Data Element
Number Fetal Deaths This Delivery
Description

The number of fetal deaths in this delivery.
Submitted By: Craig Newman / Altarum
Data Element Information
Use Case Description(s)
Use Case Description The details of a delivery are crucial for providing the best possible post-natal care to the mother and infant. As well, after delivery, Public Health needs to capture this data as part of birth certification, fetal death reporting and birth defect reporting. In particular, birth certification forms the basis of the patient census required by a large number of other Public Health programs including newborn screening, birth defect reporting and immunization registries making it critical that birth certification is as automated, timely and accurate as possible.
Estimate the breadth of applicability of the use case(s) for this data element Consumption of this data is widespread. Every jurisdiction in the country captures birth certification information and immunization adminstration. Most also capture birth defects and fetal deaths. Healthcare systems which provide care for expectant mothers should be collecting this data.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) LOINC codes exist for each of the proposed data elements:
69461-2 - Mother's body weight --at delivery
68493-6 - Prenatal visits for this pregnancy #
69044-6 - Date first prenatal visit
57722-1 - Birth plurality of Pregnancy
73772-6 - Number of fetal deaths delivered
73773-4 - Number of infants in this delivery delivered alive

https://loinc.org/
Additional Specifications Vital Records Common Profiles Library FHIR IG - http://build.fhir.org/ig/HL7/fhir-vr-common-ig/branches/master/index.html
Birth Defect Reporting FHIR IG - https://build.fhir.org/ig/HL7/fhir-birthdefectsreporting-ig/index.html
Vital Records Birth and Fetal Death Reporting - https://build.fhir.org/ig/HL7/fhir-bfdr/index.html
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
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 No concerns over and above the typically privacy and security considerations associated with any health related data.
Estimate of Overall Burden These data elements are straightforward in nature and should not present a large burden to implement provided the EHR system is capturing the data as part of caring for the woman.

Comment

Submitted by nedragarrett_CDC on

CDC's Consolidated Comment for USCDI v5

Proposed change:

  • Please REMOVE the following from "Applicable Standard(s)" because they are not relevant to this data element: 69461-2 - Mother's body weight --at delivery68493-6 - Prenatal visits for this pregnancy #69044-6 - Date first prenatal visit57722-1 - Birth plurality of Pregnancy73773-4 - Number of infants in this delivery delivered alive.
  • Please KEEP the following in "Applicable Standard(s)": The LOINC code for the data element is:73772-6 - Number of fetal deaths delivered (https://loinc.org/)
  • Please UPDATE the URL for two "Additional Specifications" entries: Vital Records Common Profiles Library FHIR IG - http://hl7.org/fhir/us/vr-common-library/Vital Records Birth and Fetal Death Reporting - http://hl7.org/fhir/us/bfdr/.

NACCHO supports CDC's recommended change.

Submitted by maria.michaels… on

Support for this element is…

Support for this element is submitted on behalf of MedMorph project which includes relevant specifications and supporting artifacts. We propose a new Delivery and Pregnancy Information class where data elements like The Number of Fetal Deaths this Delivery may be captured.

Annually there are approximately 3.7 million births in the United States. It is important to note that 57 jurisdictions are required to report data elements like the Number of Fetal Deaths for to local and nationally reporting.  Consumption of these types of data are widespread and every jurisdiction in the country captures birth certification information. Accurate pregnancy information is important to improve outcomes and is a research and public health imperative.  Among other things this type of delivery and pregnancy Information provide key birth and fetal death statistics that identify public health trends on fertility rates, when prenatal care was initiated, and percent of newborns born preterm. Additionally, given the current pandemic real time birth and fetal death reporting for public health is paramount in assessing the medical care for both expectant mothers and newborns.

While the proposed data class ‘Observation’ can capture data elements such as the Number of Fetal Deaths for the specified delivery it is important to recognize that birth, fetal death and delivery events are information that may be captured within specific areas of a healthcare system such as labor and delivery summaries and prenatal care records. To help lessen the burden of implementations and queries of these events we propose a new Delivery and Pregnancy Information class where data elements like the Number of Fetal Deaths this Delivery may be appropriately captured.

Additional relevant specification for this data element includes HL7 and IHE standards listed below.

HL7 Version 2.6 Implementation Guide: Vital Records Birth and Fetal Death Reporting, Release 1 STU Release 2 - US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=320

IHE Quality, Research and Public Health Technical Framework Supplement – Birth and Fetal Death Reporting-Enhanced (BFDR-E) Revision 3.1: https://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf

The use of the Number of fetal death this delivery data element includes widespread use, required to be reported nationally and is routinely collected on EHR/HIT systems. Below lists examples of artifacts of where this data element is collected.

Facility worksheet information:
https://www.cdc.gov/nchs/data/dvs/facility-worksheet-2016-508.pdf
https://www.cdc.gov/nchs/data/dvs/fetal-death-mother-worksheet-english-2019-508.pdf

EPIC stork module (obstetrics) for birth reporting: https://www.epic.com/software#PatientEngagement

EPIC FHIR APIs for patient, vitals, obstetric details:
https://fhir.epic.com/Specifications?api=932
https://fhir.epic.com/Specifications?api=968
https://fhir.epic.com/Specifications?api=966

BFDR-E in ISA:
https://www.healthit.gov/isa/reporting-birth-and-fetal-death-public-health-agencies

IHE Connectathon integration profiles for BFDR-E (2013 - 2020)

HL7 FHIR Connectathon results (Sept 2020): birth and fetal death reporting results testing between electronic birth registration system vendors (FHIR)

NACCHO 360X Interoperability Demonstrations for Birth and Fetal Death reporting 2020 between NextGen and two state electronic birth registrations system vendors using FHIR.

HIMSS Interoperability showcase (2018 – 2019)

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