| Submitted By: Matt Reid / American Medical Association | |
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| Data Element Information | |
| Use Case Description(s) | |
| Use Case Description | Physicians, suppliers, payers, and patients need the ability to order and track DME electronically to eliminate paper and fax and to ensure accurate ordering, minimize denials, and to reduce time required to supply patients with needed DME and related supplies. As patients move from sites of service, between payers, or when accessing their own medical information, DME information should be structured and included within a common data set associated to the patient. Yet, there is currently no well adopted standard for electronically ordering DME equipment and supplies. Including DME within the USCDI will heighten the importance of DME capture and exchange, promote adoption using FHIR-based standards, and support use cases such as prior authorization. Suggested Use: Provider sends a message bundle with an order (e.g. medical equipment request and supporting documentation). The receiver (supplier or service provider) is able to receive it, respond back to the message, instantiate the order, and has the ability to respond back to the ordering provider’s message with an alert when the order is updated. There is also a need to support the ability to exchange an updated order or cancel the order. ONC Certified Health IT should support message bundle (DME and order) handoff between systems. Use Case 1: Ordering home oxygen therapy with the required elements to meet CMS/private payer standards for ordering and documentation. Capturing and exchanging the required elements for medical necessity and appropriateness along with the provenance to support both the order and the documentation requirements. Use Case 2: Ordering CPAP (Continuous Positive Airway Pressure) devices with the required elements to meet CMS/private payer standards for ordering and the documentation. Capturing and exchanging the required elements for medical necessity and appropriateness along with the provenance to support both the order and the documentation requirements. |
| Estimated number of stakeholders capturing, accessing using or exchanging | This would pertain to many patients, providers or requestors, including Medicare Part B beneficiaries. |
| Use Case Description | Support for the communication of substantiating review (e.g. prior authorization, appropriate use, medical review services) information (e.g. tracking and authorization numbers). |
| Estimated number of stakeholders capturing, accessing using or exchanging | This would pertain to many patients, providers or requestors, including Medicare Part B beneficiaries. |
| Healthcare Aims |
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| Maturity of Use and Technical Specifications for Data Element | |
| Applicable Standard(s) | The Centers for Medicare & Medicaid Services (CMS) annually updates a spreadsheet that contains a list of the HCPCS codes for DME MAC and Part B MAC jurisdictions to reflect codes that are either added or discontinued (deleted) each year. The jurisdiction list is an Excel file and is available at https://www.cms.gov/Center/Provider-Type/Durable-Medical-Equipment-DME-Center https://www.cms.gov/Center/Provider-Type/Durable-Medical-Equipment-DME-Center |
| Additional Specifications | https://build.fhir.org/ig/HL7/dme-orders/index.html |
| Current Use | In limited use in test environments only |
| Supporting Artifacts |
Comment Level – in limited test environment or pilot |
| Number of organizations/individuals with which this data element has been electronically exchanged | 2-3 |
| Supporting Artifacts |
Comment Level – used only in connect-a-thons of small pilots https://chat.fhir.org/#narrow/stream/236612-DME-Orders.20on.20FHIR |
| 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 | We support expanding the USCDI and the overall goal of getting meaningful information into the hands of clinicians and patients. However, we stress that the USCDI coupled with increased access to this information (both inside and outside HIPAA), could create a conduit for bad actors to syphon sensitive data from patients. We believe there should always be a balance between more information and strengthening patients’ trust in how the information is used. As with any personal information, there is a need to ensure patients are comfortable sharing such data with their physicians. Thus, we encourage ONC to expand the USCDI to include the DME data elements while concurrently coordinating with standards development organizations working to ensure data is shared with appropriate protections, including when it is accessed by third parties outside of the health care system. |
| Estimate of Overall Burden | DME information is captured within both inpatient and outpatient settings. There are two separate components for consideration; the first is the DME itself and the other is the DME order. Automatically retrieving and documenting the DME and associated order would greatly reduce physician burden. Consistently communicating the DME order to the payer may also reduce prior authorization review and response. Physicians and patients would also benefit from easily accessing DME information as part of the patients’ core data (i.e., USCDI) communicated between certified health IT systems. |
Data Element |
Information from the submission form |
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| DME Orders |
Description
Medically necessary equipment (and the corresponding order) that a physician prescribes for use in a patient’s home, including wheelchairs, walkers, and hospital beds.
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Submitted by t.reed.udi on 2021-03-02
Support for using UDI as part of DME ordering
Symmetric Health Solutions Response to Comment: Durable medical equipment (DME) are regulated medical devices and fall under the FDA CDRH UDI Regulations. Since DME is an essential part of patient care and DME performance affects patient outcomes, we agree that the UDIs of DMEs should be included in USCDI. In addition, our organization can map the device identifier of UDI (UDI-DI) to DME for reimbursement purposes and assumes that other vendors could create similar functionality that would use UDI to increase transparency of the healthcare supply chain.