Physical place of available services or resources.

Data Element
Facility Managing Organization Identifier
Submitted By: Keith W. Boone / Audacious Inquiry
Data Element Information
Data Element Description A unique identifier for the managing organization.
Use Case Description(s)
Use Case Description Facility level data is associated with laboratory tests (the testing facility), and health care provider locations, including hospitals, ambulatory providers, long-term and post acute care, and pharmacy providers.
Location data is used to support reporting of data for public health and emergency response (e.g., situation awareness reporting).

See https://build.fhir.org/ig/HL7/fhir-saner/ for details (note that (minus) - is a legal character in URLs, had to use a bit.ly link to get past validation errors in URL)
Estimate the breadth of applicability of the use case(s) for this data element Hospitals in the US (Approximately 7000), Laboratories (260,000), pharmacies (88,000), ambulatory physicians (260,000).
Link to use case project page https://bit.ly/SANERBUILD
Healthcare Aims
  • Improving the health of populations
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) Various:

FHIR DSTU2, 3 and 4, CDA Release 2.0, HL7 V2 PL Data Type
https://bit.ly/FHIRLocation
Additional Specifications V3.1.0: https://www.hl7.org/fhir/us/core/StructureDefinition-us-core-location.html
V3.0.0: http://hl7.org/fhir/us/core/2019Sep/StructureDefinition-us-core-location.html
V2.1.0: http://hl7.org/fhir/us/core/2019Jan/StructureDefinition-us-core-location.html
V2.0.0: http://hl7.org/fhir/us/core/STU2/StructureDefinition-us-core-location.html
Current Use Extensively used in production environments
Supporting Artifacts Widely available within EHR Systems, but not necessarily searchable.
https://open.epic.com/Interface/FHIR#Location
https://mydata.athenahealth.com/static/apidoc/ig-ge-location.html
https://fhir.cerner.com/millennium/r4/encounters/encounter/ (Reference to a Location resource)
https://developer.allscripts.com/FHIR?PageTitle=Resources
https://api.evident.com/dstu2/encounter (Location as an embedded resource)
https://www.questdiagnostics.com/dms/Documents/care360/Terms-Conditions/Quanum_EHR_FHIR_API.pdf (Quest only supports Location name in Immunizations)
https://bit.ly/USCore31
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 See US Core Connectathon report out: https://drive.google.com/file/d/1WNYWLEf28j8DPyDachC8jpk-QbkyuPxP/view

https://bit.ly/2DTBheD
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns Locations associated with Critical Access Hospitals, and single provider facilities may constitute PHI (in geographic locations with limited populations) and/or Individual Identifiable Information (e.g., for HCPs working from a combined home/office facility).
Estimate of Overall Burden Most electronic systems provide the capacity to store location and organization information. Many EHRs already provide access to the Location resource via READ operations, some (e.g., Epic, AthentaHealth) provide search capabilities as well. This information is routinely communicated in HL7 V2 Messages, CDA Documents and some FHIR API transactions. To address gaps, implementers would need to modify interfaces (e.g., for CDA or HL7 V2), or add an endpoint. Estimated effort (based on past experience building EHR systems) is about one two-week sprint to implement the capability by a developer.
Other Implementation Challenges Standards for location identifier may need flexibility depending on use of Location for reportiong, as there are a number of distinct location identifier systems which may be necessary for different reporting use cases. For example, CDC/NHSN assigns identifiers for HAI reporting, CLIA assigns identifiers to laboratories, CMS provides location identifiers, et cetera.

Comment

Submitted by CDC_DSMH_WG on

CDC's comment for inclusion in USCDI v7

a. National Ambulatory Medical Care Survey (NAMCS) Health Center Component samples all care delivery sites under the sampled health center. To increase NAMCS quality control it would be helpful to receive Facility Managing Organization Identifier. As NAMCS grows, a Facility Managing Organization Identifier would help ensure that data is correctly linked to the specific facility and decrease risk for data loss and duplication. National Hospital Care Survey relies on hospitals to submit data and hospitals can contain non-sampled facilities (e.g., Federally Qualified Health Centers, primary care practices, etc.). In this context, having detailed facility information is essential for the unique identification of each facility. Additionally, an important goal of the National Health Care Surveys data modernization effort is to reduce redundancy and reporting burden. To that end, DHCS is collaborating with CDC other programs to repurpose data that is already being collected from ambulatory and hospital-based settings. This requires linking to other existing data sets using unique IDs such as Facility Managing Organization ID. The unique facility identifiers increases accurate and reliability in the matching process, resulting in improved data quality available for decision making. Having these unique IDs will also be critical as the National Health Care Surveys explore leveraging the TEFCA framework to facilitate interoperability with QHINS which require patient and organizational matching across the complex health care ecosystem. In summary, having critical IDs results in overall cost savings in the health care and public health ecosystem while potentially improving patient outcomes.

b. Location of data element in the current HCS CDA IG V1.2: x-path /ClinicalDocument/documentationOf/serviceEvent/performer/assignedEntity/id

c. This data element is in C-CDA 4.0. Link in the C-CDA IG- https://hl7.org/cda/us/ccda/StructureDefinition-USRealmHeader.html

d. Description of what DHCS currently receives in production: Nothing is available currently.

Submitted by CDC_DSMH_WG on

CDC's comment for proposed inclusion in USCDI v7

National Ambulatory Medical Care Survey (NAMCS) Health Center Component samples all care delivery sites under the sampled health center. To increase NAMCS quality control it would be helpful to receive Facility Managing Organization Identifier. As NAMCS grows, a Facility Managing Organization Identifier would help ensure that data is correctly linked to the specific facility and decrease risk for data loss and duplication. National Hospital Care Survey (NHCS) relies on hospitals to submit data and hospitals can contain non-sampled facilities (e.g., Federally Qualified Health Centers, primary care practices, etc.). In this context, having detailed facility information is essential for the unique identification of each facility.  

Location of data element in the current HCS CDA IG V1.2: 

x-path/ClinicalDocument/documentationOf/serviceEvent/performer/assignedEntity/id

This data element is in C-CDA 4.0. Link in the C-CDA IG- https://hl7.org/cda/us/ccda/StructureDefinition-USRealmHeader.html

Description of what DHCS currently receives in production: Nothing is available currently.

Submitted by CDC_DSMH_WG on

CDC's Comment for draft USCDI v6

CDC is requesting that Facility Managing Organization Identifier be added for consideration to USCDI V6 to inform hospital and ambulatory medical care survey data collection efforts.

Justification: NAMCS Health Center Component samples all care delivery sites under the sampled health center. To increase NAMCS quality control it would be helpful to receive Facility Managing Organization Identifier.

Submitted by CDC_DSMH_WG 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: Very useful for this information to be captured in some way and then subsequently used in reporting to PH.

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