Data Element
Travel History Dates
Description

The dates spent in a location traveled to.
Submitted By: Craig Newman / Altarum
Data Element Information
Use Case Description(s)
Use Case Description o Exposures to communicable and environmental pathogens during travel pose a risk for importation of nonendemic, emerging, or antimicrobial-resistant pathogens to the United States. For this reason, it is important for public health officials to receive discrete and accurate travel history information about patients, including dates of travel. This information is particularly important during outbreaks.
o Travel dates, specifically the timing and duration of travel with respect to illness onset, are essential to determine the timing and location of exposure for a diagnosed infectious disease, or to formulate a complete differential diagnosis for illnesses of unknown etiology, based on known or estimated incubation periods and natural history of disease progression.
o During periods when outbreaks are occurring in an international location with risk of case importation to the United States, identifying travel-associated cases is essential to ensure appropriate public health management of case-patients and contacts as well as to inform guidance for travelers or clinicians or public health policy.
o In some situations, cases in travelers may serve as sentinel events in identifying new or re-emerging pathogens or previously unidentified outbreaks.
o Surveillance for travel-associated disease importation and spread also informs travel health prevention and treatment recommendations for travelers and clinicians.

Estimate the breadth of applicability of the use case(s) for this data element o Travel history would be reported in all jurisdictions as part of electronic case reporting.
o Healthcare providers – physicians, pharmacists, nurses, and physician assistant
o 50 states Local and State health department
o CDC Division Global Migration and Quarantine
o Centers for Medicare & Medicaid Services
o Currently built into national case notifications to CDC for 25 reportable conditions using the case notification HL7 message mapping guide format. Anticipate within the next couple of years to make travel history available for all notifiable conditions
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) § SNOMED: 420008001 |Travel (event)|
§ Geographical location history (https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.do 11.3201)
§ ISO 3166 country codes (https://www.iso.org/iso-3166-country-codes.html)
§ LOINC v2.72 Date travel started:Date:Pt:^Patient:Qn (Code 82752-7)
§ LOINC v2.72 Date of departure from travel destination:Date:Pt:^Patient:Qn (Code 91560-3
Additional Specifications § HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) http://build.fhir.org/ig/HL7/case-reporting/StructureDefinition-us-ph-travel-history.html
Current Use Extensively used in production environments
Supporting Artifacts Used as part of electronic case reporting
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 Somewhere between 56 and 2400 public health agencies and 5000 reporting sites.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns o Health Insurance Portability and Accountability Act (HIPAA, https://www.hhs.gov/hipaa/index.html)
Estimate of Overall Burden These data elements are straightforward in nature and should not present a large burden to implement provided the EHR system is capturing the data.
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.

Comment

Submitted by BLampkins_CSTE on

CSTE Comment - v6

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

Submitted by nedragarrett_CDC on

CDC's Consolidated Comment

  • Strongly recommend inclusion of this data element along with travel history location as part of USCDI v3. Not only is this information important for public health, but also plays an important role in developing a differential diagnosis list as some infectious diseases are more common or only found internationally. Additionally, these concepts are built into national case notifications to CDC for 25 reportable conditions using the case notification HL7 message mapping guide format. Anticipate within the next couple of years to make travel history available for all notifiable conditions as it is not only important for general surveillance, but also for work done at CDC related to global migration and quarantine e.g., it helps to identify post-exposure prophylaxes needs and plays critical role in outbreak response such as Ebola and/or early SARS-CoV-2 response.

CSTE Comment:

  • Agree with CDC: Strongly recommend inclusion of this data element along with travel history location as part of USCDI v3. Not only is this information important for public health, but also plays an important role in developing a differential diagnosis list as some infectious diseases are more common or only found internationally. Additionally, these concepts are built into national case notifications to CDC for 25 reportable conditions using the case notification HL7 message mapping guide format. Anticipate within the next couple of years to make travel history available for all notifiable conditions as it is not only important for general surveillance, but also for work done at CDC related to global migration and quarantine e.g., it helps to identify post-exposure prophylaxes needs and plays critical role in outbreak response such as Ebola and/or early SARS-CoV-2 response.
  • For travel history it is important to capture the dates the person was in the location/destination (start date and end date) - also important to phrase the question so that it does not always represent travel FROM the US to another country and back as many individuals who may have been residing in another country or another relevant location may present for care. Recommend the question be asked as whether time was spent recently in a foreign country or another location outside of the jurisdiction.

Submitted by nedragarrett_CDC on

Unified Comment from CDC

  • CDC considers this element to be high priority and strongly recommends its inclusion in the USCDI V3
     
  • CSTE supports inclusion of this measure into USCDI v3: Indicating international travel flag and country visited (with dates of travel and return to US) would be beneficial for some diseases. In general, public health would capture this information during a case investigation and think it might be a burden for clinical care to capture ALL travel (domestic and international) but in some cases, charts are reviewed for travel or the provider is interviewed for patient travel hx, so agree this is useful for some conditions.

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