Submitted by rclark@carequest.org on
CareQuest Comments on Referral Data Element for USCDI Version 5
CareQuest Institute for Oral Health recommends creating a separate data class for Referral with its own data elements including Reason for Referral. A referral can also be an intervention as part of a patient’s treatment plan to address a health problem or diagnosis. When a CCD document is generated and shared externally, a referral should display as part of the patient’s treatment plan or order to request additional care and is not always a procedure that was completed as part of the provision of care from that visit.
Health records are also sent to HIEs or are exchanged with other entities such as QHINS, QIOs to be made available to the patient’s care team when requested. It would be helpful to have additional information included about the referral to provide more context to the care team member reviewing the summary of care document. This will also better support coordination of care for both the Primary Care providers as well as other specialties such as Oral Health providers.
In most cases, this may be the only record to which a provider would have access. Therefore, data elements in the USCDI should also furnish the provider with enough information to administer the appropriate service that is needed, thereby closing the loop on the referral.
For broader sharing of electronic health information and to be inclusive of all specialties such as Oral Health, the USCDI is critical toward establishing the basic standards to support both patient care and care coordination for all providers in a community.
Submitted by portmi3 on
Commenter: Michael Porter, Mport Media Group, Inc. (Discharge Bridge — care-transition orchestration).
We support USCDI v7 Referral Order, Referral Note, and Reason for Referral for hospital → SNF / post-acute exchange. Please keep SNF / post-acute explicitly in examples and vocabulary guidance.
We support Medication Order and Medication Administration for transition medication safety, and recommend leveling Level 0 Discharge medications (and Medication List Type as applicable) so implementers can exchange a reconciled active list at handoff distinct from open orders vs administration.
We support Encounter Disposition, Appointment, Healthcare Agent, and Discharge Summary Note for operational handoff / decision-maker / disposition context, mapping to these existing elements before inventing new definitions.
(3) We recommend evaluating structured Prior Authorization Determination Status for inclusion or leveling (ONDEC or comment adjacent to Health Insurance Information / related coverage elements), because authorization fragmentation blocks timely acute→post-acute transitions and is relevant under CMS interoperability and prior-authorization directions that reference USCDI. Prefer placement under Health Insurance Information or Orders as ONC prefers — not a new data class.
(4) Prefer mapping operational handoff needs to existing USCDI elements — Encounter Disposition, Discharge Summary Note, Healthcare Agent, Facility Information — and leveling Level 0 Discharge medications — before inventing new definitions. ONDEC Post-acute Placement Disposition only if Encounter Disposition cannot close SNF acceptance/decline + destination + level of care + bed-ready timing.
This comment reflects an implementer perspective. It does not imply ONC endorsement and does not claim HIPAA or SOC 2 certification.