Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.

Data Element

Vital sign results: date and timestamps


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

Vital signs need a date and time stamp

Clinicians and patients need to be able to trend vital signs over time.  Analytic and decision support tools, including those leveraging AI technology, need to understand the temporal relationship between vital sign entries in order to provide actionable insights. Essentially all HIT systems that support the documentation of vital signs, including those meant to be used by consumers/patients support the documentation of the date/time at which the measurement was made.  This information should be included in USCDI and exchanged between HIT systems in a standard manner when it is available.

Please Include Vital Signs Results

The addition of dates and timestamps 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 three blood pressures from different visits across three different months were all uploaded at once into an 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.

CMS-CCSQ Support for Date and Timestamps for USCDI v4

The date and timestamp metadata associated with vital signs already included in USCDI provide the critical context to making the vital sign information usable for patient care, care coordination, public health tracking, and quality measurement. Specifically, the clinically relevant date/time (i.e., FHIR US Core Vital Sign Profile effective[x]) is essential clinical information. We request ONC add date and timestamp data elements to USCDI, or further clarify which types of date/timestamps (i.e., administered, occurred, resulted, issued/entered) for which elements are required under the existing Provenance Author Time Stamp element.

Vital sign information must be usable (i.e., includes the appropriate metadata) to support critical use cases identified as ONC USCDI v4 priorities including addressing needs of historically vulnerable and/or underserved populations, mitigating health inequities, and addressing public health interoperability needs. By adding date and timestamp elements for vital signs, ONC can also ensure data elements necessary to calculate a clinical average (i.e., average blood pressure) are available for specific use cases, without adding any substantial burden on vendors or implementers, as this metadata should already be routinely captured. Additionally, CMS uses this information extensively in quality measurement to define appropriate measurement populations and numerator events to support improving patient care.

Maturity: This data element is classified as Level 2 by ONC and continues to have strong standardization and be in wide use.

Current uses, exchange, and use cases: This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders. Date and timestamps for vital signs are 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. Vital sign date/time metadata is electronically exchanged for quality measurement used across CMS programs.

date and timestamps

The CDC Division for Heart Disease and Stroke Prevention and the Million Hearts® 2022 Hearts national initiative (co-led by and the Centers for Medicare & Medicaid Services) uses this data as it is available for monitoring and evaluation to prevent 1 million heart attacks and strokes in 5 years. Furthermore, the CDC plans to leverage this data further in the future for surveillance and epidemiology studies if advanced through policy and available from EHRs. The Multi-state EHR-based Network for Disease Surveillance (MENDS) pilot will use electronic health record (EHR) data collected in clinical settings leading to a real-time, chronic disease surveillance model to plan and evaluate short-term outcomes of policies and program interventions.This field is for general comments on this specific data element. To submit new USCDI data classes and/or data elements, please use the USCDI ONDEC system:

USCDI_Version_2_Draft_Template for Comments_DHDSP_MENDS_04.15.2021_5.docx

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