concerns none known
Estimate of Overall Burden Moderate burden. Orders for isolation are currently irregularly implemented, so there is a need for more consistent documentation. Implementing appropriate transmission-based precautions is important for individual patient care as well as facility infection control. Easy access to isolation status of a patient for situational awareness is critical.
Other Implementation Challenges none known

Comment

Submitted by hantran on 2023-04-17

CAP Comment on Time of Procedure

  • Data Class: Procedures
  • Data Element: Time of Procedure
  • CAP Comment: The ONC has issued a request for information as to whether a single USCDI data element Time of Procedure satisfies the community submissions to add timing elements to a variety of USCDI data classes. The CAP does not support the use of a single Time of Procedure data element for pathology and laboratory purposes, as it cannot clearly represent the laboratory times and dates that are required by regulation to be reportable. For example, it is unclear whether a single data element named Time of Procedure is indicating the time of the sampling procedure or the time of the analytic procedure. Separate laboratory data elements are necessary to represent regulatorily mandated laboratory dates and times in the USCDI. With respect to current USCDI submissions, this single Time of Procedure data element would not be sufficient to represent the Level 2 laboratory time data elements which are necessary for interoperability and should be added into the USCDI.

Submitted by nedragarrett_CDC on 2023-04-13

Clarification - CDC's Consolidated Comment for USCDI v4

A procedure use case may include multiple timing type data elements within a procedure (e.g. in-room time, time of induction, surgery start). Similar to labs, we recommend new data element called Type of Timing to capture these types of observations within a Procedure.

Submitted by nedragarrett_CDC on 2023-04-07

CDC's Consolidated Comment for USCDI v4

  • Recommend 'Time of Procedure' be specified like labs. For example, procedures with anesthesia for example will include in-room time, time of induction, surgery start, etc.
  • Comments from NACCHO: NACCHO expects that this data element will not provide much value to Local Health Departments as not every procedure has these kinds of values.

Submitted by aphillips@imoh… on 2022-04-28

Level 2 Data Element: Procedure Timing

IMO supports the inclusion of proposed Level 2 Data Elements for Procedure Timing and Location of Procedure in USCDI V3.  These data elements are incorporated in mature technical specifications including CDA R2 Implementation Guide: Healthcare Associated Infection (HAI) Reports, Release 3. ONC certified HIT should be capable of exchanging these data elements.  

Submitted by nedragarrett_CDC on 2021-09-29

Unified Comment from CDC

The Multiple Chronic Conditions eCare Plan project successfully tested this element at the Sep 2020 and Jan 2021 FHIR connectathons and has implemented it at the OHSU testing site. 

Submitted by nedragarrett_CDC on 2021-04-15

timing

The CDC Division for Heart Disease and Stroke Prevention and the Million Hearts® 2022 Hearts national initiative (co-led by and the Centers for Medicare & Medicaid Services) uses this data as it is available for monitoring and evaluation to prevent 1 million heart attacks and strokes in 5 years. Furthermore, the CDC plans to leverage this data further in the future for surveillance and epidemiology studies if advanced through policy and available from EHRs. The Multi-state EHR-based Network for Disease Surveillance (MENDS) pilot will use electronic health record (EHR) data collected in clinical settings leading to a real-time, chronic disease surveillance model to plan and evaluate short-term outcomes of policies and program interventions.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_MENDS_04.15.2021_3.docx

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