This issue is a result of discussion in the QDM User Group regarding QDM-68 and the potential use of HL7's episodeLink relationship.

There are several measures that establish links between ED visits and their subsequent Inpatient Encounters, but they can only establish the link using timing relations. This can be imprecise and may result in false negatives or false positives. It would be very helpful to have a more deterministic linking between the two (where the link actual exists as discrete data in the EHR).

There are some challenges here: How can this link be established with little (or no) burden to clinicians? How should this be supported in systems that currently treat the ED visit and inpatient care as a single encounter? How does this work for the many institutions that may utilize different EHR systems for the ED and inpatient settings?

We should talk to provider groups (e.g., CMMI Pioneer ACOs) and vendor groups to determine if/how they link these things, and what their perceived value is (particularly for providers). We should also talk with the CQI workgroup and HL7 to determine if episodeLink is the proper relationship type to express this link. Ultimately, we need to determine the need for this relationship (and other similar relationships), the feasibility and impact of implementation, and whether the cost is worth the value.

While linking ED visits to Inpatient Encounters was the primary use case discussed, there are other types of links that may also be of interest (e.g., linking re-admission to the previous encounter).