|Submitted By: Nedra Garrett / Centers for Disease Control and Prevention|
|Data Element Information|
|Use Case Description(s)|
|Use Case Description||"Monitoring disease and making decisions about public health threats depends on accessible and accurate data. EHRs are a data source with potential to provide timely and relevant data beyond its use by health care providers. EHR data, if made more available for public health professionals and researchers, can lead to new innovations and more rapid disease detection.
Patient demographics such as patient medical record number, patient Medicare number, patient social security number are used to link health information to help address differences and gaps in care within specific populations. Patient gender identity, patient marital status, patient address use period, patient vital status, patient pregnancy status observation, patient birth place (City, Town, Or Location Of Delivery), and patient country of birth are patient demographics utilized by multiple public health use cases to help assess characteristics within patient populations.
The public health use case(s) that support the adoption of these added elements are part of the Making EHR Data More Available for Research and Public Health (MedMorph) Reference Architecture. The goal of the MedMorph project is to develop and pilot a scalable and extensible standards-based reference architecture. This reference architecture will enable clinical data exchange with EHR systems and public health systems, specialized registries, national health care survey systems, and research information systems for multiple conditions."
|Estimate the breadth of applicability of the use case(s) for this data element||"All 50 states participate in one or more of the public health surveillance use cases that exchange this data element.
All hospitals and physicians who diagnose or treat cancer are required to provide cancer related information to state cancer registries. Vital records reporting such as birth, fetal death and death are also required to be reported by each state. Every year there are approximately 2.8 million deaths and 3.7 million births in the United States.
Approximately 600,000 physicians in the US are active and have at least some component of ambulatory practice and thus are annually eligible to sampling and recruitment into the National Ambulatory Medical Care Survey (NAMCS), which samples from between 3,500 to 20,000 of these physicians annually. Presently each sampled physician submits one weeks' worth of patient encounters to NAMCS. Approximately 600 hospitals are in the National Hospital Care Survey (NHCS). 1/3 of that number are either in, or actively being recruited into, the EHR data submission mode for NHCS. NHCS is already receiving electronic CDA documents. When they reach their target of 200 hospitals submitting by this mode annually they will be receiving >1.2 million documents and sets including multiple sets of medication data annually.
There were approximately 1,000,000 practicing physicians (as of 2020), approximately 120,000 certified physician assistants (as of 2019) and 290,000 licensed nurse practitioners (as of 2019). Most of these licensed clinicians interact with one of these public health use cases intermittently, annually. As of 2018 AHA reported 6,146 hospitals in the US experiencing 36,353,946 admissions. Almost all of those hospitals and at least half of the admissions interact with one or more of the public health use cases.
Additionally, public health reporting use cases are part of the of the Center for Medicare and Medicaid (CMS) Meaningful Use/Promoting Interoperability program adding on to the list of stakeholders under public health registries who capture electronic health information."
|Link to use case project page||https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html|
|Use Case Description||The MedMorph project is being developed with the goal of generalizability to support many more public health and research use cases. Therefore, other public health and research use cases that use the MedMorph architecture will also benefit from adoption of this data element
|Estimate the breadth of applicability of the use case(s) for this data element||N/A
|Link to use case project page||https://www.cdc.gov/ecr/index.html|
|Maturity of Use and Technical Specifications for Data Element|
|Applicable Standard(s)||Medicare Beneficiary Identifiers (MBIs)
|Additional Specifications||"HL7 CDA ® Release 2 Implementation Guide: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1, DSTU Release 1.1 – US Realm (https://www.hl7.org/implement/standards/product_brief.cfm?product_id=398)
HL7 CDA® R2 Implementation Guide: National Health Care Surveys (NHCS), R1 STU Release 3 - US Realm (https://www.hl7.org/implement/standards/product_brief.cfm?product_id=385) (Confirm version with Brian)
C-CDA (HL7 CDA® R2 Implementation Guide: Consolidated CDA Templates for Clinical Notes - US Realm) (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492)
HL7 FHIR® US Core Implementation Guide STU3 Release 3.1.1 (https://www.hl7.org/fhir/us/core/index.html)
HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm (http://hl7.org/fhir/us/ecr/STU1/Electronic_Initial_Case_Report_(eICR)_Transaction_and_Profiles.html)
HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 2 - US Realm - the Electronic Initial Case Report (eICR) (https://www.hl7.org/implement/standards/product_brief.cfm?product_id=436)
IHE Quality, Research and Public Health Birth and Fetal Death Reporting-Enhanced
|Current Use||Extensively used in production environments|
"eCase Reporting with The Council of State and Territorial Epidemiologists (CSTE) and The Association of Public Health Laboratories (APHL)
National Health Care Survey Registry - HL7 CDA® R2 Implementation Guide: National Health Care Surveys (NHCS), R1 STU Release 1.2 was never named in a final rule but rather became part of Promoting Interoperability through Certification Companion Guide (CCG) and Test Procedures Updates to the ISA in 2017.
EPIC stork module (obstetrics) for birth reporting.
IHE integration profiles for BFDR (CDA)
EPIC FHIR patient, vitals, obstetric details (DSTU2, DSTU3, R4)
Cerner FHIR patient resource (DSTU2, R4)
Evident FHIR patient resource (DSTU2)
Allscripts FHIR patient resource (DSTU2)"
"eCase Reporting: https://ecr.aimsplatform.org/about-us#:~:text=A%20US%20federal%20agency%20under,the%20United%20States%20and%20internationally.
EPIC stork module (obstetrics) for birth reporting: https://www.epic.com/software#PatientEngagement
https://fhir.epic.com/Specifications?api=932, https://fhir.epic.com/Specifications?api=968, https://fhir.epic.com/Specifications?api=966
|Extent of exchange||N/A|
|Restrictions on Standardization (e.g. proprietary code)||N/A
|Restrictions on Use (e.g. licensing, user fees)||None
|Privacy and Security Concerns||Concerns with the use of personally identifying information (PII). However, these data are intended to be a part of the medical record and will be protected as such using proper secure protocols.
|Estimate of Overall Burden||For those use cases not currently in production level or who have not tested with vendors may require additional development hours or resources.
|Other Implementation Challenges||N/A
Data used to categorize individuals for identification, records matching, and other purposes.
Patient's Primary Care Provider
Patient's nominated care provider. [Knowing this at the patient level can help answer the question at the encounter level whether the pt. was seen by PCP.]