USCDI Export for the Public

The Eastern Cooperative Oncology Group (ECOG) Performance Status represents the patient's functional status and is used to determine how a disease impacts a patient’s daily living abilities and their overall ability to tolerate therapies in serious illness, specifically for chemotherapy.

LOINC, SNOMED-CT, and FHIR see: https://search.loinc.org/searchLOINC/search.zul?query=functional+status http://hl7.org/fhir/us/mcode/ https://browser.ihtsdotools.org/?perspective=full&conceptId1=273472005&edition=MAIN/2020-07-31&release=&languages=en

"The estimated gestational age (in weeks, or weeks and fraction of week) of the pregnancy at the time of the health care encounter (in contrast to the gestational age at birth), beginning from the time of fertilization. Needs to be correlated with the date the gestational age was documented. Gestational age (written with both weeks and days) is calculated using the best obstetrical estimated delivery date (EDD) based on the following formula: Gestational Age = (280 - (EDD - Reference Date))/ 7"

https://www.hl7.org/implement/standards/product_brief.cfm?product_id=494

Represents a location in a person’s travel plans (either an address or a coded location).

§ 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) § NCI_Thesaurus 22.08e: code C173619 § LOINC v2.72 code: PhenX measure - international travel history:-:Pt:^Patient:-:PhenX (Code 62887-5)

Dates planned for travel to a location.

Geographical location history (https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3201) ISO 3166 country codes (https://www.iso.org/iso-3166-country-codes.html)

The date the vaccination event occurred.

LOINC:30952-6- Date and time of vaccination: https://loinc.org/30952-6/

Indicates the reason the immunization event was not performed.

Immunization Code: CVX: Vaccines Administered 2.16.840.1.113762.1.4.1010.6: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1010.6/expansion Immunization Code: National Drug Codes (NDC): http://www2a.cdc.gov/vaccines/iis/iisstandards/ndc_tableaccess.asp Immunization Status: FHIR Immunization Status Codes: http://hl7.org/fhir/ValueSet/immunization-status Immunization Administered Date: FHIR datatypes: dateTime, String: https://www.hl7.org/fhir/us/core/StructureDefinition-us-core-immunization-definitions.html#Immunization.occurrence[x] Reason Immunization Not Performed: FHIR Immunization Status Reason Codes: http://hl7.org/fhir/R4/valueset-immunization-status-reason.html

The following value should be used to document patient consent during a disaster or pandemic in Texas: TXD – Disaster consent In Texas, there is legislation that requires health care providers to report antiviral, immunization or other medications (AIM) administered to patients in response to a disaster such as COVID-19. When the AIM information is reported the TX IIS (ImmTrac) flags the information as disaster-related. If the patient signs the disaster-related consent form, their personal and disaster related AIMs are stored for the patient’s lifetime. If the patient does not sign the disaster related consent form or the regular, applicable consent form but receives a disaster related AIM, then their personal information and disaster related AIMs are stored in Texas’ IIS for up to 5 years after the end of the disaster. It is crucial for Electronic Health Records to capture, store, and exchange information regarding whether the patient received an AIM that was administered in response a disaster/pandemic so that this information can be shared with others to ensure appropriate medications are delivered and patient health can be maximized..

This element will document the patient’s consent for participating in the Texas statewide immunization information system (IIS). Under state statute, the Texas immunization registry is opt-in.. The following are the different values Texas currently uses to desctibe a patient’s consent status: TXA - Consented Adult, >=18 years old TXY - Consented ImmTrac Child, <18 years of age TXR - First Responder, >=18 years old TXF - Adult Family Member of a First Responder, >=18 years old TXM - Minor Family Member of a First Responder, <18 years old - no consent is on file. After the first initial consent is sent to the registry, the EHR vendor would need to be able to leave the field blank when the patient's information is sent again to the registry.

This variable contains the date consent was obtained or changed. When a provider queries ImmTrac for a patient and a patient who has already consented is found, the query will return the Texas IIS Consent Date stored in the registry. The provider, at the patient’s (or parent/guardian’s direction, as appropriate) can change the consent status. If there is a change, the updated Texas IIS Consent Date should be submitted to the IIS. Texas IIS Consent Date should be stored in date format: YYYYMMDD.

Unique, disambiguating identifier components for Organization-related elements. e.g. Provenance, identifier.assigner, and other elements and components that rely upon Organizations, especially those that may not be provider organizations nor have a URL. USCDI may need to support (or even consider requiring) organization.identifier.system to improve data portability. The parent way of identifying the system that enumerates multiple Organization identifiers may best be modeled as Organization.identifier.system, where the identifier uses existing FHIR properties for Identifiers data type. These include: identifier.system (URI namepsace) identifier.assigner (itself an organization!) identifier.value (a unique value)

For organizations like payers and ACOs, while health plan ID is no longer being pursued by industry, existing, in-production Payer IDs exist in multiple EDI (Electronic Data Interchange) environments. There are a set of Payer IDs in use today already; in concert with a clear description of the system that enumerates the Payer ID, these can be an example of the standards that may be used in uniquely identifying organizations beyond a free-text string description/label. These IDs may, however, be proprietary, but also already permissioned for use by the trading partners of the entities using the IDs for treatment, payment, and health care operations.

A record of the patient’s authorizations and directions regarding disclosure and use of the patient’s SDOH data.

Yes, structural standards exist for each of these six elements in current HL7 standards. Specifically, in FHIR, (1) Assessments are Observation resources; (2) Problems/Health Concerns are Condition resources; (3) Goals are Goal resources; (4) Interventions are ServiceRequest and Procedure resources; (5) Outcomes are represented by the status on any of the previously mentioned resources or creation of new Observation resources; and (6) Consent is represented by the Consent resource. Yes, a vocabulary/terminology standard and/or technical specification exists for each proposed data element. The technical specifications for value sets under each data element are described below: • Assessments: LOINC • Health Concerns/Problems/Diagnoses: SNOMED-CT, ICD-10-CM • Goals: LOINC • Procedures/Interventions: SNOMED-CT (clinical), CPT/HCPCS (billing) • Outcomes: LOINC (NCQA measures) • Consent (where needed): based on existing HL7 code systems For the respective SDOH domains: For (1) Food Insecurity: LOINC, SNOMED-CT, ICD-10-CM, and CPT/HCPCS terminologies are specified by value sets in NLM’s Value Set Authority Center (VSAC). For (2) Housing Instability and Homelessness, (3) Inadequate Housing, (4) Transportation Insecurity, (5) Financial Strain, (6) Social Isolation, (7) Stress, (8) Interpersonal Violence, (9) Education, (10) Employment, and (11) Veteran Status: • The corresponding value sets are under development by the Gravity Project. • The value sets will be complete prior to publishing of USCDI v2.0; • Even if a particular value set might be incomplete, the value set will be citable. The details of the domains and specific consensus-approved value sets for each of the activities will be externally maintained as part of a hierarchy of LOINC panels and, where necessary, VSAC value sets referenced by the LOINC panels. The proposed structure is as follows: Survey (Panel) LOINC code a. Food Insecurity Domain (Panel) (LOINC code) i. Food Insecurity Assessment (Panel) (LOINC code) 1. Value set (LOINC codes) ii. Food Insecurity Health Concerns (Panel) (LOINC code) 1. Value set (SNOMED-CT and ICD-10-CM) iii. Food Insecurity Goals (Panel) (LOINC code) 1. Value set (LOINC codes) iv. Food Insecurity Interventions (Panel) (LOINC code) 1. Value set (SNOMED-CT, HCPCS, CPT, LOINC) v. Food Insecurity Outcomes (Panel) (LOINC code) 1. Value set (LOINC codes) b. Domain: Housing Instability and Homelessness c. Etc.

An outcome may be the result of the SDOH intervention to achieve the goal or address the problem. Outcomes are the measurable result of an intervention that may form the basis of quality metrics.

Yes, structural standards exist for each of these six elements in current HL7 standards. Specifically, in FHIR, (1) Assessments are Observation resources; (2) Problems/Health Concerns are Condition resources; (3) Goals are Goal resources; (4) Interventions are ServiceRequest and Procedure resources; (5) Outcomes are represented by the status on any of the previously mentioned resources or creation of new Observation resources; and (6) Consent is represented by the Consent resource. Yes, a vocabulary/terminology standard and/or technical specification exists for each proposed data element. The technical specifications for value sets under each data element are described below: • Assessments: LOINC • Health Concerns/Problems/Diagnoses: SNOMED-CT, ICD-10-CM • Goals: LOINC • Procedures/Interventions: SNOMED-CT (clinical), CPT/HCPCS (billing) • Outcomes: LOINC (NCQA measures) • Consent (where needed): based on existing HL7 code systems For the respective SDOH domains: For (1) Food Insecurity: LOINC, SNOMED-CT, ICD-10-CM, and CPT/HCPCS terminologies are specified by value sets in NLM’s Value Set Authority Center (VSAC). For (2) Housing Instability and Homelessness, (3) Inadequate Housing, (4) Transportation Insecurity, (5) Financial Strain, (6) Social Isolation, (7) Stress, (8) Interpersonal Violence, (9) Education, (10) Employment, and (11) Veteran Status: • The corresponding value sets are under development by the Gravity Project. • The value sets will be complete prior to publishing of USCDI v2.0; • Even if a particular value set might be incomplete, the value set will be citable. The details of the domains and specific consensus-approved value sets for each of the activities will be externally maintained as part of a hierarchy of LOINC panels and, where necessary, VSAC value sets referenced by the LOINC panels. The proposed structure is as follows: Survey (Panel) LOINC code a. Food Insecurity Domain (Panel) (LOINC code) i. Food Insecurity Assessment (Panel) (LOINC code) 1. Value set (LOINC codes) ii. Food Insecurity Health Concerns (Panel) (LOINC code) 1. Value set (SNOMED-CT and ICD-10-CM) iii. Food Insecurity Goals (Panel) (LOINC code) 1. Value set (LOINC codes) iv. Food Insecurity Interventions (Panel) (LOINC code) 1. Value set (SNOMED-CT, HCPCS, CPT, LOINC) v. Food Insecurity Outcomes (Panel) (LOINC code) 1. Value set (LOINC codes) b. Domain: Housing Instability and Homelessness c. Etc.

Unique identifier for a healthcare organization (i.e. CCN, NPI)

Unique identifiers for organizations/providers are assigned and governed uniformly. NPI: https://nppes.cms.hhs.gov/#/ CCN: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R29SOMA.pdf Clinical Laboratory Improvement Amendments (CLIA) for laboratories: https://www.cdc.gov/clia/index.html

A question about how often an individual uses or used any tobacco product. An ordered reference standard related to the use of tobacco within a period of time. Element from the TAPS Tool: In the PAST 12 MONTHS, how often have you used any tobacco product (for example, cigarettes, e-cigarettes, cigars, pipes, or smokeless tobacco)? Value: 1. Daily or almost daily (displayed as "0"): a subjective response that something happens daily or almost daily 2. Weekly (displayed as "1"): Every week 3. Monthly (displayed as "2"): Every month 4. Less than Monthly (displayed as "3"): An event that occurs less frequently than once a month 5. Never (displayed as "4"): Not ever, at no time in the past (or future).

Elements were recently submitted for inclusion in LOINC.

Uncertain, limited, or unstable access to food that is: adequate in quantity and in nutritional quality; culturally acceptable; safe and acquired in socially acceptable ways. (Gravity Project.)

Yes, a vocabulary/terminology standard and/or technical specification exists for each proposed data element. The Gravity Project attaches a letter with an overview. For (1) Food Insecurity: LOINC, SNOMED-CT, ICD-10-CM, and CPT/HCPCS terminologies are specified by value set in NLM’s Value Set Authority Center (VSAC). For (2) Housing Instability and Homelessness, (3) Inadequate Housing, (4) Transportation Insecurity, (5), Financial Strain, (6) Social Isolation, (7) Stress, (8) Interpersonal Violence, (9) Education, (10) Employment, and (11) Veteran Status: • The corresponding value sets are under development by the Gravity Project; • The value sets will be complete prior to publishing of USCDI v2.0; • Even if a particular value set might be incomplete, the value set will be citable. The technical specifications for value sets under each data element are described below: • Assessments: LOINC • Health Concerns/Problems/Diagnoses: SNOMED-CT, ICD-10-CM • Goals: LOINC • Procedures/Interventions: SNOMED-CT (clinical), CPT/HCPCS (billing) • Outcomes: LOINC (NCQA measures) • Consent (where needed): based on existing HL7 code systems

In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility? ☐ Yes ☐ No ☐ I choose not to answer this question

Z56.0 Conviction in civil and criminal proceedings without imprisonment Z65.1 Imprisonment and other incarcerations SNOMED: (Include children concepts) 365565007 - Finding of legal affairs and legal constraints (finding) LOINC: 93025-5 - Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]

Use of the tobacco plant leaf or its products. The predominant use of tobacco is by smoke inhalation of cigarettes, pipes, and cigars. Smokeless tobacco refers to a variety of tobacco products that are either sniffed, sucked, or chewed. An electronic cigarette is a vaporizer device that simulates smoking by providing some of the aspects of smoking that includes nicotine but without combusting tobacco. These products include psychoactive ingredient, nicotine. Question Prompt: Any use of tobacco (or nicotine-containing) products? Permissible Values: o Never (SNOMED: 702979003) An individual who has never consumed tobacco products in their lifetime. o Former (SNOMED: 702975009) An individual who has consumed tobacco products in his or her lifetime but who had quit consumption at the time of question. o Current - Daily (SNOMED: TBD) An individual who has consumed tobacco products in his or her lifetime, and who does so every day. o Current - Occasionally (SNOMED: TBD) An individual who has consumed tobacco products in his or her lifetime, who uses now, but does not use every day. o Unknown (SNOMED: TBD) An individual for whose tobacco product use is unknown.

There are SNOMED and LOINC Codes for most of the data elements but new codes will be requested for eCigarette use.

The Karnofsky Performance Status (KPS) is a tool used to measure a patient's functional status. It can be used to compare the effectiveness of different therapies and to help assess the prognosis of certain patients, such as those with certain cancers. The KPS score ranges from 0 to 100 in intervals of 10. Higher scores are associated with better functional status, with 100 representing no symptoms or evidence of disease, and 0 representing death.

LOINC, SNOMED-CT, and FHIR see: https://search.loinc.org/searchLOINC/search.zul?query=functional+status http://hl7.org/fhir/us/mcode/ https://browser.ihtsdotools.org/?perspective=full&conceptId1=273472005&edition=MAIN/2020-07-31&release=&languages=en

In the past year whether patient has been able to unable to find affordable or pay for childcare. (LOINC) LA30127-7 Synonyms: (ICD-10-CM) Z59.68 (Unable to pay for child care)

LOINC 93031-3 In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?

Currently consistently housed, but experiencing any of the following circumstances in the past 12 months: being behind on rent or mortgage, multiple moves, homelessness; or currently living in a shelter, motel, temporary or transitional living situation, scattered site housing, or not having a consistent place to sleep at night; or lacking a fixed, regular, and adequate nighttime residence. (Richard Sheward, Allison Bovell-Ammon, Nayab Ahmad, Genevieve Preer, Stephanie Ettinger de Cuba & Megan Sandel, Promoting Caregiver and Child Health Through Housing Stability Screening in Clinical Settings, 39 Zero to Three J. 52, 52-53 (Mar. 2019); Megan Sandel, Richard Sheward, Stephanie Ettinger de Cuba, Sharon M. Coleman, Deborah A. Frank, Mariana Chilton, Maureen Black, Timothy Heeren, Justin Pasquariello, Patrick Casey, Eduardo Ochoa & Diana Cutts, Unstable Housing and Caregiver and Child Health in Renter Families, 141 Pediatrics e20172199, p. 3 (2018); McKinney-Vento Homeless Assistance Act of 1987, Pub. L. 100-77, § 103(a)(1), 101 Stat. 482, 485 (July 22, 1987).) Currently under consideration by and in process with the Gravity community.

Yes, a vocabulary/terminology standard and/or technical specification exists for each proposed data element. The Gravity Project attaches a letter with an overview. For (1) Food Insecurity: LOINC, SNOMED-CT, ICD-10-CM, and CPT/HCPCS terminologies are specified by value set in NLM’s Value Set Authority Center (VSAC). For (2) Housing Instability and Homelessness, (3) Inadequate Housing, (4) Transportation Insecurity, (5), Financial Strain, (6) Social Isolation, (7) Stress, (8) Interpersonal Violence, (9) Education, (10) Employment, and (11) Veteran Status: • The corresponding value sets are under development by the Gravity Project; • The value sets will be complete prior to publishing of USCDI v2.0; • Even if a particular value set might be incomplete, the value set will be citable. The technical specifications for value sets under each data element are described below: • Assessments: LOINC • Health Concerns/Problems/Diagnoses: SNOMED-CT, ICD-10-CM • Goals: LOINC • Procedures/Interventions: SNOMED-CT (clinical), CPT/HCPCS (billing) • Outcomes: LOINC (NCQA measures) • Consent (where needed): based on existing HL7 code systems