Submitted by sg999 on 2021-09-28
CMS-CCSQ Support for Orders in USCDI v3CMS-CCSQ continues to support inclusion of the broader Orders data class to capture and exchange all orders for medical services (service requests). This information confirms appropriate and high-quality care is provided in quality measurement, is relevant information required to support a referral or a transfer of care request from one practitioner or organization to another, and is used for prior authorization activities. CMS-CCSQ also recommends inclusion of an End of Life Care Orders data element defined as orders for hospice, palliative care, and comfort care. Rationale: End of life care orders are especially critical for care coordination and care decision making. This concept may be used to share relevant information required to support a transfer of care request from one practitioner or organization to another that provides end of life care services, which often happen at different organizations. Interoperability of these orders would also allow orders to move more easily between organizations, facilitating patient choice. Maturity:
- Current standards:
- Orders can be exchanged in mature FHIR standards, including Service Request profile included in QI Core.
- End of Life Care concepts are captured in mature terminology: LOINC, SNOMED
- Current uses, exchange, and use cases: Orders (service requests) for end-of-life care services are routinely captured in EHR systems used by hospitals and providers and are used in CMS quality reporting eCQMs across programs including IQR, QPP, and Promoting Interoperability programs. CMS requires the submission of order (service request) related data for quality measurement for eligible hospitals/CAHs and clinicians using ONC Certified Health Electronic Record Technology (CEHRT)—this includes orders (service requests) for an intervention (i.e., palliative care, hospice, comfort care).
Submitted by dvreeman on 2021-09-30
Support for orders and request for data model clarityWe support the USCDI TF and HITAC recommendations to prioritize medical orders for life sustaining treatment (POLST/MOLST) and End of Life Care Orders as noted by CMS-CCSQ. We also concur with Lisa Nelson's sentiment that additional thought should be given to the data model structure for representing orders more generally.