Submitted by nedragarrett_CDC on 2022-04-28
|Submitted By: Jeff Lyall / Cigna|
|Data Element Information|
|Use Case Description(s)|
|Use Case Description||1. Systematic awareness and data life cycle completeness in regards to a Patient records and data maintainers (i.e. Providers and Health Plans)
2. Meaningful analytic driven guidance relating to disease tracking, patient longevity, and population trends.
3. Population studies – include or exclude members based on living status from study criteria will have more accurate outcomes and or interventions
4. Bereavement considerations impacting family members. Payers could reduce member notification to member and family or better service survivors on next steps
5. Health Plans can reduce fraud and abuse by monitoring claim activity for deceased membership.
|Estimated number of stakeholders capturing, accessing using or exchanging||>1M+ : This would be used by multiple entities (plans , providers, health proxies) for the individuals and for population health uses.|
|Use Case Description||Date of death is required to be captured in inpatient certified EHR systems as part of ONC's 2015 Certification|
|Estimated number of stakeholders capturing, accessing using or exchanging||All inpatient EHRs are required to capture date of death in their certified EHRs.|
|Link to use case project page||https://www.healthit.gov/test-method/demographics|
|Maturity of Use and Technical Specifications for Data Element|
|Applicable Standard(s)||Follow the DOB format
|Additional Specifications||HL7 USCore Implementation Guide v3.1.0 and v3.1.1 (Errata release) both allow for capturing deceased as either a Boolean (yes/no) or the date of death in the Patient profile. (Reference Link)
However, neither version of the USCore Implementation Guide state the element as a Must Support or required. USCore would need to bring the Patient profile up-to-date if the proposed Date of Death element is approved for USCDI v2.
|Current Use||In limited use in production environments|
|Number of organizations/individuals with which this data element has been electronically exchanged||N/A|
|Restrictions on Standardization (e.g. proprietary code)||N/A|
|Restrictions on Use (e.g. licensing, user fees)||N/A|
|Privacy and Security Concerns||Same security measure apply to this data element.|
|Estimate of Overall Burden||EMR capture expiration dates|
|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|
|Evaluation Comment||Significant support for adoption (15 comments total to date) across the industry, capacity to exchange (in various ways) across standards and terminologies, low implementation burden for most developers.|
Submitted by RUy on 2022-04-29
Codes, value sets and other feedbackNACHC is supportive of a standards-based concept of date and time of death; however, we feel more guidance and support would be useful to accompany this concept.
NACHC is sensitive to the fact that in some use cases a date of death may be available but not a time, and so suggests that the implementation guidance in this case addresses the situation in which date but not time are available by defaulting to a null time or by linking this code to the clinical date of death code 81954-0 which specifies a date and not a date/time and could be mapped to an 80616-6 code with a null time.
- The USCDIv3 submission page does not point to a specific concept for date of death.
The applicable standard specified in the draft USCDIv3 submission does not identify a terminology standard but specifies a data format.
We recommend modifications in this field to specify adherence to a clinical terminology standard such as LOINC and SNOMET-CT to represent the concept of Date of Death.
NACHC suggests the use of the LOINC code 80616-6 as the appropriate term due to its use in federal programs for death reporting and certification.
Please see attached NACHC letter, documenting this comment and other feedback for v3 accepted draft data elements.
- It should be noted that the FHIR profile referenced in comment for DeathCertification, for example, references SNOMED-CT concepts (SCT 419099009) and not LOINC and it is expected that the USCore profile would reference the LOINC code for both patient deceased and date of death (LOINC 80816-6, 81956-5, 81954-0).
2022-04-30 NACHC USCDIv3 Letter of Support_9.pdf