Vital Signs

MedMorph's request for Mother's Prepregnancy Weight

The MedMorph team requests that Mother's Prepregnancy Weight is published separately rather than being placed in Vital Sign - Body Weight as recommended by ONC. MedMorph requests that Mother's Prepregnancy Weight is an item that should be directly reported by the mother or patient (fetal death), and not directly taken from clinical documentation.  For example, data collection of prepregnancy weight may be collected manually from a mother or patient on paper format and then transferred into the electronic medical record or directly into an electronic birth registration system (EBRS).  Additionally, a mother or patient may use a public health record or a patient portal to input their information.  For data quality purposes it is important to recognize these data sources and why it is important to distinguish Mother's prepregnancy weight from body weight.   Mother's prepregnancy weight is captured within the Mother's and Patient's worksheet that populates information within the US standard certificate of live birth and fetal death. As commented in other delivery and pregnancy related items to help lessen the burden of implementations and queries of these events is the reason to propose a Delivery and Pregnancy Information class where data elements like Mother's prepregnancy weight may be captured. This will also provide information on recognizing how this data item should be captured within an electronic system. Use case project pages: MedMorph: https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html Birth Reporting: https://www.cdc.gov/nchs/nvss/births.htm Birth Defect Reporting: https://www.cdc.gov/ncbddd/birthdefects/index.html Existing LOINC code for this data elements: 56077-1 - Body weight --pre current pregnancy Relevant specification for this data element includes HL7 and IHE standards include: 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 Worksheet information: https://www.cdc.gov/nchs/data/dvs/birth11-03final-ACC.pdf https://www.cdc.gov/nchs/data/dvs/FDEATH11-03finalACC.pdf https://www.cdc.gov/nchs/data/dvs/fetal-death-mother-worksheet-english-2019-508.pdf

MedMorph's request for Mother's Delivery Weight

The MedMorph team requests that Mother's Delivery Weight is published separately rather than being placed in Vital Sign - Body Weight as recommended by ONC. Mother's weight at delivery is a specific encounter related to a pregnancy. It is captured within the labor and delivery nursing admission triage from under-physical assessment-weight or admission history and physical. The current Body Weight element captures a general weight. However, there are other unique classes captured within the Vital Signs data class, such as BMI Percentile (2-20 years), and Weight-for-length Percentile (Birth – 36 Months).  In recognizing this mix of general and specific capture of elements within the Vital Signs data class we propose either having a Mother's weight at delivery data element within Vital Signs or to help organize all delivery and pregnancy type information create a Delivery and Pregnancy Information as a new data class.  As commented on other birth reporting data elements submitted to USCDI, it is important to recognize that birth and delivery events information 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 is the reason to propose a new Delivery and Pregnancy Information class where data elements like Mother's weight at delivery may be captured. Further justification for Mother's weight at delivery to be added to USCDI: 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 such as Mother's weight at delivery locally and nationally.  Consumption of these types of data are widespread and every jurisdiction in the country captures birth certification information.  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 medical care for both expectant mothers and newborns. Use case project pages: MedMorph: https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html Birth Reporting: https://www.cdc.gov/nchs/nvss/births.htm, National Center for Health Statistics guide to completing facility worksheet for live birth and fetal death reporting: https://www.cdc.gov/nchs/data/dvs/GuidetoCompleteFacilityWks.pdf Birth Defect Reporting: https://www.cdc.gov/ncbddd/birthdefects/index.html Existing LOINC codes for this data elements: 69461-2 Mother's body weight --at delivery LOINC: https://loinc.org/ Relevant specification for this data element includes HL7 and IHE standards listed below. 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 FHIR IG:  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 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 Mother's weight at 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 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)

The MedMorph team requests…

The MedMorph team requests that Birth Weight is published separately rather than being placed in Vital Sign - Body Weight as recommended by ONC. We propose a new Delivery and Pregnancy Information class where data elements like Birth Weight score may be captured. Unlike almost all other weights the Birth Weight is a very specific encounter and should be measured in grams not lbs and oz. The current Body Weight element captures a general weight. However, there are other unique classes captured within the Vital Signs data class, such as BMI Percentile (2-20 years), and Weight-for-length Percentile (Birth – 36 Months).  In recognizing this mix of general and specific capture of elements within the Vital Signs data class we propose either having a Birth Weight data element within Vital Signs or to help organize all delivery and pregnancy type information create a Delivery and Pregnancy Information as a new data class.  As commented on other birth reporting data elements submitted to USCDI, it is important to recognize that birth and delivery events information 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 is the reason to propose a new Delivery and Pregnancy Information class where data elements like Birth Weight may be captured. Further justification for Birth Weight to be added to USCDI: 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 Birth Weight local and nationally.  Consumption of these types of data are widespread and every jurisdiction in the country captures birth certification information.  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 medical care for both expectant mothers and newborns. Use case project pages: MedMorph:https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html Birth Reporting: https://www.cdc.gov/nchs/nvss/births.htm Birth Defect Reporting: https://www.cdc.gov/ncbddd/birthdefects/index.html Existing LOINC codes for this data elements: 8339-4 - Birth weight Measured LOINC: https://loinc.org/ Relevant specification for this data element includes HL7 and IHE standards listed below. 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 FHIR IG:  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 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 Birth Weight 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)