Assessments of a health-related matter of interest, importance, or worry to a patient, patient’s family, or patient’s healthcare provider that could identify a need, problem, or condition.

Data Element

Additional Information
Functional Status
Description
Assessment of a patient’s capabilities, or their risks of development or worsening of a condition or problem. (e.g., fall risk, pressure ulcer risk, alcohol use)

Applicable Vocabulary Standard(s)

Applicable Standards
  • Logical Observation Identifiers Names and Codes (LOINC®) version 2.72
Submitted By: Holly Miller, MD / MedAllies
Data Element Information
Use Case Description(s)
Use Case Description We are proposing “Assessment” as a USCDI data class to serve as a repository for any standardized assessment instrument. There are thousands of assessment instruments in use across clinical settings, public health providers, payors, and researchers.
As one example, the CMS Data Element Library (DEL: Home - Data Element Library (cms.gov)) is an example of multiple standardized data elements used in the federally mandated assessment instruments by LTPAC (Long-Term and Post-Acute Care) providers who collectively provide care to over 7 million Medicare Beneficiaries per year. Because these assessments are required for payment and quality reporting, they are collected by the more than 15,000 Skilled Nursing Facilities (SNFs), 11,000 Home Health Agencies (HHAs), 4,600 Hospice Care agencies, 1,100 Inpatient Rehabilitation Facilities (IRFs), and 400 Long-Term Care Hospitals (LTCHs). These standardized data are collected and submitted to CMS as required by these entities. Most of these data elements are mapped to LOINC and some are mapped to C-CDA templates.
The DEL incorporates only a tiny percentage of standardized assessments currently in use; and the use of standardized assessments is universal in health care.
Estimated number of stakeholders capturing, accessing using or exchanging This data class pertains to most or all patients, providers or requestors.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) LOINC, SNOMED-CT
https://loinc.org/; https://www.snomed.org/
Additional Specifications N/A
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
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.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns None
Estimate of Overall Burden This would vary depending on the specific assessment instrument and how it is used.
Other Implementation Challenges Unknown

Comment

Submitted by PACIO-Project on 2022-09-29

Support to Advance Functional Status

  • 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. Functional and Mental/Cognitive Status are important data classes that have widespread use in all healthcare settings and sharing the content of federally required PAC assessments with non-PAC providers (e.g., hospitals, physicians) would improve the quality of care and facilitate care coordination during transitions of care. These instruments use a consistent framework mapped to HIT standards for functional status, contain administrative and clinical patient data, can be considered as individual data elements (mobility, pressure ulcer, transportation, social isolation, etc.) or a “questionnaire” of grouped data elements together (MDS, OASIS, IRF-PAI, etc.)
  • The PACIO Community wishes to update the ONC/USCDI with current efforts relating to several of the data elements under the proposed USCDI v.4 data class of Health Status (Health Concerns, Functional Status, Disability Status, and Mental/Cognitive Status). The PACIO Community recognized the value of creating data models (like Gravity’s SDOH) that allow for expansion across multiple domains. As a result, PACIO created a new FHIR Implementation Guide (IG), “Personal Functioning and Engagement,” which consolidates PACIO’s prior published IGs (STU1) “Cognitive Status” and “Functional Status”. The PACIO group also is incorporating data elements of communication, swallowing, and hearing to the “Personal Functioning and Engagement” IG currently under development. Currently the Personal Functioning and Engagement IG data structures focus on observation/ assessment data. However, the IG could include future expansion using additional resources as the work matures. The concept of “Personal Functioning and Engagement” encompasses both an individual’s abilities (positive strengths) and disabilities (impairments) across all types of functioning. The PACIO Community examined and incorporated the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework that underpins this new PACIO Personal Functioning and Engagement IG. PACIO’s current work focuses on ICF “Body Functions” including mental functions, sensory functions (including hearing), voice and speech functions, and ingestion functions (swallowing). Current PACIO focus for ICF “Activities and Participation” functions include Learning and Applying Knowledge, Communication, Mobility, and Self-care.
    • The PACIO Community encourages ONC to consider adopting the value sets developed for the “Personal Functioning and Engagement” IG as part of the USCDI v.3 updates to the U.S. Core IG to incorporate Functional Status and Cognitive Status data elements.

Submitted by claricelmiller… on 2022-05-01

AOTA's Comments on Functional Status

AOTA encourages USCDI to consider including assessments that assess activities of daily living (ADLs) and instrumental activities of daily living (IADLs) as these are critical elements of an individual's function. We would recommend utilizing tools that already have LOINC codes that assess function on a broader scale (e.g. FASI). The other assessments mentioned as examples are limited in scope and may not capture sufficient data to communicate an individual’s function beyond basic elements.   We support the use of the CMS Data Element Library but encourage the utilization of other instruments. The post-acute care assessment instruments capture limited information on ADLs that may not provide a full picture of an individual's ability to function after discharge from facilities or after therapy services have ceased.    

2022 USCID Final Comments_0.pdf

Submitted by RUy on 2022-04-29

A Class for Functional Status

NACHC supports the comments from Ann Phillips/IMO and suchen.   NACHC is supportive of the concept of functional status; however, it is not likely to support interoperability to solely create a terminology binding to support the concept. Because concepts in the draft version are in fact different types of functional status or causes of disability, we believe that creating a class for this concept will likely create larger transitions of care documents without being able to be processed by receiving systems.   This approach creates liability for providers who at best can use this data as free text in this case and contributes to data overload and burnout. We strongly recommend providing either specific category of functional status with equivalent semantics and clear terminology bindings.   Please see attached NACHC letter, documenting this comment and other feedback for v3 accepted draft data elements.

2022-04-30 NACHC USCDIv3 Letter of Support_3.pdf

Submitted by suchen on 2022-04-27

Functional status with needs beyond post acute care

Functional status assessments are commonly used in healthcare to document a patient’s baseline ability to manage daily routines and life activities. This assessment can be used as an indicator of quality of life (QOL) and help guide delivering patient-centered care. Functional status assessments are used broadly in healthcare, and can be used to: * screen initially for problems, as well monitor the patient over time * assess how a disease impacts a patient’s baseline functional status and their overall ability to tolerate certain therapies during serious illness Functional status assessments can be generic or disease specific. For instance, in oncology, the Eastern Cooperative Oncology Group (ECOG) Performance Status assists in determining a patient’s potential chemotherapy tolerance. A plethora of functional status assessment tools have been created to assist clinical management and are used broadly in medicine in fields such as oncology, palliative care, surgery, orthopedics, geriatrics, psychiatry, neurology, physical medicine and rehabilitation, nursing, etc. Achieving optimal patient outcomes for health and well-being requires an understanding of factors that affect quality of life (QOL), such as the ability of patients to perform basic activities and participate in life situations. Please see attachment with similar prior submission regarding need for standardized "functional status" data. This comment is made on behalf of CodeX (Common Oncology Data Elements eXtensions), a member-driven HL7 FHIR Accelerator community of professional medical societies, health systems, industry and others seeking to achieve interoperability via the mCODE (minimal Common Oncology Data Elements) standard in order to drive step-change improvements in cancer patient care and research.

Functional Status Assessment _ USCDI Version 3 Proposal.docx

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