Submitted by LisaRNelson on 2023-07-18
| Submitted By: Kensaku Kawamoto, MD, PhD, MHS / University of Utah | |
|---|---|
| Data Element Information | |
| Rationale for Separate Consideration | Birth date is part of the USCDI. Birth time is also important for newborns, e.g., for neonatal bilirubin management and avoidance of neurotoxicity. Both the capture and exchange of this data element are important for neonatal care within and between systems and organizations, and the data element may support business processes related to identity management and patient matching/record linkage. |
| Use Case Description(s) | |
| Use Case Description | To support higher quality care for newborns, where the number of hours and minutes elapsed since birth can be important, e.g., for neonatal bilirubin management and avoidance of neurotoxicity. Both the capture and exchange of this data element are important for neonatal care within and between systems and organizations, and the data element may support business processes related to identity management and patient matching/record linkage. |
| Estimate the breadth of applicability of the use case(s) for this data element | This data element would affect all newborns, or approximately 4 million babies a year. |
| Link to use case project page | https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2755484 |
| Healthcare Aims |
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| Maturity of Use and Technical Specifications for Data Element | |
| Applicable Standard(s) | FHIR birthTime extension https://www.hl7.org/fhir/extension-patient-birthtime.html |
| Additional Specifications | N/A |
| Current Use | Extensively used in production environments |
| Supporting Artifacts |
This data element is already supported in the FHIR interface of major EHR systems such as Cerner. https://fhir.cerner.com/millennium/dstu2/individuals/patient/#extensions, https://fhir.cerner.com/millennium/r4/individuals/patient/#extensions |
| 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 |
This data element can be exchange across institutions, but a primary use case is expected to be use within an institution by standards-based tools such as SMART on FHIR apps and CDS Hooks services. Most neonates continue to be cared for where they are born, and once it has been several days, the time of birth generally provides little additional value clinically compared to the birth date. Some newborns must be transferred from labor & delivery to the NICU, pediatrics, or referred to a specialist soon after birth; the exchange of this data element would be valuable. |
| Potential Challenges | |
| Restrictions on Standardization (e.g. proprietary code) | No relevant restrictions are anticipated. |
| Restrictions on Use (e.g. licensing, user fees) | No relevant restrictions are anticipated. |
| Privacy and Security Concerns | No relevant concerns are anticipated. |
| Estimate of Overall Burden | Because birth time is already routinely captured in structured form in many EHRs, and it would be fine for this information to only be made available if already captured in structured form, there should be minimal burden compared to the current state with regard to 1) supporting the data elements in the EHR and 2) users collecting the information. With regard to adding this information to the current Patient Demographics information when available, the overall burden is expected to be limited as the data element is already widely captured in structured form in EHRs today. For example, it took our group only a few days to implement support for this data element within the Epic FHIR API. |
| Other Implementation Challenges | No other challenges to implementation are anticipated. |
Submitted by nedragarrett_CDC on 2023-09-15
CDC's Consolidated Comment for USCDI v5
Proposed change: Please ADD to the "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/.