|Submitted By: Craig Newman / Altarum|
|Data Element Information|
|Use Case Description(s)|
|Use Case Description||o Exposures to communicable and environmental pathogens during travel pose a risk for importation of nonendemic, emerging, or antimicrobial-resistant pathogens to the United States. For this reason, it is important for public health officials to receive discrete and accurate travel history information about patients, including dates of travel. This information is particularly important during outbreaks.
o Travel dates, specifically the timing and duration of travel with respect to illness onset, are essential to determine the timing and location of exposure for a diagnosed infectious disease, or to formulate a complete differential diagnosis for illnesses of unknown etiology, based on known or estimated incubation periods and natural history of disease progression.
o During periods when outbreaks are occurring in an international location with risk of case importation to the United States, identifying travel-associated cases is essential to ensure appropriate public health management of case-patients and contacts as well as to inform guidance for travelers or clinicians or public health policy.
o In some situations, cases in travelers may serve as sentinel events in identifying new or re-emerging pathogens or previously unidentified outbreaks.
o Surveillance for travel-associated disease importation and spread also informs travel health prevention and treatment recommendations for travelers and clinicians.
|Estimated number of stakeholders capturing, accessing using or exchanging||o Travel history would be reported in all jurisdictions as part of electronic case reporting.
o Healthcare providers – physicians, pharmacists, nurses, and physician assistant
o 50 states Local and State health department
o CDC Division Global Migration and Quarantine
o Centers for Medicare & Medicaid Services
o Currently built into national case notifications to CDC for 25 reportable conditions using the case notification HL7 message mapping guide format. Anticipate within the next couple of years to make travel history available for all notifiable conditions
|Maturity of Use and Technical Specifications for Data Element|
|Applicable Standard(s)||§ SNOMED: 420008001 |Travel (event)|
§ Geographical location history (https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.do 11.3201)
§ ISO 3166 country codes (https://www.iso.org/iso-3166-country-codes.html)
§ LOINC v2.72 Date travel started:Date:Pt:^Patient:Qn (Code 82752-7)
§ LOINC v2.72 Date of departure from travel destination:Date:Pt:^Patient:Qn (Code 91560-3
|Additional Specifications||§ HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) http://build.fhir.org/ig/HL7/case-reporting/StructureDefinition-us-ph-travel-history.html
|Current Use||Extensively used in production environments|
Used as part of electronic case reporting
|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.|
Somewhere between 56 and 2400 public health agencies and 5000 reporting sites.
|Restrictions on Standardization (e.g. proprietary code)||None|
|Restrictions on Use (e.g. licensing, user fees)||None|
|Privacy and Security Concerns||o Health Insurance Portability and Accountability Act (HIPAA, https://www.hhs.gov/hipaa/index.html)|
|Estimate of Overall Burden||These data elements are straightforward in nature and should not present a large burden to implement provided the EHR system is capturing the data.|
|ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following 4 criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
|Maturity – Standards/Technical Specifications||Level 1/2 - Must be represented by a vocabulary standard or an element of a published technical specification|
|Maturity - Current Use||Level 2 - Used at scale in more than 2 different production environments|
|Maturity - Current Exchange||Level 2 - Demonstrates exchange between 4 or more organizations with different EHR/HIT systems|
|Breadth of Applicability - # Stakeholders Impacted||Level 2 - Used by a majority of patients, providers or events requiring its use|