Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.
Data Element
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Vital sign results: date and timestamps
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Submitted By: Joel Andress
/ Centers for Medicare and Medicaid Services (CMS) Center for Clinical Standards and Quality (CCSQ)
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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
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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
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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
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Maturity of Use and Technical Specifications for Data Element |
Applicable Standard(s) |
LOINC codes for vitals—date and timestamps collected in standard format
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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)
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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
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Extent of exchange
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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
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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 |
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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