Data Element
Healthcare Services
Description

Describe a specific healthcare service or category of services (such as counseling, imaging, or laboratory) offered by an organization at a designated location, which can be either physical or virtual. The service provider may include hospitals, clinics, pharmacies, or other specialized healthcare providers.
Submitted By: Mike Hamidi / Vulcan
Data Element Information
Rationale for Separate Consideration Although, not an existing USCDI element but one that is proposed. This data request can support or replace the Organization/Hospital Identifier (see https://www.healthit.gov/isp/taxonomy/term/1851/level-0). The proposed data element remains agnostic to the exact healthcare service, the organization, or provider. Therefore, the data element implementation can be driven by the nature of its intended use that will remain flexible to accommodate those use cases.
Use Case Description(s)
Use Case Description The Healthcare Service data element supports several key use cases that enhance its adoption into the US Core Data for Interoperability (USCDI):

1. Service Identification: It provides a standardized way to identify and categorize healthcare services available at various locations, facilitating better communication and interoperability between healthcare providers and systems.

2. Care Coordination: By detailing the services offered by different providers, Healthcare Service aids in care coordination, allowing providers to refer patients more effectively to appropriate services based on their needs.

3. Access to Services: It enhances patient access to healthcare by clearly outlining available services in both physical and virtual settings, enabling patients to find and utilize the services they require.

4. Resource Management: The data element supports better resource management and planning by allowing organizations to maintain an up-to-date inventory of services, including availability and operational status.

5. Regulatory Compliance: Integrating Healthcare Service into the USCDI helps organizations comply with regulatory requirements for transparency in service offerings, thereby improving accountability and patient trust.

6. Public Health Reporting: It facilitates public health reporting by providing essential information about service availability and utilization, which can be vital for health authorities in monitoring and responding to community health needs.

7. Transparency: It can support the consistency of what healthcare services are provided by an organization, which can support clinical care or research needs (e.g., site feasibility). It can further enhance the understanding of healthcare services in a specific geographic region (e.g., proximity of services to an existing patient or organization).

These use cases collectively demonstrate how the Healthcare Service data element contributes to improved interoperability, care delivery, and patient outcomes within the healthcare system.
Estimate the breadth of applicability of the use case(s) for this data element The breadth of applicability for the Healthcare Service data element is extensive, encompassing a wide range of healthcare settings and services. Key points include:

1. Diverse Healthcare Settings: It applies to various healthcare environments, including hospitals, outpatient clinics, specialty practices, pharmacies, and telehealth services, making it relevant across the entire spectrum of care delivery.

2. Interdisciplinary Use: The data element can be utilized by multiple healthcare disciplines, such as primary care, mental health, rehabilitation, and preventive services, supporting a holistic view of patient care options.

3. Patient Engagement: By providing clear information about available services, it empowers patients to make informed decisions about their healthcare, enhancing patient engagement and satisfaction.

4. Regulatory Compliance and Quality Reporting: It supports regulatory requirements and quality measurement initiatives by offering standardized data that can be used for reporting and analysis at local, state, and national levels.

5. Public Health and Emergency Response: The data element is crucial for public health initiatives and emergency response planning, as it allows health authorities to assess available services and allocate resources effectively during health crises.

6. Research and Analysis: Researchers can leverage the Healthcare Service data to analyze service utilization patterns, access disparities, and outcomes, contributing to evidence-based practices and healthcare improvements.

Overall, the Healthcare Service data element's applicability spans clinical, administrative, and public health domains, making it a vital component for enhancing interoperability and improving healthcare delivery across the system.
ONC Priority
  • Mitigate health and health care inequities and disparities
  • Address the needs of underserved communities
  • Address public health interoperability needs of reporting, investigation, and emergency response
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) In addition to LOINC and SNOMED CT, other relevant code systems for the Healthcare Service data element include:

1. NDC (National Drug Code): For identifying medications and drug services.
2. ICD (International Classification of Diseases): For coding diagnoses that may relate to specific healthcare services.
3. CPT (Current Procedural Terminology): For coding medical procedures and services provided by healthcare professionals.
4. HCPCS (Healthcare Common Procedure Coding System): For coding healthcare services, supplies, and equipment.

These additional code systems further support the standardized representation of healthcare services.
Additional Specifications Supporting FHIR IGs of HealthcareService include, but not limited to: SDOH Clinical Care 2.2.0 - STU 2.2 (see https://hl7.org/fhir/us/sdoh-clinicalcare/STU2.2/) and FHIR Human Services Directory1.0.0 - STU1 (see https://hl7.org/fhir/us/hsds/STU1/). It would also be highly beneficial for clinical research trials that need to identify potential site services, such as those from the definitional standpoint (e.g., Clinical Study Schedule of Activities 1.0.0 - trial-use, https://hl7.org/fhir/uv/vulcan-schedule/STU1/)
Current Use (Level 2) Captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer
Extent of exchange (Level 2) Between more than two production EHRs or other HIT modules using available interoperability standards
Supporting Artifacts The use of HealthcareService is an integral part of care provisioning (e.g., associated with ServiceRequest) and ordering (e.g., Procedures). Some of the likely production uses of HealthcareService include varying implementations and uses by the following.

Epic Systems: Incorporates HealthcareService in its electronic health record (EHR) solutions to manage and display available services across healthcare settings.
Cerner: Utilizes HealthcareService within its EHR platform to support service availability and care coordination functionalities.
Allscripts: Employs HealthcareService in its healthcare IT solutions for managing service offerings and patient access.
Mayo Clinic: Implements HealthcareService in its systems to provide comprehensive information about the various services offered at its facilities.
InterSystems HealthShare: Uses HealthcareService to support interoperability and data sharing among healthcare organizations.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) Restrictions on the standardization of the Healthcare Service data element may arise from proprietary coding systems used by specific vendors or healthcare organizations, which can limit interoperability and data exchange. Additionally, variations in how different organizations implement the FHIR specification may lead to inconsistencies in data representation and usage. Some institutions may also have unique service categorizations or terminology that do not align with standardized vocabularies like SNOMED CT, CPT, HCPS, or LOINC, creating barriers to seamless integration. Furthermore, regulatory compliance requirements and differing interpretations of FHIR guidelines can hinder the uniform application of the Healthcare Service data element across diverse healthcare settings.
Restrictions on Use (e.g. licensing, user fees) Restrictions on the use of the Healthcare Service data element may include licensing fees associated with certain coding systems, such as SNOMED CT, CPT, or LOINC, which require healthcare organizations to obtain licenses for commercial use. Additionally, organizations implementing FHIR may face costs related to software development, integration, and ongoing maintenance to ensure compliance with FHIR standards. Furthermore, proprietary EHR systems may impose limitations on data access and sharing, restricting the ability to fully utilize the Healthcare Service element across different platforms. Lastly, regulatory and privacy considerations may impose constraints on the sharing of service-related data, particularly in relation to patient confidentiality and data security requirements.
Privacy and Security Concerns Privacy and security concerns regarding the use and exchange of the Healthcare Service data element primarily revolve around the potential exposure of sensitive patient information. When sharing details about healthcare services, there is a risk that personally identifiable information (PII) or protected health information (PHI) could be inadvertently disclosed, leading to breaches of confidentiality. Additionally, the integration of this data element across various systems may introduce vulnerabilities that can be exploited by unauthorized users, increasing the risk of data theft or misuse. Compliance with regulations such as HIPAA is critical, as any lapses in security measures could result in significant legal and financial repercussions. Moreover, ensuring that data is accurately and securely transmitted between healthcare providers requires robust encryption and access control mechanisms to protect against cyber threats. However, this concern is no more different than any other health related data element available or under consideration.
Estimate of Overall Burden The overall burden to implement the Healthcare Service data element can be estimated as moderate to high, depending on the size and complexity of the healthcare organization. Implementation costs may include software development, system integration, staff training, and compliance with regulatory requirements, which can vary widely among institutions. Organizations with existing EHR systems may face additional challenges in aligning their proprietary coding and service categorization with the standardized FHIR specifications. Moreover, smaller practices might experience a disproportionate burden due to limited resources, leading to potential disparities in the adoption of standardized services. Additionally, the need for ongoing maintenance and updates to ensure interoperability across various platforms further contributes to the overall implementation burden for the broader healthcare community, particularly in specialty-specific areas where unique service definitions and coding practices may apply. However, the benefits of consistency in its implementation can be highly valuable to patients, care providers, vendor platforms, health exchange networks, and other stakeholders.
ASTP 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.
Evaluation Comment This data element broadly represents several other data types in USCDI, including Encounter Type, Facility Type, and Procedures.

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