Vital Signs

Vizient vital signs comments

BMI: Inclusion of BMI would allow for quicker querying of patients in FHIR via BMI rather than having to calculate BMI from the data elements Body height and Body weight. A potential benefit to patients is that addition of BMI would provide more health information, especially as certain patients may not do the calculations themselves (e.g., patients outside of the 2-20 years range for which BMI percentile is included currently). Vital Sign Results: date and timestamps: The addition of dates and time stamps 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 3 blood pressures from different visits across 3 different months were all uploaded at once into a 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.

Data Class: Vital Signs

Data Class: Vital Signs Level 2 Data Element: BMI Level 2 Data Element: Vital sign results: date and timestamps Level 2 Data Element: Average Blood Pressure Level 2 Data Element: Oxygen delivery device IMO supports the inclusion of the proposed Level 2 data elements for the Vital Signs data class in USCDI V3. The Level data elements included in the submission are incorporated in eCQMs reported in CMS quality programs, represented in implemented terminology specifications such as the, CDA R2 C-CDA Templates for Clinical Notes R2.1, and C-CDA Document Types for History and Physical and Care Plan, documented in structured data, and incorporated in interoperability requirements for ONC certified HIT.

Vital Signs: Average Blood Pressure

The Regenstrief Institute supports the addition of average/mean Blood pressure as a distinct and additional data element within the vital signs class of USCDI V3. Including average blood pressure to the USCDI is critically important in supporting health care providers with diagnosing high blood pressure and more effectively assessing blood pressure control.   The Regenstrief institute has been working with the American Medical Association to ensure that there is a broad set of LOINC content to express BP readings. Included in this set are LOINC concepts to encode the average systolic and average diastolic blood pressure over a defined time period or number of readings to more robustly represent a patient’s true blood pressure for clinical decision making. The specific panel that includes average diastolic and systolic can be found here: Average Blood Pressure Panel.

Vital Signs: Average Blood Pressure

The Regenstrief Institute supports the addition of average/mean Blood pressure as a distinct and additional data element within the vital signs class of USCDI V3. Including average blood pressure to the USCDI is critically important in supporting health care providers with diagnosing high blood pressure and more effectively assessing blood pressure control.   The Regenstrief institute has been working with the American Medical Association to ensure that there is a broad set of LOINC content to express BP readings. Included in this set are LOINC concepts to encode the average systolic and average diastolic blood pressure over a defined time period or number of readings to more robustly represent a patient’s true blood pressure for clinical decision making. The specific panel that includes average diastolic and systolic can be found here: Average Blood Pressure Panel.  

CDC Unified Comment: California Department of Public Health

The California Department of Public Health recommends adding the following data elements for the Patient Profile in exchange between EHRs:    

• Vital Signs: Expand to include social/mental assessment 
• Last reported blood pressure (both systolic and diastolic if possible) 

• Last PHQ-9 >10 consistent with moderate to severe depression 
• Last BMI >30 consistent with medical obesity 
• Pregnancy Status (if pregnant, estimated date of delivery) 
• CDPH recommends that providers screen patients for signs of loneliness as per the three-item loneliness scale in the journal article "Social Isolation and Loneliness: The New Geriatric Giants: Approach for Primary Care" at  Can Fam Physician. 2020 Mar;66(3):176-182. PMID: 32165464. 
• For patients older than 65 years of age: Last asked about cognitive impairment/Last memory assessment (e.g., Mini-Cog© S. Borson) administered. 

• Results of Adverse Childhood Experiences screening questions (i.e., number and type of ACEs) 
• Referrals made based on ACEs screening results/score 
• Resources provided based on ACEs screening results/score 
• Was patient referred to child welfare services as a result of the screening results/score 
• Number and type of Positive Childhood Experiences (PCEs) 

Pain

The CMS Data Element Library (DEL) Health IT Workgroup supports the importance of representing Pain as a multifaceted domain. We recommend that USCDI offer support for representing pain observations (both clinician observed and patient + care team member reported) using the common structure of Observations (e.g. Observation.code, Observation.value, Observation.performer). Such a structure, using codes from LOINC to identify the observations, offers a consistent pattern for representing the many dimensions of importance in different contexts (frequency, effect on function, intensity, interference with activities, etc). Pain observations across these dimensions are included the assessments used in post acute care settings.

NCPDP Comment

NCPDP recommends ONC to add NCPDP SCRIPT Standard Version2017071 as an acceptable standard.

Loinc code for Weight Percentile

This is regarding Weight for length percentile. Is it ok if we display weight for length percentile to only age 0-36 months then it reads value as WEIGHT %TILE OBS with LOINC  code 8336-0. LOINC – 77606-2 is the loin code for Weight for length Percentile. Is it required to display weight percentile or weight per length percentile as per USCDI. Also the Vital signs form is customized by the Customer. So if they have not chosen weight percentile is Vital signs form, then it will not appear in CCDA.

Optional variables to qualify

Would be better if it allowed some optional (not required) variables to qualify some of the measures. For weight, the clothing worn. For blood pressure and pulse, the body position (sitting, standing, reclining), cuff size. Oxygen may be delivered as %O2 or as liters per minute, so having both variables for both delivery methods would be better.