| 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. |
| Estimated number of stakeholders capturing, accessing using or exchanging | 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. |
| Estimated number of stakeholders capturing, accessing using or exchanging | 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 |
|
| 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; |
| 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. |
| 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 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 1 - Used in limited production environments, 1 or 2 different systems |
| Maturity - Current Exchange | Level 1 - Demonstrates exchange between 2 or 3 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 |
Comment