| Submitted By: Smitha Vellanky, on behalf of Joel Andress and Centers for Medicare and Medicaid Services (CMS) Center for Clinical Standards and Quality (CCSQ)
/ On behalf of Centers for Medicare and Medicaid Services (CMS) Center for Clinical Standards and Quality (CCSQ)
|
| Data Element Information |
| Rationale for Separate Consideration |
The additional medication details are critical to put context around a medication. These details allow for patients and clinicians to understand how the medication should be taken, and are details used in quality measurement.
The Office of the National Coordinator for Health Information Technology (ONC) previously added dose to the United States Core Data for Interoperability (USCDI) v3, but did not add the additional information around route, which we believe is also critical. |
| Use Case Description(s) |
| Use Case Description |
Medication information, including medications administered with administration details, such as route, are key data elements currently used in CMS electronic clinical quality measures (eCQMs) across hospital and clinician reporting programs. These data are necessary to confirm that appropriate and a high quality of care is received for patients across different populations, and include critical information for patient care and coordination of care. A medication alone does not provide enough clinical context for patient care without the inclusion of dose and route information. ONC added dose information into USCDI v3, but still does not include route information. |
| Estimate the breadth of applicability of the use case(s) for this data element
|
As noted in the April 2022 Interoperability Standards Workgroup’s (ISWG) recommendations to the Health Information Technology Advisory Committee (HITAC) for USCDI v3, medication route is already included in Health Information Technology (IT) Certification criteria using National Council for Prescription Drug Programs (NCPDP) SCRIPT, Fast Healthcare Interoperability Resources (FHIR) and Consolidated Clinical Document Architecture (C-CDA)—accordingly USCDI stakeholders are already capturing, accessing, and exchanging this data element.
Additionally, more than 4,000 hospitals and 1 million providers are currently capturing, accessing and exchanging this information for the purposes of CMS quality measurement. The Electronic Clinical Quality Improvement (eCQI) Resource Center includes measure specifications for CMS program eCQMs, some of which (i.e., CMS 190, CMS 108) use medication route. |
| Link to use case project page |
https://ecqi.healthit.gov/ecqms |
| Use Case Description |
Data exchange of medication information is also critical for clinical care. Each step in the chain of events between a clinician’s request for a medication and the complete administration of that medication is critical for vigilance and surveillance of patient safety. Assessment, improvement, and accountability around quality measurement is a consistent and critical focus of human and financial resources throughout the healthcare system. It is important to have the capacity to evaluate the clinician’s intent, the actual administration, and ongoing provision of medications across care settings and across time. Clinicians need to exchange information about each aspect to guide new treatment decisions and identify near harm and actual harm events. The metadata associated with medications (route, dose) are critical to clinical care, coordination, and handoffs. |
| Estimate the breadth of applicability of the use case(s) for this data element
|
All healthcare providers using certified electronic health record technology (CEHRT) should be capturing, accessing, using, and exchanging these medication data elements. The capture of medication route in addition to dose should also be common in electronic health record (EHR) systems.
As noted above, the April 2022 Interoperability Standards Workgroup’s recommendations to the HITAC for USCDI v3 notes that medication route is already included in Health IT Certification criteria using NCPDP SCRIPT, FHIR and C-CDA—accordingly USCDI stakeholders are already capturing, accessing, and exchanging this data element. |
| Link to use case project page |
http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492 |
| Healthcare Aims |
- Improving patient experience of care (quality and/or satisfaction)
- Improving the health of populations
- Improving provider experience of care
|
| Maturity of Use and Technical Specifications for Data Element |
| Applicable Standard(s) |
SNOMED
Health Level Seven International (HL7) value set, SNOMED CT Route Codes
Medication Route: SNOMED (i.e. VSAC OID: 2.16.840.1.113883.3.117.1.7.1.222)
http://hl7.org/fhir/R4/valueset-route-codes.html
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| Additional Specifications |
HL7 FHIR US Core Implementation Guide STU3-STU5 based on FHIR R4, MedicationRequest. (https://www.hl7.org/fhir/us/core/StructureDefinition-us-core-medicationrequest.html) This profile supports specification of route, among other medication details.
HL7 FHIR QI Core Implementation Guide STU4 based on FHIR R4, specifies MedicationAdministration profile (http://hl7.org/fhir/qicore/StructureDefinition-qicore-medicationadministration.html) This profile supports exchange of route HL7 C-CDA Release 2.0.
(http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492) ePrescribing NCPDP SCRIPT Standard Implementation Guide Version 2017071 |
| Current Use |
Extensively used in production environments |
| Supporting Artifacts |
Medication data is routinely captured and widely available in EHR systems used by hospitals, providers, and other healthcare stakeholders including pharmacies. Medication data is used in CMS program eCQMs across the Hospital Inpatient Quality Reporting (IQR) Program, the Quality Payment Program (QPP), and Promoting Interoperability and therefore are widely stored in production environments. Additionally, several ONC Health IT Certification criteria including NCPDP SCRIPT, FHIR and C-CDA include mediation route specifications.
Medication route is commonly available in FHIR standards.
https://mydata.athenahealth.com/fhirapidoc https://fhir.cerner.com/millennium/r4/clinical/medications/medication-administration/
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| Extent of exchange
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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 |
As noted above, the April 2022 Interoperability Standards Workgroup’s recommendations to the HITAC for USCDI v3 notes that medication route is already included in Health IT Certification criteria using NCPDP SCRIPT, FHIR and C-CDA—accordingly USCDI stakeholders are already capturing, accessing, and exchanging this data element.
https://www.healthit.gov/topic/certification-ehrs/certification-criteria
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| Potential Challenges |
| Restrictions on Standardization (e.g. proprietary code) |
No challenges anticipated. This data is available in standard terminology that can be publicly accessed via the Value Set Authority Center (VSAC) and HL7. |
| Restrictions on Use (e.g. licensing, user fees) |
We are not aware of any restrictions. |
| Privacy and Security Concerns |
This data, like any patient data, should be exchanged securely. Current processes exist, governed by CMS and ONC, to securely transfer this data. |
| Estimate of Overall Burden |
Medication data is regularly captured as part of EHR systems. Most hospitals, including critical access hospitals, and providers are already capturing and exchanging these medication data for quality measurement to CMS. Many medication FHIR profiles are also required by the US Core Capability Statement and therefore will be stood up by those stakeholders complying with the ONC requirement for the Standardized API for patient and population services—some additional efforts are needed to add in profiles to clarify medication administration. |
| Other Implementation Challenges |
N/A |
Official Website of The Office of the National Coordinator for Health Information Technology (ONC)
Submitted by BLampkins_CSTE on
CSTE Comment - v5
Medication data is critical for exchange with public health and is included in eCR standards. It is especially important for STI programs, HIV and TB surveillance as well as for public health response and surveillance for antimicrobial resistant pathogen infections. CSTE also strongly agrees that the ability to exchange data on prescribing of opioid medications in particular is of great importance to public health programs which aim to reduce opioid overdoses and deaths.