Pregnancy Information

This is fundamental clinical information used by all OBGYNs

LMP information is one of the first and fundamental information that OBGYN physicians ask. This is taught in the early years of medical school, and drives care for all women in various stages of their lives.  This element is used to estimate delivery date. Please merge this with https://www.healthit.gov/isa/taxonomy/term/4666/level-2.   LOINC and SNOMED-CT codes are unspecified. Recommend the following:   LOINC 8665-2 | Date last menstrual period Patient Date Pt Qn 33066-2 | Last menstrual period Patient Date Pt Qn Estimated from EDD 11955-2 | Last menstrual period Patient TmStp Pt Qn Reported 3145-0 | Menstrual period start.last Patient TmStp Pt Qn Stated 75203-0 | Mother's Last menstrual period start date before delivery 53661-5 | Reliability of last menstrual period observation Patient Find Pt Nom SNOMED-CT 21840007 | Date of last menstrual period 161713000 | Last menstrual period -1st day

CDC's Consolidated Comment

• Viral hepatitis: Due date is collected as part of routine case surveillance for acute Hepatitis A, B, C, and chronic hepatitis B and C. At the jurisdictional level, completion of pregnancy due date can rely on both estimated data of delivery and/or last menstrual period therefore both data elements are needed to ensure data accuracy" Promote this data element as it is integral to understanding maternal and child health in relation to exposure to disease conditions
• STD - congenital syphilis: very important to know how far along in the pregnancy the female is and is essential to calculate estimated gestational age 

Support for this element is…

Support for this element is submitted on behalf of MedMorph project which includes relevant specifications and supporting artifacts. We propose a new Delivery and Pregnancy Information class where data elements like Last Menstrual Period may be captured. Annually there are approximately 3.7 million births in the United States. It is important to note that 57 jurisdictions are required to report data elements such as Last Menstrual Period for local and national level reporting.  This item is used to compute the gestational age of the infant.  Consumption of these types of data are widespread and every jurisdiction in the country captures birth and pregnancy information. Accurate pregnancy information is important to improve outcomes and is a research and public health imperative.  Among other things this type of pregnancy Information provide key birth and pregnancy related statistics that identify public health trends on fertility rates, when prenatal care was initiated, and percent of newborns born preterm. Additionally, given the current pandemic real time birth and pregnancy related information for public health reporting is paramount in assessing the medical care for both expectant mothers and newborns. While the proposed data class ‘Observation’ can capture data elements such as Last Menstrual Period for the specified delivery it is important to recognize that birth, pregnancy 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 Last Menstrual Period may be appropriately captured. Use case project pages: MedMorph:https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html Birth Reporting: https://www.cdc.gov/nchs/nvss/births.htm Birth Defect Reporting: https://www.cdc.gov/ncbddd/birthdefects/index.html Existing LOINC codes for this data elements: Last menstrual period start date: 8665-2 https://loinc.org/8665-2/ Relevant specification for this data element includes HL7 and IHE standards listed below. 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 FHIR IG:  https://build.fhir.org/ig/HL7/fhir-bfdr/index.html 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 The use of the Last Menstrual Period element includes widespread use, required to be reported nationally and is routinely collected on EHR/HIT systems. Below list 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 There has been demonstrations and exchange of this data element with outside entities and stakeholders, below are examples of such exchanges: 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)