Activity performed for or on a patient as part of the provision of care.

Data Element
Procedure Sequence
Description

A number to uniquely identify procedure entries.
Submitted By: Jenna Stern / Vizient
Data Element Information
Rationale for Separate Consideration Procedure Sequence data element would be related to the Procedure element and possibly even Procedure Time if that is also added. Together, we would be able to differentiate when different procedures occurred to give clarity on various times associated with procedures.
Use Case Description(s)
Use Case Description Addition of Procedure Sequence and Procedure Time would allow for quality and performance improvement measures to be collected and analyzed based on the availability of sequencing and times. Procedure Time would allow for scheduled case start and end time, patient in room and patient out of room, anesthesia start and end time, incision start and end time, and recovery start and end time data elements to be collected. Time studies and procedure practice variation could be done with the availability of Procedure Time. Procedure Sequence could then further tie in studying time spent on procedure and outcomes related to procedure time or sequence of events (including time spent at each stage).
Estimate the breadth of applicability of the use case(s) for this data element Many requestors in the healthcare quality and peformance improvement space would access and utilize the Procedure Sequence and Procedure Time to further augment the data collected through the Procedure Element. Additionally, providers and payers could utilize this information for their own tracking purposes and to address variation in procedural care. Lastly, this element could tie into a future ExplanationOfBenefit or Claim USCDI Data Class to further give patients insight to their procedural data. Vizient receives data from over 1000 facility participants, both Vizient and our members are currently collecting these data points through manual submissions. Improved standardization would reduce hospital burden when it is reported and make the information more accessible.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) N/A
Additional Specifications Procedure Sequence is currently available via the Industry Standard ExplanationOfBenefit R4 FHIR Resource. Procedure.sequence is available within this resource. Procedures sequence is also available within the similar Claim FHIR Resource. https://build.fhir.org/explanationofbenefit-definitions.html#ExplanationOfBenefit.procedure.sequence. Also utilized in CARIN Blue Button IG (https://build.fhir.org/ig/HL7/carin-bb/StructureDefinition-C4BB-ExplanationOfBenefit.html and https://build.fhir.org/ig/HL7/carin-bb/StructureDefinition-C4BB-ExplanationOfBenefit-definitions.html#ExplanationOfBenefit.item).
Current Use In limited use in production environments
Supporting Artifacts Procedure sequence is currently collected and used in several EHR systems including Epic’s production environment. This data element is utilized by various healthcare performance improvement organizations for the associated use cases discussed. Epic on FHIR currently has Procedure sequence available via the ExplanationOfBenefit resource.
https://fhir.epic.com/Specifications?api=1072 See also: Industry Standard ExplanationOfBenefit R4 FHIR Resource: https://build.fhir.org/explanationofbenefit-definitions.html#ExplanationOfBenefit.procedure.sequence. CARIN Blue Button IG: https://build.fh
Extent of exchange 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 Members are currently manually submitting this data element to Vizient. Vizient understands hospitals submit this data element to other outside entities, including payers and patients. Vizient receives this data and sends it back to hospitals.
https://fhir.epic.com/Specifications?api=1072
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) Due to the Procedure Sequence data element being a sequence number, it is a integer that will be passed from the EHR system already being collected. There is not a vocabulary, terminology or content to reference as it will follow the basic integer structural standard.
Restrictions on Use (e.g. licensing, user fees) To our knowledge, does not require any licensing or user fees.
Privacy and Security Concerns Same privacy and security concerns associated with collection of Procedure data element in general. No additional privacy and security concerns added with sequencing.
Estimate of Overall Burden Data already available via various EHR systems including Epic. Data has also been retrived from Cerner hospitals too. Data element does not need to be calculated by patient or provider.
Data Sequence may be an optionally collected data type which may be provided by EHR vendors, but it is not mandatory that such vendors offers this data element to our knowledge. Structure does exist already within the EHR frameworks.
ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following 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
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 2 - Use cases apply to most care settings or specialties.

Comment

Submitted by erjones on

Please Include Procedure Sequence in USCDI v5

Consistent with Vizient’s comments regarding USCDI v4, the addition of Procedure Sequence would provide further clarification as to which steps took place from start to finish for each procedure. This information could help support performance improvement, among other benefits.

Submitted by erjones on

Please Include Procedure Sequence in USCDI v4

Consistent with Vizient’s comments regarding USCDI v3, the addition of Procedure Sequence would provide further clarification as to which steps took place from start to finish for each procedure. This information could help support performance improvement, among other benefits.

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