Data Element
Exposure/Contact Direction
Description
Whether the direction of exposure/contact is acquisition (patient is the target and another person, animal, location, etc. is the source) or transmission (patient is the source and another person, animal, location, etc. is the target).
Submitted By: Laura Conn
Data Element Information
Data Element Description Whether the direction of exposure/contact is acquisition (patient is the target and another person, animal, location, etc. is the source) or transmission (patient is the source and another person, animal, location, etc. is the target).
Use Case Description(s)
Use Case Description This data element in used in electronic case reporting (eCR) which provides case reports to state, tribal, local, or territorial (STLT) public health agencies (PHA) for up to 292 reportable diseases and conditions. Submission of reports of persons with these conditions is required by law in every US State and Territory. Public health epidemiologists have identified the data elements necessary to be included in electronic case reports from healthcare organizations and providers. The transition is underway from providing these reports via fax, mail, email, or phone to using data available in the electronic health records to submit reports electronically to all PHAs. As of September 13, 2020, over 9,300 healthcare facilities are using eCR to submit these data. Once received at the PHA, this data is use for surveillance, case management and public health response efforts such as contact tracing or other mitigation efforts.
Estimate the breadth of applicability of the use case(s) for this data element Level 2 – elements pertain to most or all patients, providers or requestors
Link to use case project page https://www.cdc.gov/ecr/index.html
Use Case Description This data element is critical meta data for testing laboratories where exposure information may direct the type of testing performed within a laboratory. Some diseases require immediate testing and reporting due to the time sensitive nature of the pathogen and knowing the possible agent of concern can help with selection and prioritization of testing in the lab.
Estimate the breadth of applicability of the use case(s) for this data element Level 2 – elements pertain to most or all patients, providers or requestors
Link to use case project page https://www.hl7.org/implement/standards/product_brief.cfm?product_id=519 https://www.hl7.org/implement/standards/product_brief.cfm?product_id=436
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) based on FHIR R4 HL7 CDA® R2 Implementation Guide: Public Health Case Report - the Electronic Initial Case Report (eICR) HL7 FHIR: US Public Health Exposure Contact Information profile (Observation.component) HL7 CDA: Exposure/Contact Information Observation template (observation/participant)
https://www.hl7.org/implement/standards/product_brief.cfm?product_id=519 https://www.hl7.org/implement/standards/product_brief.cfm?product_id=436
Additional Specifications HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) based on FHIR R4 HL7 CDA® R2 Implementation Guide: Public Health Case Report - the Electronic Initial Case Report (eICR) HL7 FHIR: US Public Health Exposure Contact Information profile HL7 CDA: Exposure/Contact Information Observation template
Current Use Extensively used in production environments
Supporting Artifacts Soon to be published: HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) STU Release 2 Soon to be published: HL7 CDA® R2 Implementation Guide: Public Health Case Report - the Electronic Initial Case Report (eICR) Release 1, STU Release 3.0
https://www.hl7.org/implement/standards/product_brief.cfm?product_id=519 https://www.hl7.org/implement/standards/product_brief.cfm?product_id=436
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 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 None
Estimate of Overall Burden These data elements are straightforward in nature and should not present a large burden to implement provided the EHR system is capturing the data
Other Implementation Challenges None
ASTP 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 1 - Use cases apply to several care settings or specialties.
Evaluation Comment The use case for this data element is primarily limited to public health investigation.

Comment

Submitted by minigrrl on

What is the justification…

What is the justification for the demotion of the following Case Reporting data elements in USCDI, specifically:

• Exposure/Contact Information: Exposure/Contact Agent
• Exposure/Contact Information: Exposure/Contact Date
• Exposure/Contact Information: Exposure/Contact Direction
• Exposure/Contact Information: Exposure/Contact Source/Target Participant
• Exposure/Contact Information: Exposure/Contact Type
• Health Insurance Information: Medicare Patient Identifier
• Immunizations: Vaccination Administration Date
• Laboratory: Specimen Collection Date/Time
• Patient Demographics/Information: Patient Birth Place
• Patient Demographics/Information: Tribal Enrollment
• Pregnancy Information: Estimated Date of Delivery
• Pregnancy Information: Gestational Age
• Pregnancy Information: Last Menstrual Period (LMP)
• Provenance: Unique Identifier
• Social Determinants of Health: Housing Instability and Homelessness
• Social History: Congregate Living
• Work Information: Employment Status
• Work Information: Job Employer Address
• Work Information: Job Employer Name
• Work Information: Usual Industry
• Work Information: Usual Occupation

Currently, 21 certified EHR products exchange these elements using electronic Case Reporting (eCR) specifications demonstrating real-world adoption that typically supports promotion, not demotion, within the USCDI maturity model.

Collectively, these elements provide clinical, demographic, occupational, social, and epidemiological context essential to disease investigation and outbreak response for nationally notifiable conditions.

We urge ONC to either reverse this decision or publish a detailed, evidence-based rationale.

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