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  1. FHIR Specification Feedback
  2. FHIR-41265

remove Must Support for Encounter.diagnosis and its respective elements

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US QI Core (FHIR)
    • current
    • Clinical Quality Information
    • QICore Condition Encounter Diagnosis
      QICore Encounter
    • QI-Core Profiles
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      Change QI-Core Encounter profile and change reference for all referenced items to US Core 6.1.0 profiles instead of QI-Core profiles and to build off US Core 6.1.0 with the following additional elements in the differential table:

      RETAIN

      • Encounter.dischargeDisposition (MS in US Core but change value set binding to Clinical Discharge Disposition)
        • Justification - while using the US Core value set binding (an NUBC product) seems to address concerns about consistency with required interoperability modeling, the NUBC value set is primarily used to complete entry in a field in a hospital claim form/template. The content is not a clinical determination of discharge disposition. Further, that value set is not available in THO or VSAC and measure developers will not be able to reference components of that value set to express exclusions in their measures. Therefore, retain value set binding as Clinical Discharge Disposition
      • Encounter.location.period
      • Encounter.serviceProvider (reference Organization)

      REMOVE MS for:

      • Encounter.basedOn - no existing use
      • Encounter.priority (will consider adding profiles for Appointment and for Schedule in other trackers)
      • Encounter.diagnosis and all of its sub-elements
      • Encounter.length (can calculate)
      • Encounter.hospitalization.admitSource (previously used to identify denominator exclusions in hospital measures but has not been used in existing eCQMs)
      • Encounter.hospitalization.reAdmission (can be identified with logic expression and not used in existing eCQMs)
      Show
      Change QI-Core Encounter profile and change reference for all referenced items to US Core 6.1.0 profiles instead of QI-Core profiles and to build off US Core 6.1.0 with the following additional elements in the differential table: RETAIN Encounter.dischargeDisposition (MS in US Core but change value set binding to Clinical Discharge Disposition ) Justification - while using the US Core value set binding (an NUBC product) seems to address concerns about consistency with required interoperability modeling, the NUBC value set is primarily used to complete entry in a field in a hospital claim form/template. The content is not a clinical determination of discharge disposition. Further, that value set is not available in THO or VSAC and measure developers will not be able to reference components of that value set to express exclusions in their measures. Therefore, retain value set binding as Clinical Discharge Disposition Encounter.location.period Encounter.serviceProvider (reference Organization) REMOVE MS for: Encounter.basedOn - no existing use Encounter.priority (will consider adding profiles for Appointment and for Schedule in other trackers) Encounter.diagnosis and all of its sub-elements Encounter.length (can calculate) Encounter.hospitalization.admitSource (previously used to identify denominator exclusions in hospital measures but has not been used in existing eCQMs) Encounter.hospitalization.reAdmission (can be identified with logic expression and not used in existing eCQMs)
    • Floyd Eisenberg/Jen Seeman: 24-0-0
    • Enhancement
    • Non-compatible

    Description

      uSCDI v2 requires Encounter diagnosis. US Core 3.1.1 and subsequent versions address this issue using Encounter.reasonCode and Encounter.reasonReference.  US Core does not require Must Support for Encounter.diagnosis. US Core further limits the terminology binding for Encounter.type as https://hl7.org/fhir/us/core/ValueSet-us-core-encounter-type.html.  The SNOMED hierarchy included in the binding represent clinician-patient interactions. Current measures use value sets from a different SNOMED hierarchy representing facility/location-based visits. Some (but not all) of the existing eCQM uses for Encounter.type are using concepts originating in abstraction-based measures which is what may have led to the hierarchy used. However, clinically-based measures should be using the same hierarchy as suggested by US Core's terminology binding.

      Suggest remove Must Support from Encounter.diagnosis (especially from onAdmission extension and on rank and diagnosis type).  And, recommend use of Claim for principal or primary diagnosis or OnAdmission.   Will create a new tracker for the Encounter.type if needed. 

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            jen_seeman Jennifer Seeman
            feisenberg Floyd Eisenberg
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              Created:
              Updated:
              Resolved: