| Submitted By: Clem McDonald / National Library of Medicine | |
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| Data Element Information | |
| Rationale for Separate Consideration | Please consider these data elements for alcohol use for Level 2 |
| Use Case Description(s) | |
| Use Case Description | Each year, an estimated 88,000 people (approximately 62,000 men and 26,000 women) die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States, behind tobacco and diet/physical inactivity. |
| Estimated number of stakeholders capturing, accessing using or exchanging | The U.S. Preventive Services Task Force (USPSTF) recommends screening for unhealthy alcohol use in adults aged 18 years and older, including pregnant women, with a Grade B recommendation: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/unhealthy-alcohol-use-in-adolescents-and-adults-screening-and-behavioral-counseling-interventions Alcohol use is widely screened and assessed by care providers. |
| Healthcare Aims |
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| Maturity of Use and Technical Specifications for Data Element | |
| Applicable Standard(s) | See below for relevant LOINC codes: 5640-8 Ethanol [Mass/volume] in Blood 69721-9 Do you ever drink alcohol - including beer or wine [Reported.PHQ] 74013-4 Alcoholic drinks per day 11286-2 Alcohol binge episodes per month - Reported 74043-1 Alcohol use disorder 64718-0 During this pregnancy, did you receive help with an alcohol or drug problem [PhenX] 72109-2 Alcohol Use Disorder Identification Test - Consumption [AUDIT-C] |
| Additional Specifications | HL7® FHIR® US Core Implementation Guide v3.1.0 based on FHIR R4 |
| 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) | Data elements around the quantity of alcohol consumed may be measured in different units, or entered in different locations within electronic health records. However, these are minimal, as they do not involve access to proprietary code. |
| Restrictions on Use (e.g. licensing, user fees) | N/A |
| Privacy and Security Concerns | If data are aggregated and not linked to personal identifiers, concerns are minimal. Alcohol use disorder is widely stigmatized, thus, care must be taken to ensure privacy and security. |
| Estimate of Overall Burden | Low estimate of burden to implement. |
| 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 |
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| 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 |
Submitted by aphillips@imoh… on 2022-04-28
Level 2 Data Element: Substance Use
IMO supports the proposed inclusions of the Level 2 data class and data element for Substance use. However, the technical specification cited for the Level 2 submission is missing a number of LOINC codes used in evaluating alcohol use. IMO notes that the value set for Substance Use Disorder OID: 2.16.840.1.113883.3.464.1003.106.12.1001 specified in eCQM 137 for Alcohol and Drug Dependence, includes codes for evaluating alcohol use as well as other substances.