Submitted by HCapon on
PACIO Comments on Duplicate Order Type
- Data Class: Orders (Draft V5)
- Data Element: Portable Medical Orders for Life-Sustaining Treatments (Level 0)
- Recommendation: Remove the Portable Medical Orders for Life-Sustaining Treatments data element under the Orders Data Class in Level 0 and do not consider this data element for inclusion for future versions of USCDI.
- Rationale: 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. Conceptually, including data elements for “Portable Medical Orders” (Level 2) and “Portable Medical Orders for Life-Sustaining Treatment” (Level 0) in the USCDI is duplicative. The preferred language would be “Portable Medical Order” rather than “Orders for End-of-Life Care,” because we have found jurisdictions that utilize “Portable Medical Orders” during encounters that are NOT related to EOL care such as Behavioral Health Advanced Directives that have component Portable Medical Orders. “Portable Medical Order” would be more broadly applicable than either “Orders for End of Life Care” or “Portable Medical Orders for Life-Sustaining Treatments,” but in any case, only one data element should be included in future versions of USCDI to represent this concept.
Submitted by nachcinformatics on
Orders
As with SDOH and Observations, NACHC encourages ONC to create a formal data model that accounts for nested data classes with functional ones. We agree with the HL7 recommendations below;
Orders (General) - [New Data Class]
https://www.healthit.gov/isa/uscdi-data-class/orders#draft-uscdi-v5
HL7 notes that the distinction between the new Orders data class and other data classes such as Laboratory, Procedures, and Medication is unclear considering lab tests, procedures, and medications can all be ordered and a variety of the already defined data elements are relevant when ordered. HL7 recommends that the general Orders data class include data elements relevant across all order types. Individual data classes should reference these general data elements and their respective standards while adding data elements specific to that data class when being ordered.
HL7 highlights that the addition of orders in Draft USCDI v5 improves transition of care so that the receiving provider is aware of orders put in by the sending provider. HL7 observes one important scenario to recognize and accommodate, is to ensure that orders for a patient going to a skilled nursing facility (SNF) are received in a timely manner and not lost. This is linked to critical implements and accommodations a patient could need on arrival at an SNF including medications, special diets, special bed, etc. This could also provide avenues for a patient or caregiver to trace back to what was ordered and compare to what was delivered, as well as a way a patient can show another organization what was ordered in case during the transition of care, the order was lost (for example, an order for pain medication for a cancer patient when transitioning from acute care to post-acute care).