Assessments of a health-related matter of interest, importance, or worry to a patient, patient’s authorized representative, or patient’s healthcare provider that could identify a need, problem, or condition.

Data Element
Patient Communication Status
Submitted By: Howard Capon / The PACIO Project
Data Element Information
Data Element Description The PACIO (Post-Acute Care Interoperability) Project, established February 2019, is a collaborative effort between industry, government, and other stakeholders, with the goal of establishing a framework for the development of FHIR implementation guides to facilitate health information exchange. The PACIO community strongly recommends creating an element specifically for patient communication status under the USCDI category of Health Status Assessments. The most current version of USCDI does not include any data elements addressing communication. Communication is the active process of exchanging information and ideas. Communication involves both understanding and expression. Forms of expression may include personalized movements, gestures, objects, vocalizations, verbalizations, signs, pictures, symbols, printed words, and output from augmentative and alternative (AAC) devices (2). When an individual communicates effectively, they are able to express needs, wants, feelings, and preferences that others can understand and can accurately receive messages from others. A person’s ability to comprehend and express information plays a critical role in medical decision making, sharing wishes with caregivers and practitioners, navigating the health care system, patient safety and satisfaction, decrease diagnostic errors, and shapes the journey and interactions when traveling between different health care institutions where one relies heavily on patient’s communication skills (4). The PACIO community encourages the ONC/USCDI to incorporate communication as a data element under the proposed USCDI V4 data class of Health Status Assessments. Assessment or screening the presence of communication deficits and need for special accommodations should be considered under this data element. Effective communication not only improves a patient’s quality of life and independence but improves health outcomes, reduces health care costs, and eases administrative burden. Communication can take many forms. Examples include but are not limited to the person’s ability to understand spoken or written language, person’s ability to express needs, wants and wishes through spoken or written language, person’s ability to produce intelligible speech, use of sign language, use of Augmentative and Alternative Communication (AAC), use of communication devices, or strategies to be used by the communication partner.
Use Case Description(s)
Use Case Description Information describing an individual’s functioning across multiple domains is crucial for successful care coordination at transitions of care and for ongoing shared care. These domains include (but are not limited to) mental functions, sensory functions, voice and speech functions, and activities and participation concepts involving communication, mobility, and selfcare. When an individual communicates effectively, they are able to express needs, wants, feelings, and preferences that others can understand and can accurately receive messages from others. A person’s ability to comprehend and express information plays a critical role in medical decision making, sharing wishes with caregivers and practitioners, navigating the health care system, patient safety and satisfaction, decrease diagnostic errors, and shapes the journey and interactions when traveling between different health care institutions. Care coordination – when a patient transitions between healthcare settings, including ambulatory care, acute care, long-term post-acute care (LTPAC), and home- and community-based services (HCBS) – is often fragmented and relies heavily on patient’s communication skills, which can lead to poor health outcomes, increased burden, and increased costs. Interoperable health information exchange has the potential to improve patient and provider communications and supports access to longitudinal health information that enables improved efficiencies, improved quality of care, and improved health outcomes. Communication information should be usable across the continuum of care, and beyond the traditional healthcare system – into the community.
Estimate the breadth of applicability of the use case(s) for this data element Every variety of patient communication status can be found in almost any healthcare setting. Routinely providing this information to clinicians will allow providers to share and anticipate strategies to effectively communicate with their patients.
Link to use case project page https://confluence.hl7.org/pages/viewpage.action?pageId=91991989
ONC Priority
  • Address the needs of underserved communities
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) LOINC and SNOMED_CT vocabularies
Additional Specifications http://build.fhir.org/ig/HL7/fhir-pacio-pfe/
Current Use (Level 0) Captured, stored, or accessed in limited settings such as a pilot or proof of concept demonstration
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 Standard PHI considerations, no special privacy or security concerns.
Estimate of Overall Burden The burden to implement Communication Status would be relatively small, since it is based off of the FHIR Observation resource that is likely already used in many systems. Screens would need to be developed to capture and display this information, but that is generally true for all new data elements. Vendor software updates would need to be purchased and installed, but this is also true for any other update or new data element.
Other Implementation Challenges There are no specific or special challenges anticipated beyond those found in similar development work.
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 0 - Data element is captured, stored, or accessed in limited settings such as a pilot or proof of concept demonstration.
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.
Evaluation Comment The development and testing of this data element is not sufficiently mature to warrant Level 2 at this time.

Comment

Submitted by jpatterson@mitre.org on

PACIO Recommends Advancing Patient Comm Status as Defined

  • Data Class: Health Status Assessments
  • Data Element: Patient Communication Status (Level 0)
  • Recommendation: Advance Patient Communication Status (Level 0) to USCDI V6. 
  • Rationale: The PACIO Project Community* recommends advancing Patient Communication Status (Level 0) to USCDI V6. Communication is the active process of exchanging information and ideas. Communication involves both information intake, such as processing and understanding. It also includes information output in various forms of expression, such those created using human anatomy -- body movements (e.g., gestures), vocalizations (e.g., verbalizations), hand signs (e.g., American Sign Language) -- and those using a medium – such as pictures, symbols, printed text, and output from augmentative and alternative communication (AAC) devices.
  • When an individual communicates effectively, they can accurately receive messages from others and are able to express needs, wants, feelings, and preferences that others can understand. A person’s ability to comprehend and express information plays a critical role in medical decision making, sharing wishes with caregivers and practitioners, navigating the health care system, patient safety and satisfaction, decreasing diagnostic errors, and shaping the journeys and interactions when transitioning between different health care institutions where one relies heavily on communication skills. 
  • USCDI does not currently capture whether the patient overall communicates effectively, with or without accommodations or other technology. This notion is essential to many factors in their care, such as planning for accommodation and the need for readying alternative communication measures ahead of their arrival. This is notionally different from the need for an interpreter or knowing a patient’s preferred language, which only captures languages that the patient can communicate with and are already captured in the US Core Patient profiles. We recommend that the Patient Communication Status data element be a Boolean “Yes” or “No” answer, noting that it is complimentary to and informed by other communication-related information already collected.
  • The FHIR IG titled PACIO Personal Functioning and Engagement includes a communication value set containing the type of communication described in the rationale section above.
  • * The PACIO (Post-Acute Care Interoperability) Project, established February 2019, is a collaborative effort between industry, government, and other stakeholders, with the goal of establishing a framework for the development of FHIR implementation guides to facilitate health information exchange.

Submitted by HCapon on

PACIO Recommends Changes to Patient Comm Status

  • Data Class: Currently Health Status Assessments (V5) 
  • Data Element: Patient Communication Status (currently Level 0) 
  • Recommendation: Advance Patient Communication Status to USCDI V6, rename “Patient Communication” and move to Patient Demographics / Information Data Class. 
  • Rationale: The PACIO (Post-Acute Care Interoperability) Project, established February 2019, is a collaborative effort between industry, government, and other stakeholders, with the goal of establishing a framework for the development of FHIR implementation guides to facilitate health information exchange. The PACIO community applauds the addition of Patient Communication Status to USCDI as a Level 0 data element in draft V5. 
  • Communication is the active process of exchanging information and ideas. Communication involves both understanding and expression. Forms of expression may include personalized movements, gestures, objects, vocalizations, verbalizations, signs, pictures, symbols, printed words, and output from augmentative and alternative (AAC) devices. When an individual communicates effectively, they are able to express needs, wants, feelings, and preferences that others can understand and can accurately receive messages from others. A person’s ability to comprehend and express information plays a critical role in medical decision making, sharing wishes with caregivers and practitioners, navigating the health care system, patient safety and satisfaction, decreasing diagnostic errors, and shaping the journeys and interactions when transitioning between different health care institutions where one relies heavily on communication skills. Many factors can impact comprehension, including hearing, cognitive and mental status, and functional status of body structures. This information is well represented under Health Status Assessments. 
  • What is not currently captured, is whether or not the patient overall communicates effectively, with or without accommodations or other technology. This notion is not clinical, but part of the patient’s identity and essential to many factors in their care including but not limited to planning for accommodation and the need for readying alternative communication measures ahead of their arrival. This is notionally different from the need for an interpreter or knowing a patient’s preferred language which are already captured in the US Core Patient profiles. We consider this information a Boolean “Yes” or “No” answer, and it is complimentary to information already collected. 

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