Condition, diagnosis, or reason for seeking medical attention.

Data Element

Date of Onset

Comment

ANI's comment on USCDI v6: Date of onset

The Alliance for Nursing Informatics (ANI)  supports this inclusion as it is a key clinical data point for chronic disease management and outcomes analysis. Implementation guidance should clarify how estimated dates are handled and ensure consistent documentation practices across systems. Please see previously submitted ANI comments for additional recommendations.

CSTE Comment - v6

CSTE supports inclusion of this data element in USCDI V6. Please see previously submitted CSTE comments for additional recommendations.

CDC's comment on behalf of CSTE for USCDI v5

CSTE strongly encourages the inclusion of date of onset in USCDI v5. This is one of the most important data elements for public health. Date of onset often is the defining date for the beginning of a reportable condition and is used to classify cases and detect outbreaks and clusters. Exposures must be investigated in relation to the onset date. If the onset date is not captured as a distinct structural data point, public health staff must dig for it in notes or other parts of the medical record and it is inevitably vague and sometimes missing. Date of diagnosis is not the same as date of onset. Date of onset is defined as the first clinical symptom or sign for a particular condition. It would be highly beneficial if date of onset could be captured for each problem/diagnosis or condition noted in the medical record but if this is not possible it should at a minimum be noted for the primary diagnosis of the patient encounter.

CDC's comment on behalf of CSTE for USCDI v4

CSTE strongly encourages the inclusion of date of onset in USCDI v4. This is one of the most important data elements for public health. Date of onset often is the defining date for the beginning of a reportable condition and is used to classify cases and detect outbreaks and clusters. Exposures must be investigated in relation to the onset date. If the onset date is not captured as a distinct structural data point, public health staff must dig for it in notes or other parts of the medical record and it is inevitably vague and sometimes missing. Date of diagnosis is not the same as date of onset. Date of onset is defined as the first clinical symptom or sign for a particular condition. It would be highly beneficial if date of onset could be captured for each problem/diagnosis or condition noted in the medical record but if this is not possible it should at a minimum be noted for the primary diagnosis of the patient encounter.

Level 2 Data Element: Date of Onset

IMO does not support the Date of Onset as a proposed Level 2 Data Element in USCDI V3. While it is specified as a search parameter in the FHIR US Core Implementation Guide (4.0.0 STU4 Release), it is not universally recorded in all ONC Certified HIT, and there is no standard for exchange in ONC requirements for HIT Certification

 

CDC's Consolidated Comment

CSTE Comment:

  • CSTE strongly encourages the inclusion of date of onset in USCDI v3. This is one of the most important data elements for public health. Date of onset often is the defining date for the beginning of a reportable condition and is used to classify cases and detect outbreaks and clusters. Exposures must be investigated in relation to the onset date. If the onset date is not captured as a distinct structural data point, public health staff must dig for it in notes or other parts of the medical record and it is inevitably vague and sometimes missing. Date of diagnosis is not the same as date of onset. Date of onset is defined as the first clinical symptom or sign for a particular condition. It would be highly beneficial if date of onset could be captured for each problem/diagnosis or condition noted in the medical record but if this is not possible it should at a minimum be noted for the primary diagnosis of the patient encounter.

Unified Comment from CDC

  • General Comment: Date of Onset currently does not  have a definition.
     
  • Proposed Definition: The estimated date, actual date or date-time the condition began.
     
  • Additional Use Cases:The Making EHR Data More Available for Research and Public Health (MedMorph) project's goal is to create a reliable, scalable, and interoperable method to get electronic health record data for multiple public health and research scenarios (use cases). MedMorph has identified Central Cancer Registry Reporting, Healthcare Surveys,  Hepatitis C Reporting, electronic Initial Case Reporting (eICR), Multiple Chronic Conditions (MCC) eCare Plan, Message Mapping Guide (MMG) for COVID 19, PCORnet, Birth and Birth Defect Reporting use cases that support the adoption of this data elements.
     
  • Applicable Standard: http://hl7.org/fhir/condition-definitions.html#Condition.onset_x
     
  • Technical Specifications using this data element:
     
  1. 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
     
  2. 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
     
  3. C-CDA (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
     
  4. HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm: http://hl7.org/fhir/us/ecr/STU1/
     
  5. 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
     
  6. HL7 CDA® R2 Implementation Guide: Ambulatory and Hospital Healthcare Provider Reporting to Birth Defect Registries Release 1 ,
     
  7.  STU 2 -US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=428
     
  8. HL7 FHIR® Implementation Guide: Birth Defect Reporting Implementation Guide 0.1.0: https://build.fhir.org/ig/HL7/fhir-birthdefectsreporting-ig/index.html
     
  9. HL7 FHIR® Implementation Guide: Common Data Models Harmonization FHIR Implementation Guide (Release 0.1.0): http://hl7.org/fhir/us/cdmh/2019May/
     
  10. Vital Records Birth and Fetal Death Reporting - https://build.fhir.org/ig/HL7/fhir-bfdr/index.html
     
  11. 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
  • This element is used by CMS Quality Reporting and is marked Required or MustSupport in the FHIR QI Core IG

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