Submitted by CDC_DSMH_WG on
CDC's Comment for draft USCDI v5
CDC supports the inclusion of this data element in USCDI v5 as it is an element that may be necessary for calculation of our digital quality metrics from FHIR data.
Pharmacologic agents used in the diagnosis, cure, mitigation, treatment, or prevention of disease.
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Indication
Description (*Please confirm or update this field for the new USCDI version*)
Sign, symptom, or medical condition that leads to the recommendation of a treatment, test, or procedure. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Comment
Submitted by pwilson@ncpdp.org on
NCPDP Comments on USCDI draft v5
NCPDP applauds the addition of SNOMED CT codes and ICD-10 as data elements code sets for Indication.
Submitted by CDC_DSMH_WG on
CDC's comment on behalf of CSTE for USCDI v5
CSTE also strongly agrees that the ability to exchange data on prescribing of opioid medications in particular is of great importance to public health programs which aim to reduce opioid overdoses and deaths.
Submitted by CDC_DSMH_WG on
CDC's Consolidated Comment for USCDI v5
- ** ADD THIS USE CASE TO SUBMISSION **
- "Medication Opioids": Unintentional injuries are the leading cause of death for Americans aged 1–44 years. The leading cause of death for unintentional injury is poisoning, specifically drug overdose. Overdose deaths continue to climb each year and accelerated during the COVID-19 pandemic. The majority of national overdose deaths involve opioids. Many patients receive their first exposure to opioids following surgery, and dentists are the leading prescriber of opioids among adolescents aged 10-19 and second-leading prescriber among young adults aged 20–29. In 2004, an estimated 3.5 million patients had wisdom teeth extracted. Filled opioid prescriptions after wisdom tooth extraction is associated with higher odds of persistent opioid use among opioid-naïve patients. Better understanding prescribing habits can help identify risk factors and particularly vulnerable populations.
- "Medications Antibiotics": More than 2.8 million antimicrobial-resistant infections occur in the United States each year, and more than 35,000 people die as a result. When Clostridioides difficile is added to these, the US toll exceeds 3 million infections and 48,000 deaths. The threat of antibiotic resistance undermines progress in health care, food production, and life expectancy. Addressing this threat requires preventing infections in the first place, slowing the development of resistance through better antibiotic use, and stopping the spread of resistance when it develops. Research shows that dentists overuse antibiotics, particularly for patients who are underinsured. Dentists prescribe 10% of all outpatient antibiotics, although there is significant geographical variability. Better understanding prescribing practices, knowledge, and beliefs can aid in the development of meaningful antimicrobial stewardship efforts addressing case selection and areas of practice.
NACCHO supports CDC's recommendations.
Submitted by pwilson@ncpdp.org on
NCPDP Comment
NCPDP recommends adding SNOMED CT and ICD-10 as data elements/code sets to further adhere to the standardized code lists that have been created to identify services or products provided to the patient. NCPDP SCRIPT Standard v2017071 data element “indication” uses SNOMED CT codes in the “SIG” directions for use and uses SNOMED CT codes and ICD-10 codes in the NCPDP SCRIPT Standard v2017071“Diagnosis” field.
Submitted by pwilson@ncpdp.org on
NCPDP Comments
- NCPDP recommends adding SNOMED CT and ICD10 as data elements/code sets to further adhere to the standardized code lists that have been created to identify services or products provided to the patient. NCPDP SCRIPT standard data element “indication” uses SNOMED CT in the “SIG” directions for use and ICD10 in the NCPDP SCRIPT “Diagnosis” field.
"Currently, most prescriptions lack a key piece of information needed for safe medication use: the patient-specific drug indication. Integrating indications could pave the way for safer prescribing in multiple ways, including avoiding look-alike/sound-alike errors, facilitating selection of drugs of choice, aiding in communication among the healthcare team, bolstering patient understanding and adherence, and organizing medication lists to facilitate medication reconciliation. Although strongly supported by pharmacists, multiple prior attempts to encourage prescribers to include the indication on prescriptions have not been successful.” https://pubmed.ncbi.nlm.nih.gov/29674327/
Submitted by CDC_DSMH_WG on
CDC's Consolidated Comment for USCDI v4
CDC continues to recommend inclusion of this high priority data element in USCDI v4
Submitted by shellyspiro on
Medications Indication terminology standard
This field is for general comments on this specific data element. To submit new USCDI data classes and/or data elements, please use the USCDI ONDEC system: https://healthit.gov/ONDEC
Recommend adding SNOMED CT and ICD-10 as the terminology standards to be used for Indication data element of Medications Data Class.
Submitted by CDC_DSMH_WG on
CDC's Consolidated Comment
Reason for medication prescription or administration is particularly important as medications can be used for multiple conditions, and for off-label use. Documentation of the specific reason a medication is prescribed is integral to understanding a patient’s specific condition.
Collected for Tuberculosis (TB) and Latent Tuberculosis Infection (LTBI) Surveillance and are included in the TB and LTBI Message Mapping Guides (MMG). https://ndc.services.cdc.gov/mmgpage/tuberculosis-and-latent-tb-infection-message-mapping-guide/
Additional Technical Specifications: HL7 FHIR Health Care Surveys Content Implementation Guide (http://hl7.org/fhir/us/health-care-surveys-reporting/2022Jan/).
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Submitted by NCQA on
NCQA recommendation: revise Indication definition
Recommendation: Revise the definition of the element to ‘Sign, symptom, medical condition, or reason (i.e. screening) for a care activity.’
Rationale: NCQA recommends clarifying the definition of Indication to be more explicit for the reasons a care activity (procedure, medication, order) may occur. Specifically, when referencing indications for an order, the indication can help distinguish orders for diagnostic purposes verse routine screening, which is important for care context and quality measurement. For example, a laboratory test order may be placed for routine screening purposes based on age or other risk assessment and not because of a specific symptom or diagnosis. This indication can still be coded with ICD and SNOMED, similar to a medical condition indication, but the distinction is important. Further clarification of the definition will better align to current practice and workflows.