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  1. FHIR Specification Feedback
  2. FHIR-40546

Encounter type value set too limited



    • Icon: Change Request Change Request
    • Resolution: Not Persuasive
    • Icon: Medium Medium
    • US Core (FHIR)
    • 6.0.0-ballot [deprecated]
    • Cross-Group Projects
    • US Core Encounter Type
    • Terminology
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      At this time, VSAC does not allow us to specify the proper value set so we are unable to do what is being asked.

      At this time, VSAC does not allow us to specify the proper value set so we are unable to do what is being asked.
    • Gay Dolin / Floyd Eisenberg : 10-0-1


      The logical definition for the US Core Encounter Type value set, for SNOMED, is specified as "is-a" 308335008 (Patient encounter procedure), which expands to 171 codes. Many clinical quality measures rely on SNOMED codes in Encounter.type which are not in that expansion. Only 59 of 424 SNOMED codes used in eCQM value sets are also in the US Core Encounter Type value set as currently defined. 365 of 424 codes are not in the US Core expansion. The US Core Encounter Type value set needs to expand to cover the codes used in these clinical quality measures.



      USCDIv2 introduced Encounter Type https://www.healthit.gov/isa/taxonomy/term/1186/uscdi-v2 and View Submission very clearly addresses quality measurement:

      Encounter information is used extensively by hospitals, clinicians and providers submitting data for quality measurement. This patient level encounter information provides context for when, why and what type of healthcare encounters occurred which may have led to conditions diagnosed, procedures performed, or medications prescribed.

      It links to https://ecqi.healthit.gov/ecqms which is the web site where CMS makes available the eCQMs with the value sets used for Encounter Type.

      "The profiles (in US Core v5.0.1) are stand alone and include requirements from the U.S. Core Data for Interoperability (USCDI) v2"
      As you know, many QI-Core profiles derive from US Core profiles. If US Core provided everything needed for quality measures, QI-Core would not need to add many of the profiles. QI-Core can be simplified as certain aspects in QI-Core are "moved up" in US Core. If US Core does not quite fit with what quality measures need, the requirement gets "pushed down" for QI-Core to add.

      Given the "extensible" binding strength of the US Core Encounter Type value set, QI-Core would need to extend it by 365 codes, which is more than twice as many codes as compared to the 171 SNOMED codes now in the US Core value set.

      Also from USCDIv2 Encounter Type (View Submission):


       Data exchange of encounter information is also critical for clinical care. Clinicians need to be aware of recent healthcare encounters, including the type of encounter, ...


      Ideally the codes used for quality measurement are taken directly from the codes recorded in the normal workflow of providing clinical care; there should not be a separate set of codes for quality measurement that require mapping or translation from the codes used to record clinical care.
      The US Core Encounter Type value set currently includes the whole CPT code system, but for SNOMED it uses a limited subset which is currently too small.

      USCDI explicitly calls out a few examples


      {{SNOMED CT (example, value set OID: 2.16.840.1.113883.3.666.5.307)
      HCPCS (example, value set OID: 2.16.840.1.113883.3.464.1003.101.12.1087)


      That SNOMED value set is just one example, and it has only 3 codes, which are not in the US Core value set.




            GDolin Gay Dolin
            mitrep9g Paul Denning
            Paul Denning
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