Provider-authored request for the delivery of patient care services.

Usage notes: Orders convey a provider’s intent to have a service performed on or for a patient, or to give instructions on future care.

Data Element
Service Request
Submitted By: Philip Lieberman / Analog Informatics Corporation
Data Element Information
Data Element Description 12.18 Resource ServiceRequest

ServiceRequest represents an order or proposal or plan, as distinguished by ServiceRequest.intent to perform a diagnostic or other service on or for a patient. ServiceRequest represents a proposal or plan or order for a service to be performed that would result in a Procedure or DiagnosticReport, which in turn may reference one or more Observations, which summarize the performance of the procedures and associated documentation such as observations, images, findings that are relevant to the treatment/management of the subject. This resource may be used to share relevant information required to support a referral or a transfer of care request from one practitioner or organization to another when a patient is required to be referred to another provider for a consultation /second opinion and/or for short term or longer term management of one or more health issues or problems.
Use Case Description(s)
Use Case Description The ServiceRequest resource provides a list of tests and results ordered for a patient. Without this resource, you cannot see the tests ordered, when fulfulled, and the results. The real time tracking of these requests allow practitioners and patients/related persons to be informed when their test results are completed. We have implemented an automated multilingual messaging system that keeps patients and families up to date on their lab tests without using staff resources. In an ER situation, these updates can keep family members updated on the status of their loved ones without distracting staff. It can also alert an ER doctor of a test results they are waiting for.
Estimate the breadth of applicability of the use case(s) for this data element Any appointment that uses external services such as pathology, blood tests, and others generates a ServiceRequest. These are currently invisible under the USCDI interface.
Link to use case project page https://www.hl7.org/fhir/servicerequest.html
ONC Priority
  • Address behavioral health integration with primary care and other physical care
  • Mitigate health and health care inequities and disparities
  • Address the needs of underserved communities
  • Address public health interoperability needs of reporting, investigation, and emergency response
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) N/A
Additional Specifications 2.18 Resource ServiceRequest
https://www.hl7.org/fhir/servicerequest.html
Current Use (Level 2) Captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer
Extent of exchange N/A
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns Under HIPAA the results of tests are supposed to be shared with patients, but practitioners tend to want to explain them first. We have chosen to only share completion status rather than actual results to overcome misunderstandings of test results.
Estimate of Overall Burden None
Other Implementation Challenges None
ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.
Evaluation Comment The proposed Service Request data element overlaps with the existing data elements in the Orders data class.

Comment

Submitted by CDC_DSMH_WG on

CDC comment on data element-

CDC recommends that ONC should for the Orders data class, include the following language in the data class’ description: "Usage note: may include information on status, intent, priority, do not perform, code, occurrence, and as-needed criteria." Rationale: The current definitions for the data elements under the Orders data class identify the types of provider-authored requests but do not clearly specify which order attributes are expected. Explicitly including this useage note in each data elements description would clarify what is being ordered, the order’s status and intent, urgency, whether it should not be performed, when it should occur, and any conditions that must be met before action. This would improve consistency with FHIR/QI-Core and support more reliable clinical and quality reporting.

FHIR path(s):
ServiceRequest.status
ServiceRequest.intent
ServiceRequest.priority
ServiceRequest.doNotPerform
ServiceRequest.code
ServiceRequest.occurrence[x]
ServiceRequest.asNeeded[x]
 

Submitted by rdillaire on

CMS CCSQ supports CDC’s…

CMS CCSQ supports CDC’s recommendation to revise the Orders data class description to include the following: "Usage note: may include information on status, intent, priority, do not perform, code, occurrence, and as-needed criteria."

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