Contextual information that provides supporting details for healthcare data.

Data Element
Anatomic Localization
Submitted By: Matthew Molenda / Anatomy Mapper OpCo
Data Element Information
Data Element Description A standardized, codeable representation of a patient body site (anatomic location) used to localize, document, and track clinical findings, procedures, specimens, imaging findings, and orders; includes a canonical, visual-anchored site identifier and explicit laterality.
Rationale for Separate Consideration Anatomic Localization is related to existing contextual and location-oriented elements in USCDI, most notably Specimen Source Site. However, it should be considered separately because it represents a distinct, reusable clinical concept: where on the patient’s body a finding, procedure, specimen, order, or event applies.

Current USCDI elements capture body site only in narrow, workflow-specific ways. For example, "Specimen Source Site" applies specifically to laboratory workflows, while "Location of Procedure" has been used to refer to the healthcare service location or setting where the procedure occurred rather than the anatomical body site. A general-purpose Anatomic Localization element would provide a reusable and interoperable mechanism to represent body site consistently across multiple USCDI data classes. Note: "Anatomic Location" would be an alternate Data Element Name, but "Localization" may have less likelihood of confusion with other data elements like "Location of Procedure"
Use Case Description(s)
Use Case Description Anatomic Localization is needed to support standardized documentation, exchange, and interpretation of body site information across clinical workflows. In many scenarios, it is not sufficient to know that a procedure, order, test, finding, or event occurred. It is also necessary to know where on the patient’s body it occurred in a standardized, machine-readable way.

Examples include:

documenting the body site of a procedure or procedure note,
specifying the target of a diagnostic imaging order,
identifying the body site of a clinical finding or problem,
associating a laboratory specimen with its source site,
documenting the anatomical location relevant to an adverse event,
supporting referral orders and clinical notes where body site is clinically significant.

A canonical, standardized anatomic localization/location would improve routing, scheduling, documentation clarity, result interpretation, referral workflows, longitudinal tracking, quality measurement, and interoperability.

Additional Use Case Description: Anatomic Localization is particularly valuable where existing applicable vocabulary standards are broad, overlapping, or inconsistently granular. In these situations, standardized, unambiguous, and machine-readable body-site data can distinguish between otherwise similar procedures, findings, orders, and reports.

For example:

the same type of procedure may occur at very different body sites,
the same diagnosis may have different significance depending on body site and laterality,
imaging orders often require explicit anatomical targeting,
specimen interpretation benefits from knowing the source site.

A reusable Anatomic Localization element would support both coarse-grained and fine-grained anatomical specificity depending on clinical workflow and implementation feasibility.
Estimate the breadth of applicability of the use case(s) for this data element Anatomic Localization applies broadly across most care settings and specialties because body site is a fundamental clinical attribute relevant to procedures, orders, imaging, laboratory workflows, clinical findings, documentation, and patient safety. It is applicable in ambulatory care, hospital care, emergency care, surgical workflows, specialty care, imaging, pathology, and laboratory settings.
Link to use case project page https://edu.anatomymapper.com/case-studies
Use Case Description Anatomic Localization also has broader applicability beyond the primary documentation and exchange use cases. Standardized, unambiguous, and machine-readable body-site data would support quality measurement and registries, public health and surveillance, clinical decision support, referral management, imaging interoperability, patient-facing summaries and care coordination, and research and analytics. These use cases are relevant because many downstream activities depend not only on knowing that a finding, order, procedure, or event occurred, but also on knowing where on the patient’' body it applies.
Estimate the breadth of applicability of the use case(s) for this data element This data element would be relevant to a large national cross-section of healthcare stakeholders, including hospitals, ambulatory practices, health systems, imaging centers, laboratories, specialty practices, EHR developers, HIE participants, public health agencies, registries, payers, researchers, and patients accessing their data through certified health IT. Because Anatomic Localization applies across multiple USCDI data classes and workflows, the number of affected stakeholders would reasonably be in the tens of thousands of provider organizations and health IT entities, with downstream impact on millions of patients whose records include procedures, findings, orders, imaging, laboratory specimens, or other site-specific clinical data.
ONC Priority
  • Address public health interoperability needs of reporting, investigation, and emergency response
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) Anatomy Mapper terminology is a standardized terminology and codeable concept set for surface anatomy that is spatially linked to visual definitions. SNOMED CT is already an applicable vocabulary standard in USCDI, but (especially for surface anatomy) it includes overlapping or ambiguous concepts where multiple concepts describe the same anatomic region or body structure. Anatomy Mapper terminology provides a canonical spatial and semantic reference for surface anatomy while supporting interoperable use of codeable concepts.
https://anatomymapper.com/Terms/AMID
Additional Specifications N/A
Current Use (Level 1) Captured, stored, or accessed in at least one production EHR or HIT module
Extent of exchange (Level 0) Limited environments, such as connectathons or pilots
Supporting Artifacts Anatomy Mapper EDU version is already in clinical use where users in multiple EHR platforms label their health findings with the the standardized, visual labeling tools provided. A FHIR IG is proposed but not yet complete at time of writing.
https://edu.anatomymapper.com
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) Anatomy Mapper OpCo looks forward to working with ASTP/ONC and the USCDI process to help define a practical implementation floor and associated usage guidance for Anatomic Localization. Anatomy Mapper terminology is an external terminology. Its AMcode codeable concepts, hierarchical relationships, and visual definitions are proprietary in order to maintain a canonical spatial and semantic source of truth, together with consistent visual references for each term and composed description. This proprietary structure supports unambiguous anatomical representation, but it may limit full open redistribution of the complete terminology. Proprietary terminology should not preclude inclusion of a high-value reusable data element in USCDI, particularly where the data element itself can be standardized and the applicable vocabulary standard can be transparently identified and appropriately licensed. A practical approach would be to support a clearly defined implementation floor for interoperability, with broader or more detailed proprietary concepts available where licensing permits.
Restrictions on Use (e.g. licensing, user fees) Use of the data element itself should not be restricted. Anatomy Mapper terminology may be one Applicable Vocabulary Standard for this data element, initially for representation of surface and external anatomy. Anatomy Mapper’s EDU version provides free access to a visual label generator, along with a free license for clinical users to use generated outputs, including semantic descriptions and composed codeable concepts, in a patient's chart. Separate commercial licenses are required for vendors and other organizations seeking to use Anatomy Mapper in direct integrations, analytics, automated coding, AI workflows, visualization, summarization, targeting, or other scaled commercial uses.
Privacy and Security Concerns None beyond standard clinical data protections.
Estimate of Overall Burden Moderate burden overall. The burden to implement in direct clinical care is relatively low because body-site information is already routinely documented, and structured body-site capture is already used in production clinical workflows across multiple EHRs. The primary implementation work involves standardizing representation, mapping existing free-text or local site fields, and incorporating structured body-site capture into exchange workflows. Burden is higher for vendors and broader health IT environments that wish to fully integrate Anatomic Localization into EHRs, imaging systems, laboratory systems, interoperability APIs, analytics, or decision support. A baseline implementation floor would likely be feasible with modest effort.
Other Implementation Challenges Other implementation challenges include variability in how body-site information is currently documented across specialties and systems, including free text, local abbreviations, and workflow-specific fields. Existing standards and terminologies also vary in granularity, hierarchy, overlap, precision, and laterality support. Some workflows require only coarse anatomical representation, while others optimally require fine-grained specificity. There may also be ambiguity between anatomical body site and service or facility location in some implementations, particularly in procedural workflows. Clear implementation guidance would help distinguish these concepts and promote consistent adoption across settings.
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 0 - Data element is not represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 1 - Data element is captured, stored, or accessed in at least one production EHR or HIT module.
Criterion #3
Maturity - Current Exchange		 Level 0 - Data element is electronically exchanged in limited environments, such as connectathons or pilots.
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.

Comment

Submitted by molenda on

Comment on Anatomic Localization and FHIR

Regarding FHIR, the following clarification is offered:

In FHIR R4, anatomic localization may be represented using a bodySite element as a coded concept. When the anatomic location needs to be separately identified, described in greater detail, or tracked, FHIR R4 also supports the BodyStructure resource.

 

In the current FHIR R6 specification under development, the bodySite element is being deprecated in relevant contexts, such as Observation, in favor of BodyStructure, which can represent a coded anatomic concept or reference a BodyStructure resource.

 

The same content in FHIR R4 can be expressed through the updated modeling in FHIR R6. Accordingly, implementations should account for these differences when representing anatomic localization across FHIR versions.

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