Encounter Information

Support to Advance Reason for the Encounter

• The PACIO (Post-Acute Care Interoperability) Project, established February 2019, is a collaborative effort between industry, government, and other stakeholders, with the goal of establishing a framework for the development of FHIR implementation guides to facilitate health information exchange.
• The PACIO Community has published a Re-Assessment Timepoints FHIR implementation guide (http://hl7.org/fhir/us/pacio-rt/) that profiles the US Core Encounter to support the representation of subsets of the longer encounters such as those found in post-acute care, behavioral health, and other residential settings. Because they represent parts of the larger encounter that is already a data class within USCDI, we believe that field-level requirements within that guide provide anecdotal support to proposed encounter data elements, including status, subject, identifier, participant, and reason for encounter. By providing real-world experience from implementations of the standard, we hope the Re-Assessment Timepoints implementation guide will help motivate the inclusion of these Encounter data elements within a future version of USCDI.
• The PACIO Community also believes that the concept of an encounter subset that is at the core of the Re-Assessment Timepoints implementation guide is a useful data element to include within USCDI and we will propose this as a new data element.

Reason for the encounter

• We would need to consider capturing this variable in order to support the following domain related to Paul Coverdell National Acute Stroke Program/American Hospital Association’s (AHA) Get With The Guidelines (GTWG). The goal is to reduce gaps in stroke care across the continuum of care in states with high burden populations. • The information captured from stroke patients and those who encounter mobility related issues and are at risk of multiple hospitalizations due to post-discharge complications can help in reducing the gaps in care and to plan quality improvement efforts. # Domain # of Variables Variable Details Required or Optional 1 ED Visits 1 1. If patient had ED visit, was reason for first ED visit:   1. Fall, 2. Trans-ischemic attack, 3. Stroke, 4. Pneumonia, 5. urinary tract infection, 6. Deep venous thrombosis/Pulmonary embolism/blood clot, 7. Acute Myocardial Infarction, 8. Heart Failure, 9. Infection/sepsis, 10. Pneumonia, 11. Surgery, 12. Other Optional Use-Case Justification: The most challenging part is capturing the information post-hospital discharge for acute stroke patients. A lot of the pre-hospital care is captured through National Emergency Medical Services Information System (NEMSIS), a national database that stores EMS data from the U.S. States and Territories). The follow-up elements proposed above have been developed as a part of the Paul Coverdell National Acute Stroke Program (link provided below) and captured within EHR for submission into American Heart Association’s (AHA) Get With The Guidelines (GTWG) module. The ability to extract the follow-up encounter related dates would help with the identification of gaps in post-hospital discharge date for stroke patients and plan strategies for Quality Improvement efforts. https://www.cdc.gov/dhdsp/programs/stroke_registry.htm 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_vFinal_04.14.2021_6.docx