Data Element
Apgar Score
Description

APGAR score post-birth including scores at 1, 5 and 10 minutes.
Submitted By: Craig Newman / Altarum
Data Element Information
Rationale for Separate Consideration This could be considered as a very specific vital sign measured only at birth.
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:
11884-4 - Gestational age Estimated
73766-8 - Place where birth occurred [US Standard Certificate of Live Birth]
64710-7 - Was your pregnancy a live birth, stillbirth, miscarriage, abortion, or ectopic pregnancy [PhenX]
8339-4 - Birth weight Measured
8305-5 - Body height --post partum
9272-6 - 1 minute Apgar Score
9274-2 - 5 minute Apgar Score
9271-8 - 10 minute Apgar Score

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
Supporting Artifacts This data is exchanged routinely as part of birth certification, fetal death reporting and birth defect reporting, however these workflow typically are executed on paper or via flat files rather than through electronic interoperability.
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 newborn.

Comment

Submitted by nedragarrett_CDC on

CDC's Consolidated Comment for USCDI v5

Proposed change:

  • Please update the Description to simply "Apgar score at delivery", to allow for reporting additional timing values.
  • Please REMOVE the following from "Applicable Standard(s)" because they are not relevant to this data element:1884-4 - Gestational age Estimated.73766-8 - Place where birth occurred [US Standard Certificate of Live Birth]64710-7 - Was your pregnancy a live birth, stillbirth, miscarriage, abortion, or ectopic pregnancy [PhenX] 8339-4 - Birth weight Measured.8305-5 - Body height --post-partum.
  • Please KEEP the following in "Applicable Standard(s)": The LOINC codes for the data element are:9272-6 - 1 minute Apgar Score9274-2 - 5-minute Apgar Score9271-8 - 10-minute Apgar Score.
  • Please ADD the following from http://snomed.info/sct in "Applicable Standard(s)":443848000 - Apgar score at 15 minutes (observable entity)443849008 - Apgar score at 20 minutes (observable entity).
  • 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/.
  • Justification: Through active collaboration with State Vital Records Offices and electronic birth registration system vendors the Vital Records community has been testing within EHR sandbox environments and conducting birth reporting data quality projects accessing these data in hospital environments. Specific to these active projects in FHIR, Epic hospitals are identifying Apgar scores with the codes identified.Apgar score examples are contained in US Core Observation Screening Assessment Profile (6.1.0) and US Core Observation Survey Profile (5.0.1)

NACCHO Supports CDC's Comment.

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 Apgar score 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 Apgar score local and nationally.  Consumption of these types of data are widespread and every jurisdiction in the country captures birth certification information. The Apgar score helps assess a newborn’s overall physical condition and can quickly determine whether a newborn needed immediate medical care.  Among other things this type of delivery and pregnancy Information provide key birth 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 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 Apgar score it is important to recognize that birth and delivery events is 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 Apgar score may be 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 Apgar score 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

There has been demonstrations and exchange of this data element with outside entities and stakeholders, below are examples of such exchanges:

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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