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 |
| 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. |
| Estimated number of stakeholders capturing, accessing using or exchanging
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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. |
| Estimated number of stakeholders capturing, accessing using or exchanging
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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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| Number of organizations/individuals with which this data element has been electronically exchanged
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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 Svellanky on 2022-09-29
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 standards:
- HL7 FHIR US Core Implementation Guide STU3-STU5 based on FHIR R4, Vital Signs profiles; must have a clinically relevant time (dateTime) structured in a standardized format (http://hl7.org/fhir/R4/vitalspanel.html; HL7.FHIR.US.CORE\US Core Vital Signs Profile - FHIR v4.0.1)
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.