Information related to interactions between healthcare providers and a patient.

Data Element
Appointment
Description (*Please confirm or update this field for the new USCDI version*)

A planned healthcare event for a future date/time.

Usage note: Created, tracked and managed for planned participation. An appointment may be called a future encounter and may result in one or more Encounters.

Submitted By: Philip Lieberman / Analog Informatics Corporation
Data Element Information
Data Element Description A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s).
Use Case Description(s)
Use Case Description There are currently no FHIR Workflow Resources that are necessary to see patient appointments and the artifacts associated with the longtitudinal history of the patient. This deprives those using the patient record of understanding the history of the patient, actors involved in their care, and different service provider encounter history, as well as their adherance to commitments (no-shows, cancellations).

The FHIR workflow resources provide the ability schedule, reschedule, handle no-shows/cancellations, and provide a view of the history of the patient and their encounters. This information is currently not available in the USCDI data sets.
Estimate the breadth of applicability of the use case(s) for this data element Access to the full breadth of workflow resources (read/write) allow third parties to allow on-line scheduling/rescheduling. It provides the patient with the full list of their appointments and the list of those they have seen or will see. It can radically reduce no-shows by allowing patients to immediately reschedule appointments without making a phone call. We have implemented multilingual scheduling to address the needs of marginalized communities where the providers could not provide staff to serve them.

Access to workflow is one of the largest gaps in the USCDI standard and increases the costs to patients and providers forcing them to use phones where electronic scheduling is technically available, but only provided by high cost private APIs.
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 https://www.hl7.org/fhir/schedule.html
https://www.hl7.org/fhir/slot.html
https://www.hl7.org/fhir/appointment.html
https://www.hl7.org/fhir/appointmentresponse.html
Current Use (Level 1) Captured, stored, or accessed in at least one production EHR or HIT module
Extent of exchange (Level 2) Between more than two production EHRs or other HIT modules using available interoperability standards
Supporting Artifacts Workflow APIs are supported by most EHRs as part of their limited-access private high-cost tier. See Cerner, Epic and AthenaHealth partner programs.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None. Currently EHR companies are monitizing patient appointment and workflow access as well as blocking access to perceived competitors.
Privacy and Security Concerns None
Estimate of Overall Burden None
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 2 - Use cases apply to most care settings or specialties.

Comment

Submitted by csnewman on

Clarify the expectations for the appointment data element

It is unclear what the expectations are for supporting an Appointment data element in the Encounter data class. As described by the Usage Note for Appointment, a future appointment shares many characteristics with a previous encounter (time, location, type, etc). Does USCDI expect these sorts of attributes to be included when exchanging appointment data? Does the Appointment data element simply indicate in some way that the encounter is in the future? Are there unique attributes associated with an Appointment that aren't not associated with a past Encounter? Please clarify the expectations for supporting the concept of an appointment

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