| Submitted By: Kensaku Kawamoto, MD, PhD, MHS / University of Utah | |
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| Data Element Information | |
| Use Case Description(s) | |
| Use Case Description | A baby’s gestational age at birth has an important influence on their health risks and care needs. E.g., gestational age needs to be considered as a part of neonatal bilirubin management and avoidance of neurotoxicity. |
| Estimated number of stakeholders capturing, accessing using or exchanging | 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) | LOINC codes are available for gestational age https://search.loinc.org/searchLOINC/search.zul?query=gestational+age |
| 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 Epic. https://fhir.epic.com/Specifications?api=854, https://fhir.epic.com/Specifications?api=969 |
| Number of organizations/individuals with which this data element has been electronically exchanged | 1 |
| Supporting Artifacts |
We answered 1 entity here simply because we are unsure of the extent to which this data has been electronically exchanged with external organizations or individuals. In any case, 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. For example, this information is used over 20,000 times a year in just one institution for neonatal bilirubin management (see supporting link). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2755484 |
| 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 gestational age 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 when available, the effort is expected to be limited as the data element is already widely captured in structured form in EHRs today. For example, Epic already natively supports this data element in its FHIR API. |
Data Element |
Information from the submission form |
|---|---|
| Gestational Age at Birth |
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Submitted by maria.michaels… on 2020-11-23
MedMorph's support of Gestational Age at Birth
To support the adoption of 'Gestation Age at Birth' into USCDI it is important to note that 57 jurisdictions are required to report data elements such as 'Gestational Age at Birth' nationally for birth and fetal death reporting, and birth defects reporting. The National Center for Health Statistics guide to completing the facility worksheets for live birth and fetal death reports defines a newborn or fetus gestational age "As the obstetric estimate of the infant’s gestation in completed weeks based on the birth/delivery attendant’s final estimate of gestation." For further details on documentation of calculating gestational age for a newborn or fetus can be found under item '30. Obstetric estimate of gestation at delivery'. https://www.cdc.gov/nchs/data/dvs/GuidetoCompleteFacilityWks.pdf Accurate pregnancy dating is important to improve outcomes and is a research and public health imperative. The best estimated due date should be documented clearly in the medical records. Additionally, given the current pandemic real time birth reporting for public health is paramount in assessing the medical care for both mothers and newborns. Additionally, while the proposed data class ‘Observation’ can capture data elements such as Estimated Date of Delivery it is important to recognize that birth and delivery events are information that 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 we propose a new Delivery and Pregnancy Information class where data elements like Gestational Age at Birth may be captured. Additional relevant specification for this data element includes HL7 and IHE standards listed below. 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 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: https://build.fhir.org/ig/HL7/fhir-bfdr/index.html 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 LOINC codes exist for each of the proposed data element: 11884-4: Gestational age Estimated The use of the Gestation Age at Birth 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 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)