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
Health Literacy Status
Description

Degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
Submitted By: Nedra Y Garrett / CDC
Data Element Information
Use Case Description(s)
Use Case Description Mr. John Doe is visiting his family physician, Dr. Smith, for the annual health exam. A medical assistant from Dr. Smith’s office has asked John to fill out a brief HL questionnaire ( 4 questions), and then calculated his HL score. It appeared that the John’s total score is 14, which is marginal. Also, this assessment shows that John has problems with learning about his medical condition (asthma) because of difficulty understanding written information. Dr. Smith discussed with John details of his asthma treatment and other aspects of secondary prophylaxis. In addition, it was recommended that Mr. Doe will participate in Asthma Virtual HL Services.
Estimate the breadth of applicability of the use case(s) for this data element Approximately 36% of adult Americans have only basic or below basic HL skills. As assessed by the National Academy of Sciences, Engineering and Medicine (2022), using a survey amongst older adults during the COVID-19 pandemic, a half of participants had limited health literacy. Nearly one-third of the study participants were Black, 21.5 percent were Hispanic, 29.4 percent were living below the poverty level. It means that adding the HL Status data element and evaluation of patients' HL is critical component of health equity activities.
Link to use case project page https://www.cdc.gov/healthliteracy/learn/Understanding.html; https://www.cdc.gov/healthliteracy/pdf/Report-on-2016-BRFSS-Health-Literacy-Data-For-Web.pdf; https://www.unitedhealthgroup.com/content/dam/UHG/PDF/About/Health-Literacy-Brief.pdf
Use Case Description The PL Status is the component of the population-level assessment. For example, it was included into the CDC BRFSS.
Estimate the breadth of applicability of the use case(s) for this data element As it has been evaluated by the United Health Group, in the highest health literacy level counties between 15 and 27 percent of the population is predicted to have limited health literacy. In the lowest heath literacy level counties (marked darkest blue in the map), between 36 and 59 percent of the population is predicted to have limited health literacy. Also, this project had estimated that improving HL could prevent nearly 1 million hospital visits and save over $25 billion a year
Link to use case project page https://www.cdc.gov/healthliteracy/pdf/Report-on-2016-BRFSS-Health-Literacy-Data-For-Web.pdf; https://www.unitedhealthgroup.com/content/dam/UHG/PDF/About/Health-Literacy-Brief.pdf; https://www.cdc.gov/healthliteracy/learn/; https://www.cdc.gov/healt
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 95866-0, BRIEF health literacy screening tool [BRIEF]; LOINC LL3268-1 (for answers)
https://loinc.org/95866-0/; LOINC LL3268-1 — Always/Usually/Sometimes/Rarely/Never/;
Additional Specifications The UAMS Center for Health Literacy: Patient Health Literacy Measures: https://afmc.org/wp-content/uploads/2017/01/Literacy-Tools-UAMS-CHL-DHS-2017.pdf
LOINC panel for standardized responses (answers): LL3268-1
Technical specification for the test administration: https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fhealthliteracy.bu.edu%2Fdocuments%2F19%2FBRIEF.doc&wdOrigin=BROWSELINK
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Supporting Artifacts CDC. Health Literacy. Guidelines, Laws, & Standards
CDC Healthy Schools. National Health Education Standards
DHHS. Healthy People 2030. Health Communication and Health Information Technology Workgroup

https://www.cdc.gov/healthliteracy/guidelines.html; https://www.cdc.gov/healthyschools/sher/standards/index.htm; https://health.gov/healthypeople/about/workgroups/health-communication-and-health-information-technology-workgroup;
Extent of exchange 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts CDC. Health Literacy by State;
AHRQ. The SHARE Approach—Health Literacy and Shared Decisionmaking: A Reference Guide for Health Care Providers;
https://www.ahrq.gov/health-literacy/professional-training/shared-decision/tool/resource-4.html
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) There are no restrictions. There is a need for improvement skills of healthcare providers. Additional training materials were provided by AHRQ and CDC.
Restrictions on Use (e.g. licensing, user fees) There are no restrictions for use of this data element
Privacy and Security Concerns All privacy and security regulations for EHR apply to the HL assessment. There are no additional concerns
Estimate of Overall Burden How hard is it to access and provide the data? There are no additional problems with access the data
Is it only available in an outside system, such as a lab reporting system? This record shall be an EHR component
Does it need to be calculated by the patient or provider, or can it be automatically retrieved or calculated by the system in a production environment? It needs to be calculated by provider based on attached to this submission guidance. These calculations take no more than 30 seconds.
Does it require significant time on the part of patient or provider to access or record or does it require an interruption in normal workflow to capture? It takes 1-2 minutes of the patient’s time.
Does it require significant developer time to implement in EHR systems? It does not require significant developer time for implementation
This may be unknown to the submitter and additional information would be needed from industry or may be determined as part of the ONC consideration process. N/A
Other Implementation Challenges We are not aware at this moment.
ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following 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
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 1 - Data element is captured, stored, or accessed in at least one production EHR or HIT module.
Criterion #3
Maturity - Current Exchange		 Level 1 - Data element is electronically exchanged between two production EHRs or other HIT modules using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 2 - Use cases apply to most care settings or specialties.

Comment

Submitted by nedragarrett_CDC on

CDC's Consolidated Comment for USCDI v5

  • We provide recommendation for a core set of priority SDOH coded terminologies be required in USCDI v5. This core set is needed in order for these elements to be included in standard build for improved data capture and interoperability. These should be separate from the current four SDOH elements (of assessment, goals, interventions and problems) which represent broad categories and allow optionality of hundreds of coded terminologies. The base set of required SDOH international standard data elements (coded terminologies) will advance priority SDOH initiatives of the White House, department and agency missions, for partners and the public, and within the clinical setting. They are aligned with policy, programs, and evaluation and clinical tools for improved data assets and evidenced based decision-making benefiting patients and populations. 
  • NACCHO supports CDC's recommendations. Standardized SDoH information would provide value to LHDs by reducing the time gap between when the data is collected and when it is available for LHDs to use in their programing. These data elements should follow the consensus-based terminology developed by the Gravity Project.

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