Data used to categorize individuals for identification, records matching, and other purposes.

Data Element
Patient Birth Place
Description

The city, state, county and country or location in which the patient was born.
Submitted By: Adam Bazer, MPD / Integrating the Healthcare Enterprise USA (IHE USA)
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.

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.
Capturing birth order for multiple births is important for public health reporting and helps with identfying if a newborn or fetal death has potentially greater susceptibility to a unfavorable perinatal outcome. Being part of patient demographics ties directly to the patient and not the details of the delivery for either the mother or newborn.

Patient demographics such as patient birth place (City, Town, County Or Location Of Delivery), and patient country of birth are patient demographics utilized by multiple public health use cases to help assess characteristics within patient populations.

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. MedMorph has identified Cancer Reporting, Healthcare Surveys, Hepatitis C Reporting, electronic Initial Case Reporting (eICR), Multiple Chronic Conditions (MCC) eCare Plan, Message Mapping Guide (MMG) for COVID 19, PCORnet, Birth and Birth Defect Reporting use cases that support the adoption of these data elements. 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 All 50 states participate in one or more of the public health surveillance use cases that exchange this data element.

All hospitals and physicians who diagnose or treat cancer are required to provide cancer related information to state cancer registries. Vital records reporting such as birth, fetal death and death are also required to be reported by each state. Every year there are approximately 2.8 million deaths and 3.7 million births in the United States.

Approximately 420,000 physicians in the US are active and have at least some component of ambulatory practice and thus are annually eligible to sampling and recruitment into the National Ambulatory Medical Care Survey (NAMCS), which samples from between 3,500 to 20,000 of these physicians annually. Presently each sampled physician submits one weeks' worth of patient encounters to NAMCS. Approximately 600 hospitals are in the National Hospital Care Survey (NHCS). 1/3 of that number are either in, or actively being recruited into, the EHR data submission mode for NHCS. NHCS is already receiving electronic CDA documents. When they reach their target of 200 hospitals submitting by this mode annually they will be receiving >1.2 million documents and sets including multiple sets of medication data annually.

There were approximately 1,000,000 practicing physicians (as of 2020), approximately 120,000 certified physician assistants (as of 2019) and 290,000 licensed nurse practitioners (as of 2019). Most of these licensed clinicians interact with one of these public health use cases intermittently, annually. As of 2018 AHA reported 6,146 hospitals in the US experiencing 36,353,946 admissions. Almost all of those hospitals and at least half of the admissions interact with one or more of the public health use cases.

Additionally, public health reporting use cases are part of the of the Center for Medicare and Medicaid (CMS) Meaningful Use/Promoting Interoperability program adding on to the list of stakeholders under public health registries who capture electronic health information.
Link to use case project page https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html https://www.cdc.gov/cancer/npcr/ https://www.cdc.gov/hepatitis/hcv/index.htm https://www.cdc.gov/nchs/dhcs/nhcs_registry_landing.htm https://www.cdc.gov/ecr/index.html https://pcornet.org/
Use Case Description The MedMorph project is being developed with the goal of generalizability to support many more public health and research use cases. Therefore, other public health and research use cases that use the MedMorph architecture will also benefit from adoption of this data element.
Estimate the breadth of applicability of the use case(s) for this data element All 50 states participate in one or more of the public health surveillance use cases that exchange this data element.

All hospitals and physicians who diagnose or treat cancer are required to provide cancer related information to state cancer registries. Vital records reporting such as birth, fetal death and death are also required to be reported by each state. Every year there are approximately 2.8 million deaths and 3.7 million births in the United States.

Approximately 420,000 physicians in the US are active and have at least some component of ambulatory practice and thus are annually eligible to sampling and recruitment into the National Ambulatory Medical Care Survey (NAMCS), which samples from between 3,500 to 20,000 of these physicians annually. Presently each sampled physician submits one weeks' worth of patient encounters to NAMCS. Approximately 600 hospitals are in the National Hospital Care Survey (NHCS). 1/3 of that number are either in, or actively being recruited into, the EHR data submission mode for NHCS. NHCS is already receiving electronic CDA documents. When they reach their target of 200 hospitals submitting by this mode annually they will be receiving >1.2 million documents and sets including multiple sets of medication data annually.

There were approximately 1,000,000 practicing physicians (as of 2020), approximately 120,000 certified physician assistants (as of 2019) and 290,000 licensed nurse practitioners (as of 2019). Most of these licensed clinicians interact with one of these public health use cases intermittently, annually. As of 2018 AHA reported 6,146 hospitals in the US experiencing 36,353,946 admissions. Almost all of those hospitals and at least half of the admissions interact with one or more of the public health use cases.

Additionally, public health reporting use cases are part of the of the Center for Medicare and Medicaid (CMS) Meaningful Use/Promoting Interoperability program adding on to the list of stakeholders under public health registries who capture electronic health information.
Link to use case project page https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html https://www.cdc.gov/cancer/npcr/ https://www.cdc.gov/hepatitis/hcv/index.htm https://www.cdc.gov/nchs/dhcs/nhcs_registry_landing.htm https://www.cdc.gov/ecr/index.html https://pcornet.org/
Use Case Description This data element is also used in the Vital Records Common Profiles Library FHIR IG - http://hl7.org/fhir/us/vr-common-library/Vital Records Birth and the Fetal Death Reporting - http://hl7.org/fhir/us/bfdr/.

NACCHO supports this additional use case
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) FHIR patient extension: birthplace

FHIR patient address.period
http://hl7.org/fhir/R4/extension-patient-birthplace.html http://hl7.org/fhir/us/core/StructureDefinition-us-core-patient.html
Additional Specifications HL7 CDA ® Release 2 Implementation Guide: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1, DSTU Release 1.1 – US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=398. SHALL for the following elements: Patient Address Use Period, Patient Birth Place, Patient Medical Record Number, Patient Social Security Number.

HL7 CDA® R2 Implementation Guide: National Health Care Surveys (NHCS), R1 STU Release 3 - US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=385

HL7 CDA® R2 Implementation Guide: Consolidated CDA Templates for Clinical Notes - US Realm: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492. SHALL for the following elements: Patient Vital Status. SHOULD for the following elements: Patient Marital Status

HL7 FHIR® US Core Implementation Guide STU3 Release 3.1.1: https://www.hl7.org/fhir/us/core/index.html

HL7 FHIR US Core Patient: http://hl7.org/fhir/us/core/StructureDefinition-us-core-patient.html. MustSupport for the following elements: Patient Medical Record Number, Patient Medicare Number, Patient Social Security Number, Patient Address Use Period

HL7 FHIR® Implementation Guide: Electronic Case Reporting (eCR) - US Realm: http://hl7.org/fhir/us/ecr/STU1/Electronic_Initial_Case_Report_(eICR)_Transaction_and_Profiles.html

HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 2 - US Realm - the Electronic Initial Case Report (eICR): https://www.hl7.org/implement/standards/product_brief.cfm?product_id=436

IHE Quality, Research and Public Health Birth and Fetal Death Reporting-Enhanced (BFDR-E): https://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf

HL7 FHIR Common Data Models Harmonization FHIR Implementation Guide http://hl7.org/fhir/us/cdmh/2019May/
Current Use In limited use in production environments
Supporting Artifacts Level 1 – in limited production (a few) environments, 1 or 2 different EHR/HIT systems

eCase Reporting with The Council of State and Territorial Epidemiologists (CSTE) and The Association of Public Health Laboratories (APHL)

National Health Care Survey Registry - HL7 CDA® R2 Implementation Guide: National Health Care Surveys (NHCS), R1 STU Release 1.2 was never named in a final rule but rather became part of Promoting Interoperability through Certification Companion Guide (CCG) and Test Procedures Updates to the ISA in 2017.

EPIC stork module (obstetrics) for birth reporting.

IHE integration profiles for BFDR (CDA)

EPIC FHIR patient, vitals, obstetric details (DSTU2, DSTU3, R4)

Cerner FHIR patient resource (DSTU2, R4)

Evident FHIR patient resource (DSTU2)

Allscripts FHIR patient resource (DSTU2)

Promoting Interoperability Programs Eligible Hospitals and Critical Access Hospitals are required to, and Merit-based Incentive Payment System (MIPS) participants may optionally, report on any two measures under the Public Health and Clinical Data Exchange objective of these programs. The § 170.315(f)(5) – Transmission to public health agencies – electronic case reporting certification criteria in the 2015 Edition Final Rule and the ONC Cures Act Final Rule, the § 170.315(f)(7) – Transmission to public health agencies – health care surveys, and the § 170.315 (f)(4) – Transmission to Cancer Registries are three such options to meet these measures.

The current standard for § 170.315(f)(5), as listed in ONC’s 2020 Interoperability Standards Advisory Reference Edition, is HL7® CDA® R2 Implementation Guide: Public Health Case Report, Release 2: the Electronic Initial Case Report (eICR), Release 1, STU Release 1.1. ONC’s Certified Health IT Product List (CHPL) lists 73 EHR or HIT Module products certified to (f)(5) using this standard.

The current standard for § 170.315(f)(7), as listed in ONC’s 2020 Interoperability Standards Advisory Reference Edition, is HL7® CDA® R2 Implementation Guide: National Health Care Surveys (NHCS), R1 DSTU Release 1.2 - US Realm. ONC’s Certified Health IT Product List (CHPL) lists 116 EHR or HIT Module products certified to (f)(5) using this standard.

The current standard for § 170.315 (f)(4), as listed in ONC’s 2020 Interoperability Standards Advisory Reference Edition, is HL7 CDA® R2 IG: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, R1, DSTU Release 1.1 - US Realm. ONC’s Certified Health IT Product List (CHPL) lists 288 EHR or HIT Module products certified to (f)(4) using this standard.

These three widely adopted CDA standards have many of the Patient Demographic data elements contained on this form as Shall (required) or Should (best practice to include if available) conformance criteria, which demonstrates the maturity of these commonly exchanged data elements.
https://www.epic.com/software#PatientEngagement https://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_BFDR-E.pdf https://fhir.epic.com/Specifications?api=932, https://fhir.epic.com/Specifications?api=968, https://fhir.epic.com/Specifications?api
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 Level 2 – exchanged between 4 or more different EHR/HIT systems. More routinely exchanged between multiple different systems can justify adding to next draft version.

At least 38 state cancer registries have received cancer reports from at least one provider (per internal technical and programmatic documentation) that include these data elements: Patient Medical Record Number, Patient Social Security Number, Patient Marital Status, Patient Address Use Period.

HL7 CDA® R2 Implementation Guide: Public Health Case Report, Release 2 - US Realm - the Electronic Initial Case Report (eICR) is currently implemented in 5,400+ reporting sites nationally and exchanges the following Patient Demographic elements: Patient Identifiers, Patient Marital Status, Patient Gender Identity, Patient Pregnancy Status Observation.

IHE Connectathon integration profiles for BFDR (2013 - 2020) and Cancer reporting (2010 - 2020), death reporting (2019) - tested between electronic death registration vendors (EDRS) and NCHS.

HL7 FHIR Connectathon results (Sept 2020): MedMorph/eCR, birth and fetal death reporting, Integrating cancer reporting

NACCHO 360X Interoperability Demonstrations for Cancer, eCR, Birth and Fetal Death and Death reporting 2020 (CDA and FHIR)
https://www.hl7.org/implement/standards/product_brief.cfm?product_id=436 https://connectathon-results.ihe.net/view_result.php?rows=company&columns=actor&title=integration_profi https://connectathon-results.ihe.net/view_result.php?rows=company&columns=act
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns Concerns with the use of personally identifying information (PII). However, these data are intended to be a part of the medical record and will be protected as such using proper secure protocols.
Estimate of Overall Burden For those use cases not currently in production level or who have not tested with vendors may require additional development hours or resources.
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.

ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 1 - Data element is captured, stored, or accessed in at least one production EHR or HIT module.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 1 - Use cases apply to several care settings or specialties.
Evaluation Comment This data element is used in limited use cases relative to other Patient Demographics/Information data elements in USCDI.

Comment

Submitted by nedragarrett_CDC on

CDC's Consolidated Comment for USCDI v5

Proposed change:

  • Please ADD to the "Additional Specifications" entries:
  1. 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/.

NACCHO supports CDC"s recommended change.

Submitted by nedragarrett_CDC on

CDC's comment on behalf of CSTE

CSTE Comment:

  • Patient birthplace is a confusing term - here it seems to refer to location of birth (as in home vs hospital vs elsewhere?), but birth place can be taken to mean the actual location where the person was born.

Submitted by nedragarrett_CDC on

CDC's Consolidated Comment

Data elements of interest:

  1. Multiple Birth Order
  2. Patient Birthplace

Birth Reporting use case:

  • The Division of Vital Statistics (DVS) within CDC’s National Center for Health Statistics (NCHS) continues to supports inclusion of Multiple Birth Order and Patient Birthplace into USCDI.   These elements are part of the items collected within the provider supplied worksheets that hospitals complete. These data elements track demographic and health trends that includes pregnancy risk factors and preterm births. The inclusion of these elements in USCDI would have a significant impact on natality reporting by reducing the burden of duplicative data entry and streamlining the process flow.  The primary objective is to improve the timeliness, quality, and sustainability of vital statistics reporting.  The inclusion of these elements would not only support national level reporting but also benefit State partners who are the first line of receiving these data and clinical providers who are on the first line of sending these data. Inclusion of these elements would support interoperability among the vital statistics ecosystem.  DVS and State partners have been focusing working towards using the HL7 FHIR standards that adhere to the US Core resources within their implementation guides when possible.

Link to use case:

  • Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death (cdc.gov)

Additional technical specifications:

  1.  Provider worksheet for multiple births: https://www.cdc.gov/nchs/data/dvs/multiple-births-worksheet-2016.pdf
  2.  Provider worksheet for live birth: https://www.cdc.gov/nchs/data/dvs/moms-worksheet-2016-508.pdf

Applicable standards list:

  • HL7 FHIR Vital Records Birth and Fetal Death Reporting: HL7.FHIR.US.BFDR\Home Page - FHIR v4.0.1

CSTE Comment:

Patient Birth Place is important for understanding risk for many imported diseases such as tuberculosis, parasitic diseases, typhoid, previous dengue or malaria.

Submitted by nedragarrett_CDC on

Unified Comment from CDC

  • Additional Use Case: Information about a patient's place of birth, specifically country of birth, is collected as part of CDC's routine nationally notifiable disease surveillance for HIV, STDs, tuberculosis and viral hepatitis. This information is used for public health purposes to better understand a patient's lifetime risk of exposure to tuberculosis, and to help inform culturally appropriate interventions to ensure equitable access to care.
     
  • Estimate number of stakeholders who capture, access, use or exchange this data element: All US States and DC are funded through CDC’s Division of HIV Prevention, Division of TB Elimination, Division of STD Prevention, and Division of Viral Hepatitis flagship Notice of Funding Actions to perform surveillance activities, including collection of these data for surveillance purposes.
     
  • Healthcare Aims: Improving patient experience of care, Improving health of populations
     
  • Applicable standard: PHVS_BirthCountry_CDC, PHVS_BirthCountry_TB
     
  • Use of data element: Extensively used in production environments

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