| Submitted By: Adam Bazer, MPD
/ Integrating the Healthcare Enterprise USA (IHE USA)
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| Data Element Information |
| Use Case Description(s) |
| Use Case Description |
Monitoring disease and making decisions about public health threats depends on accessible and accurate data. EHRs are a data source with potential to provide timely and relevant data beyond its use by health care providers. EHR data, if made more available for public health professionals and researchers, can lead to new innovations and more rapid disease detection.
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.
The public health use case(s) that support the adoption of these added elements are part of the Making EHR Data More Available for Research and Public Health (MedMorph) Reference Architecture. The goal of the MedMorph project is to develop and pilot a scalable and extensible standards-based reference architecture. This reference architecture will enable clinical data exchange with EHR systems and public health systems, specialized registries, national health care survey systems, and research information systems for multiple conditions. |
| Estimate the breadth of applicability of the use case(s) for this data element
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Every year there are approximately 3.7 million births in the United States. Consumption of this data is widespread. Every jurisdiction in the country captures birth certification information and immunization administration. Most also capture birth defects and fetal deaths. Healthcare systems which provide care for expectant mothers should be collecting this data. |
| Link to use case project page |
https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html https://www.cdc.gov/nchs/nvss/births.htm https://www.cdc.gov/ncbddd/birthdefects/index.html |
| Healthcare Aims |
- Improving patient experience of care (quality and/or satisfaction)
- Improving the health of populations
- Improving provider experience of care
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| Maturity of Use and Technical Specifications for Data Element |
| Applicable Standard(s) |
LOINC codes exist for each of the proposed data elements:
68493-6: Prenatal visits for this pregnancy #
69044-6: Date first prenatal visit
69461-2 Mother's body weight --at delivery
73772-6 The number of fetal deaths this delivery
73773-4 - Number of infants in this delivery delivered alive
57722-1 - Birth plurality of Pregnancy
https://loinc.org/68493-6/ https://loinc.org/69044-6/ https://loinc.org/69461-2/ https://loinc.org/73772-6/ https://loinc.org/73773-4/ https://loinc.org/57722-1/
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| Additional Specifications |
Vital Records Common Profiles Library FHIR IG: http://build.fhir.org/ig/HL7/fhir-vr-common-ig/branches/master/index.html
Vital Records Birth and Fetal Death Reporting: https://build.fhir.org/ig/HL7/fhir-bfdr/index.html
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
HL7 CDA® R2 Implementation Guide: Birth and Fetal Death Reporting, Release 1, STU Release 2 - US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=387
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
Birth Defect Reporting FHIR IG: https://build.fhir.org/ig/HL7/fhir-birthdefectsreporting-ig/index.html
HL7 CDA® R2 Implementation Guide: Ambulatory and Hospital Healthcare Provider Reporting to Birth Defect Registries Release 1 , STU 2 -US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=428 |
| Current Use |
In limited use in production environments |
| Supporting Artifacts |
Level 2 – at scale, or in more widespread production use (routinely collected already) on several different EHR/HIT systems.
This data is exchanged routinely as part of birth certification, fetal death reporting and birth defect reporting, however these workflows typically are executed on paper or via flat files rather than through electronic interoperability.
EPIC FHIR APIs for patient, vitals, obstetric details (DSTU2, DSTU3, R4)
In production use:
EPIC stork module (obstetrics) for birth reporting
https://www.cdc.gov/nchs/data/dvs/facility-worksheet-2016-508.pdf https://www.cdc.gov/nchs/data/dvs/fetal-death-facility-worksheet-2019-508.pdf https://www.epic.com/software#PatientEngagement https://fhir.epic.com/Specifications?api=932
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| Extent of exchange
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4 |
| Supporting Artifacts |
Level 2 – exchanged between 4 or more different EHR/HIT systems.
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)
ONC Interoperability Standards Advisory - Sending Birth and Fetal Death Information to Public Health Agencies
https://connectathon-results.ihe.net/view_result.php?rows=company&columns=actor&title=integration_profile https://confluence.hl7.org/display/FHIR/2020-09+Public+Health+Track HIMSS: https://www.interoperabilityshowcase.org/
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| 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.
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| Other Implementation Challenges |
When using FHIR there may be associated costs with development of tools needed to access specific data. Often these costs may be a limitation for states who need to develop tools to access certain data.
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Submitted by nedragarrett_CDC on
CDC's comment on behalf of NACCHO for USCDI v5
Support - Because multiple birth order is in the patient demographics class, this element should be as well. Without it, LHDs could still determine if the birth was part of a multiple (by presence of the "multiple birth order" element, but would not be able to determine how many total fetuses their were in the delivery. This is important information for understanding potential long-term health risks and the need for preventative programming.