Wednesday, January 10, 2018

There can only be one, but it keeps getting bigger

A long while back I wrote a series (start at post 5 in this list) about what was the Common Meaningful Use Data set and became the Common Clinical Data Set under the ONC 2015 rule.  It seems that every administration has to name things differently from the past to differentiate itself, but that only seems to sow further confusion.  The new name for this is the US Core Data for Interoperability (USCDI), and was released as part of ONC's Trusted Exchange Framework.

New to the data set are Provenance and Clinical Notes.  I was thoroughly interested in seeing how ONC defined Provenance.  Here's what I found in the current document:

Yep, you got it.  Provenance is just "provenance" and everyone is expected to understand what that means.  Now, everything I ever needed to know about provenance I learned from this guy (or this one), but even I know you DON'T say this is a data element you want to exchange and NOT define it clearly.  I'm sure ONC will pick some standard for that, or perhaps even more than one.  Fortunately, this is only the dress rehearsal, so it will be fix prior to production (or if necessary, afterwards, though I'd like to see them avoid that).

In addition to these two items, there are (way too many) additional elements proposed for 2019 (without clear use cases, it's hard to address value).  Some of these are viable today, while others really should get moved around.  The short list (with definitions this time) includes:

  • Encounter
  • Discharge Instructions
  • Family Health History
  • Functional Status
  • Gender Identity
  • Pediatric Vital Signs
  • Pregnancy Status
  • Reason for Hospitalization
Then there's another set for 2020, and 2021, along with yet another set of "Emerging" things which didn't managed to get past someone's filters for the initial listing.

This is actually good stuff, all criticism aside.  We have to start somewhere, and this set is as good as any other as a starting point.

When I evaluate these, I will look at them from three perspectives:
Ease of implementation, utility, and stability.  Many of these (such as Family Health History) are already tracked and have been done so at some level of detail since the dawn of meaningful use.  Others, such as pediatric vital signs are really just a small extension to the existing set of LOINC codes, that it shouldn't wait long at all for implementation.  Others, such as "Insurance information" have no value to providers or patients in exchange unless provider workflow changes substantially.

I've heard providers tell me: We don't care about your insurance data, because we have to verify it at every visit any way, and we can't rely on what someone else tells us.  I completely believe them, because I still have to pull out my dang card even when the provider at the other end has already received a prior auth.  The real issue is that doctor's don't often worry much about the work that staff already takes out of their hands.  OK, so we set things up to send payer information, are providers actually going to use it?  With the time that would save me on each referral, over the course of the year, I think I could press the snooze button once or twice more than usual on one day of the year.  Now, I actually do value my sleep pretty much, but I think I'd trade that one out for something else.

Anyway, It's worth reading, and I won't go into details on each one yet.  Do read it yourself, and send your comments (or mine which I will be posting) to


P.S. I've extracted the data tables from @ONC_HealthIT's US Common Data for Interoperability (part of the Trusted Exchange Framework) into a Google Sheet here:


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