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Encounter Information

Data Element

Additional Information

Encounter Type
An identifiable grouping of healthcare-related activities characterized by the entity relationship between the subject of care and a healthcare provider. This data element specifies the classification of encounter that has occurred for a patient, for example an inpatient admission, an observation stay, or an office visit and the specific type of encounter such as a follow-up visit, or encounter for a procedure.

Comment

Support to Advance Encounter Type in USCDI

This comment is in support of the advancement of encounter type for inclusion in the United States Core Data for Interoperability. As part of a research project sponsored by the National Committee of Quality Assurance (NCQA) and a regional health information exchange in New York, Diameter Health was requested to examine data included in clinical documents, such as C-CDA, for 474 distinct facilities in 2020. These clinical documents are shared through health information exchange with other healthcare organizations routinely, in part to fulfill requirements for use of certified health information technology to record and transmit data related to USCDI. These facilities represented a mix of ambulatory care, inpatient and post-acute settings in New York. The project was sponsored as part of the emerging program for Data Aggregator Validation (DAV) launched by NCQA (https://www.ncqa.org/programs/data-and-information-technology/hit-and-data-certification/hedis-compliance-audit-certification/data-aggregator-validation/). These comments represent the perspective of Diameter Health and are not meant to represent the opinions, perspectives or policy of any other organization. Over the data analysis of 474 organizations having sampled 100 clinical documents from each, Diameter Health found that vast majority of organizations recorded and transmitted encounter data. For the 47,400 records, over 300,000 encounters were recorded within C-CDA documents, either through the inclusion of an “encounters section” or “encompassingEncounter” portion of a clinical document. Encounters were routinely structured with machine readable entries that could be parsed by software and human readable content that could be read by clinicians. Clinical documents included encounter information on over 75% of sampled records. Over 90% of the 474 organizations were sending encounter information for at least some patient records. The most common way that these encounters were encoded was through the usage of CPT (codeSystem OID 2.16.840.1.113883.6.12), although some records used HCPCS (OID 2.16.840.1.113883.6.14), HL7 (OID 2.16.840.1.113883.5.4) and SNOMED (OID 2.16.840.1.113883.6.96) terminologies in addition to locally developed or vendor provided codes. Diameter Health works with over 20 health information exchanges nationally as well as an array of health plans, health information technology vendors and governmental entities. The findings shared as part of this research supports observations from other clients and data modalities, such as HL7v2 messages. Encounter information is important for patient care as part of care transitions, the performance of quality reporting and other population health analyses. The role in quality reporting is paramount, since patients only qualify for denominators in most electronic clinical quality measures based on encounter type. Diameter Health strongly supports the continued elevation of encounter type information in the USCDI and we believe that the data from the field shows that this information is already widely recorded and exchanged among healthcare organizations. Please feel welcome to reach out if it would be helpful to share more details or to answer questions regarding this comment.

Thank you for your comment…

Thank you for your comment in support of Encounter Type data element.  ONC has received multiple submissions in support of Encounter Type, and have designated it Level 2 and will be considered for addition to USCDI version 2.

MedMorph's Support of Encounter Type

Support for this element is submitted on behalf of MedMorph project which includes relevant specifications and supporting artifacts. Classification of Encounter can be representing using the V3 Value SetActEncounterCode. Relevant technical specifications include the following: HL7 CDA ® Release 2 Implementation Guide: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1, DSTU Release 1.1 – US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=398 HL7 CDA® R2 Implementation Guide: National Health Care Surveys (NHCS), R1 STU Release 3 - US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=385 HL7 CDA® R2 Implementation Guide: Consolidated CDA Templates for Clinical Notes - US Realm: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492 HL7 FHIR® US Core Implementation Guide STU3 Release 3.1.1: https://www.hl7.org/fhir/us/core/index.html HL7 FHIR US Core Encounter: http://hl7.org/fhir/us/core/StructureDefinition-us-core-encounter.html. MustSupport for the following elements: Encounter status, Classification of Encounter, Encounter type, Encounter subject, Encounter Identifier, Encounter period, Encounter participant type, Participant overseeing the encounter, Primary participant responsible for encounter, Encounter participant individual, Encounter primary performer NPI, Encounter primary performer name, Encounter primary performer professional role, Time period participant participated in the encounter, Reason for the visit, Hospital encounter discharge disposition, Encounter location address                                                                                                                                                                                                                                                                                                                              HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm: http://hl7.org/fhir/us/ecr/STU1/Electronic_Initial_Case_Report_(eICR)_Transaction_and_Profiles.html HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 2 - US Realm - the Electronic Initial Case Report (eICR): https://www.hl7.org/implement/standards/product_brief.cfm?product_id=436 Vital Records Birth and Fetal Death Reporting FHIR - US Realm: https://build.fhir.org/ig/HL7/fhir-bfdr/index.html HL7 Version 2.6 Implementation Guide: Vital Records Birth and Fetal Death Reporting, Release 1 STU Release 2 - US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=320 HL7 CDA® R2 Implementation Guide: Birth and Fetal Death Reporting, Release 1, STU (Release 2 - US Realm): https://www.hl7.org/implement/standards/product_brief.cfm?product_id=387 IHE Quality, Research and Public Health Technical Framework Supplement: Birth and Fetal Death Reporting-Enhanced (BFDR-E) Revision 3.1: (https://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf)

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