CUBS Required for Disability Status?

[Michelle Knighton]

The CCDA Companion Guide seems to indicate that CUBS is required for Disability Status: https://hl7.org/ccdasearch/templates/2.16.840.1.113883.10.20.22.4.505.html

However, CUBS is focused on behavioral health disabilities, while the USCDIv3 data element for Disability Status is much broader, encompassing all types of disabilities: https://www.healthit.gov/isp/taxonomy/term/3276/uscdi-v3

There appears to be misalignment between the broadness in scope of the USCDIv3 data element and the CCDA specification for Disability Status. Can you clarify whether CUBS is truly a SHALL requirement for certification purposes?

Unfortunately, the system will not allow me to upload attachments or images, so I am unable to share with you the screenshots from the above items. However, I did provide hyperlinks so that you can review the information to which I am referring.

[NGO Solutions]

Edge Tool,

Can we get some clarifications on this question? Why is the CCDA Companion Guide A forcing the  Comprehensive Universal Behavior Health Screen (CUBS) for disability status. 

Healthcare providers would want to document and share Disability status information without being required to document a CUBS questionnaire.  USCDI defines Disability Status at a large context then just Behavior Health.

The assumption is the USCDIv3 category is better defined as  Behavior Health Disability Status. I also want to note that USCDIv5+ further defines Disability Status under a broader term

https://www.healthit.gov/isp/taxonomy/term/3276/uscdi-v5

Disability Status

Assessment of a patient’s physical, cognitive, or psychiatric disabilities.

Examples include but are not limited to American Community Survey, Veterans RAND Health Survey, and Patient-Reported Outcomes Measurement Information System (PROMIS).

Applicable Vocabulary Standard(s)

• Logical Observation Identifiers Names and Codes (LOINC®) version 2.77

The companion guide references general assessments similar to what USCDI references per Michelle's question above.

6.2.8 Health Status/Assessments

Disability Status

Assessments of a patient’s physical, cognitive, intellectual, or psychiatric disabilities. (e.g., vision, hearing, memory, activities of daily living)
• Logical Observation Identifiers Names and Codes (LOINC®) version 2.72
Disability Status Observation
observation/code
observation/effectiveTime
observation/value

The CCDA companion guide goes on to state "a specific concern about a patient" and "not limited to these 8 concepts, and adds the ability to include an Assessment Scale Observation/Assessment Scale Supporting"

6.2.8.2 Disability Status
A clinician can use the new Disability Status Observation to assert a specific concern about a patient. A prior HL7 standard, the electronic initial case report (eICR), created a Disability Status Observation template constrained to 8 concepts (see VSAC (log-in required): Disability Status). The eICR project is restricted to report "minimum necessary” data needed for public health case reporting. The new Disability Status Observation is not limited to these 8 concepts, and adds the ability to include an Assessment Scale Observation/Assessment Scale Supporting Observation.

However, when we review the new Disability Status Observation in the Companion Guide Appendix A

3.10 Disability Status Observation
[observation: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.4.505:2023-05-01 (open)]

It has SHALL statements for CUBS

4. SHALL contain exactly one [1..1] code (CONF:4537-32624).

a. This code SHALL contain exactly one [1..1] @code="89571-4" Disability Status [CUBS] (CONF:4537-33023).

7. SHALL contain exactly one [1..1] value, which MAY be selected from ValueSet CUBS_Disability urn:oid:1.3.6.1.4.1.12009.10.1.3932 DYNAMIC (CONF:4537-32628).

Table 46: CUBS_Disability
Value Set: CUBS_Disability urn:oid:1.3.6.1.4.1.12009.10.1.3932
This set of values is the LOINC Answer List for the LOINC Code "Comprehensive Universal Behavior Health Screen (CUBS)© "89571-4 Disability status [CUBS]
Value Set Source: https://loinc.org/LL5052-7/
Code
Code System
Code System OID
Print Name
LA29240-1
LOINC
urn:oid:2.16.840.1.113883.6.1
I'm Thriving - no identified disability
LA29241-9
LOINC
urn:oid:2.16.840.1.113883.6.1
I'm Building Capacity - I have an asymptomatic condition controlled by services or medication
LA29242-7
LOINC
urn:oid:2.16.840.1.113883.6.1
I'm Safe - I rarely have acute or chronic symptoms affecting housing, employment, social interactions, etc
LA29243-5
LOINC
urn:oid:2.16.840.1.113883.6.1
I'm Vulnerable - I sometimes or periodically have acute or chronic symptoms affecting housing, employment, social interactions, etc.
LA29244-3
LOINC
urn:oid:2.16.840.1.113883.6.1
I'm in Crisis - acute or chronic symptoms affecting housing, employment, social interactions, etc.

[Michelle Knighton]

ETT team, do you know when we could expect a response to this?

Thanks,

Michelle

[Kim Poletti]

Hello Michelle,

From Brett on our team, the binding in the Disability Status Observation is a MAY - which mean it's optional. You are allowed to use other concepts.

Please let us know if you have further questions.

Thank you,

Kim