Activity performed for or on a patient as part of the provision of care.
Data Element
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Procedure Treatment Intent
Description
The purpose of a treatment, or the desired effect or outcome resulting from the treatment. For example, a treatment may be intended to completely or partially eradicate a disease process by disrupting its underlying physiological processes, resulting in improvement in health; or a treatment may have no expectation of eradication but rather may be intended simply to delay the onset of more severe symptoms; or may be intended to prolong life without any expectation of cure. NOTE: Treatment Intent has also been submitted under the Medications data class
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| Submitted By: Andre Quina
/ MITRE
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| Data Element Information |
| Use Case Description(s) |
| Use Case Description |
Treatment intent – curative vs. palliative (referring to amelioration of specific physical, psychological, or emotional symptoms) vs. prolongation of life vs. temporarily controlling a disease process to delay deterioration in health status.
CMMI is also requiring the collection of certain specific “clinical data elements” (CDEs) from participants in the mandatory Radiation Oncology (RO) model scheduled to begin in January 2021, and has issued an informal RFI soliciting public comment on the draft CDEs. Treatment intent is one of the proposed CDEs required for reporting in the RO model. See: https://innovation.cms.gov/media/document/ro-clin-data-elements-rfi-v2
Event for its collection and use: Treatment intent would be recorded upon the ordering of a medication or procedure. Treatment intent would be used to stratify treatments as curative vs. palliative for analytics and to record the purpose of treatment for patient facing applications. Increasingly patients wish to understand treatment, prognosis, and to participate in decision making. Accessibility of treatment intent to patient facing applications and portals is important to maintaining a shared understanding of treatment goals. Also, in order to develop interventions, payment plans, and policies for palliative care it is necessary to understand treatment intent to assess outcomes for palliative care.
Frequency of use: Treatment intent would be collected for selected medications and procedures depending on the clinical context and exchanged with instances of those elements.
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| Estimate the breadth of applicability of the use case(s) for this data element
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Applies to select medications and procedures depending on the clinical context. |
| Healthcare Aims |
- Improving patient experience of care (quality and/or satisfaction)
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| Maturity of Use and Technical Specifications for Data Element |
| Applicable Standard(s) |
SNOMED CT codes for therapeutic intent (qualifier value)
https://browser.ihtsdotools.org/?perspective=full&conceptId1=262202000
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| Additional Specifications |
The extension was introduced in mCODE (http://hl7.org/fhir/us/mcode/), specifically, http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-treatment-intent.html
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| Current Use |
In limited use in test environments only |
| Supporting Artifacts |
Treatment intent has been implemented in limited test environments with synthetic data as part of mCODE based implementations.
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| Extent of exchange
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1 |
| Supporting Artifacts |
Only in connect-a-thons and small pilots
Future exchange of treatment intent would support the development interventions, payment plans, and policies for palliative care. Treatment intent would allow stratifying treatments as curative or palliative for analytics. Access to treatment intent by patient facing applications would help to support patients understanding of treatment and prognosis.
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| Potential Challenges |
| Restrictions on Standardization (e.g. proprietary code) |
None |
| Restrictions on Use (e.g. licensing, user fees) |
None |
| Privacy and Security Concerns |
None |
| Estimate of Overall Burden |
How hard is it to access and provide the data?
Given the minimal complexity for representing treatment intent, implementation burden is expected to be low.
Is it only available in an outside system, such as a lab reporting system?
No
Does it need to be calculated by the patient or provider, or can it be automatically retrieved or calculated by the system in a production environment?
Treatment intent needs to be determined by the provider since in oncology the same drug combinations can be used both in curative and palliative settings.
Does it require significant time on the part of patient or provider to access or record or does it require an interruption in normal workflow to capture?
Clinical workflows for treatment intent are not expected to be high burden or to interrupt a normal workflow.
Does it require significant developer time to implement in EHR systems?
Given the minimal complexity for representing treatment intent, implementation burden is expected to be low.
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Submitted by suchen on
This data element has…
This data element has support from the HL7® FHIR® CodeX™ Accelerator community. CodeX supported FHIR data standards for cancer, genomics and cardiovascular health have a rapidly growing footprint of traction and adoption. The CodeX community is rapidly growing its membership, with invested Member leaders driving implementation-focused use case pilots forward.
The Treatment Intent data element has representation in the following CodeX supported FHIR Implementation Guides (IGs):
The Treatment Intent data element-related exchange is utilized in the CodeX Radiation Therapy Treatment Data Use Case by leveraging the mCODE and CodeX Radiation Therapy IGs. Pertinent links for real world adoption and traction of these IGs includes:
This data element is important to the CodeX Radiation Therapy Treatment Use Case. This use case enables exchange of radiation therapy data for enhanced patient care coordination and data reuse, such as quality management, research, and payer-required reporting. Demonstrated proof of concept for treatment summaries and piloted an end-to-end workflow for RT summaries. This Use Case completed Phase 2, which consisted of participating at an Integrating the Healthcare Enterprise-Radiation Oncology (IHE-RO) Exchange of Radiotherapy Summaries (XRTS) Workshop in May 2021. The focus of the XRTS Workshop was to test and validate the radiation therapy end of treatment and on-treatment summary information that has been defined in the CodeX RTTD project and leveraged in the XRTS technical specification. This testing was successfully achieved during the XRTS Workshop. Varian and RaySearch implemented the mCODE and CodeX radiotherapy profiles in a test version of their systems and successfully sent the radiation therapy summary information associated with five different synthetic patients to Epic and RaySearch, within a test version of their electronic health records. Pertinent links for this use case include: