Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.

Data Element
Vital sign results: date and timestamps
Submitted By: Joel Andress / Centers for Medicare and Medicaid Services (CMS) Center for Clinical Standards and Quality (CCSQ)
Data Element Information
Rationale for Separate Consideration The current concept of vital signs, including results are included in USCDI v1. To add clinical context to those results, recommending requiring the associated date and timestamps for the required vital signs.
Use Case Description(s)
Use Case Description Vital sign tests with associated results and metadata are used extensively in CMS quality measures across programs including IQR, QPP, and Promoting Interoperability to define measurement populations and numerator events. The date and timestamps associated with vital sign tests are critical for defining which tests occur within the measurement period, and help associate tests to specific encounters or visits and are standard metadata for vitals.
Estimate the breadth of applicability of the use case(s) for this data element 4,000+ hospitals and 1 million providers currently capture, access and exchange vital sign results with associated metadata (date and timestamps)
eCQI resource center, includes measure specifications for CMS program eCQMs (i.e. CMS 349, CMS 529): https://ecqi.healthit.gov/ecqms
Link to use case project page https://ecqi.healthit.gov/ecqms
Use Case Description Date and timestamps for vital signs are also critical pieces of information exchanged with test results for clinical care and care decision support. A result itself is not useful unless the context of the timing of that result is also available.
Estimate the breadth of applicability of the use case(s) for this data element All healthcare providers and laboratories who are collecting vital signs are also collecting associated date and timestamps for when tests are taken.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) LOINC codes for vitals—date and timestamps collected in standard format
Additional Specifications Many technical specifications include vital sign specifications—all require an associated date and timestamp as part of the information:
Vital Sign Profiles, including a time the measurement was taken: http://hl7.org/fhir/R4/observation-vitalsigns.html
CMS Quality Data Model (QDM) version 5.5 Guidance, relevant authored and resulted date/times (https://ecqi.healthit.gov/sites/default/files/QDM-v5.5-Guidance-Update-May-2020-508.pdf)
HL7 C-CDA Release 2.0 (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492)
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Supporting Artifacts Date/time stamps associated with vital sign results are used at scale by hospitals, providers, and laboratories. Widely available within EHR systems:
https://fhir.cerner.com/millennium/r4/diagnostic/observation/ https://fhir.epic.com/Specifications?api=998
https://mydata.athenahealth.com/fhirapidoc

https://ecqi.healthit.gov/ecqms
Extent of exchange 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts Vital sign date/time metadata is electronically exchanged for quality measurement used across CMS programs via QRDA files and other architectures.
This metadata is also exchanged for virtually all instances a vital sign result is being exchanged, as it is important for clinical context and interpretation of results.
https://ecqi.healthit.gov/qrda
http://www.hl7.org/implement/standards/product_brief.cfm?product_id=7

https://ecqi.healthit.gov/qrda
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) No challenges anticipated
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns This data, like any patient data, should be exchanged securely. Current processes exist, governed by CMS and ONC, to securely transfer this data.
Estimate of Overall Burden No burden estimated—metadata already in use across the entire stakeholder community.
Other Implementation Challenges N/A

Comment

Submitted by erjones on

Please Include Vital Signs Results in USCDI v5

The addition of dates and timestamps would allow for trending of vital signs over time from various visits rather than relying on the date that the vital sign results were uploaded. This information could be especially helpful when initially adding patient data into FHIR databases. For example, if three blood pressures from different visits across three different months were all uploaded at once into an FHIR server, they would all show the same date that they were uploaded rather than having a reference date from when they were actually recorded.

Submitted by RUy on

Reaffirming support for Vital Signs Date and Timestamps

NACHC supports promoting 'Vital sign results: date and timestamps' from Level 2 to draft USCDI v5. Although vital signs measurements are crucial in assessing health risks, its interpretation requires details like time, readings, and protocols. In July 2023, ONC acknowledged this need for additional information on average blood pressure. The 'Vital sign results: date and timestamps' element can supply this information. Different measurement protocols also yield varying hypertension thresholds, emphasizing the need for accurate protocol knowledge in tandem with vital signs metadata. Various clinical scenarios need accurate time and date stamps in proper ISO 8601 format, such as consecutive days for home vital signs measurements, single dates for clinic readings, and specific timeframes for ambulatory measurements. NACHC urges ONC to include this element in draft USCDI v5 for better contextualizing average blood pressure.

See attached letter of support for more information.

2023-09-20 NACHC USCDIv5 Letter of Support_17.pdf

Submitted by Steven.Lane on

Vital signs need a date and time stamp

Clinicians and patients need to be able to trend vital signs over time.  Analytic and decision support tools, including those leveraging AI technology, need to understand the temporal relationship between vital sign entries in order to provide actionable insights. Essentially all HIT systems that support the documentation of vital signs, including those meant to be used by consumers/patients support the documentation of the date/time at which the measurement was made.  This information should be included in USCDI and exchanged between HIT systems in a standard manner when it is available.

Submitted by erjones on

Please Include Vital Signs Results

The addition of dates and timestamps would allow for trending of vital signs over time from various visits rather than relying on the date that the vital sign results were uploaded. This information could be especially helpful when initially adding patient data into FHIR databases. For example, if three blood pressures from different visits across three different months were all uploaded at once into an FHIR server, they would all show the same date that they were uploaded rather than having a reference date from when they were actually recorded.

Submitted by Svellanky on

CMS-CCSQ Support for Date and Timestamps for USCDI v4

The date and timestamp metadata associated with vital signs already included in USCDI provide the critical context to making the vital sign information usable for patient care, care coordination, public health tracking, and quality measurement. Specifically, the clinically relevant date/time (i.e., FHIR US Core Vital Sign Profile effective[x]) is essential clinical information. We request ONC add date and timestamp data elements to USCDI, or further clarify which types of date/timestamps (i.e., administered, occurred, resulted, issued/entered) for which elements are required under the existing Provenance Author Time Stamp element.

Vital sign information must be usable (i.e., includes the appropriate metadata) to support critical use cases identified as ONC USCDI v4 priorities including addressing needs of historically vulnerable and/or underserved populations, mitigating health inequities, and addressing public health interoperability needs. By adding date and timestamp elements for vital signs, ONC can also ensure data elements necessary to calculate a clinical average (i.e., average blood pressure) are available for specific use cases, without adding any substantial burden on vendors or implementers, as this metadata should already be routinely captured. Additionally, CMS uses this information extensively in quality measurement to define appropriate measurement populations and numerator events to support improving patient care.

Maturity: This data element is classified as Level 2 by ONC and continues to have strong standardization and be in wide use.

Current uses, exchange, and use cases: This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders. Date and timestamps for vital signs are critical pieces of information exchanged with test results for clinical care and care decision support. A result itself is not useful unless the context of the timing of that result is also available. Vital sign date/time metadata is electronically exchanged for quality measurement used across CMS programs.

Submitted by nedragarrett_CDC on

date and timestamps

The CDC Division for Heart Disease and Stroke Prevention and the Million Hearts® 2022 Hearts national initiative (co-led by and the Centers for Medicare & Medicaid Services) uses this data as it is available for monitoring and evaluation to prevent 1 million heart attacks and strokes in 5 years. Furthermore, the CDC plans to leverage this data further in the future for surveillance and epidemiology studies if advanced through policy and available from EHRs. The Multi-state EHR-based Network for Disease Surveillance (MENDS) pilot will use electronic health record (EHR) data collected in clinical settings leading to a real-time, chronic disease surveillance model to plan and evaluate short-term outcomes of policies and program interventions.This field is for general comments on this specific data element. To submit new USCDI data classes and/or data elements, please use the USCDI ONDEC system: https://healthit.gov/ONDEC

USCDI_Version_2_Draft_Template for Comments_DHDSP_MENDS_04.15.2021_5.docx

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