Data Element
Estimated Date of Delivery
Description

The expected date of delivery (i.e. the due date).
Submitted By: Craig Newman / Altarum
Data Element Information
Use Case Description(s)
Use Case Description An expectant mother’s pregnancy attributes are crucial for providing the best possible pre-natal care. As well, after delivery, Public Health needs to capture this data as part of birth certification, fetal death reporting and birth defect reporting. In particular, birth certification forms the basis of the patient census required by a large number of other Public Health programs including newborn screening, birth defect reporting and immunization registries making it critical that birth certification is as automated, timely and accurate as possible.
Estimate the breadth of applicability of the use case(s) for this data element Consumption of this data is widespread. Every jurisdiction in the country captures birth certification information and immunization adminstration. Most also capture birth defects and fetal deaths. Healthcare systems which provide care for expectant mothers should be collecting this data.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) LOINC codes exist for each of the proposed data elements:
8665-2 - Last menstrual period start date
11778-8 - Delivery date Estimated
56077-1 - Body weight --pre current pregnancy

https://loinc.org/
Additional Specifications Vital Records Common Profiles Library FHIR IG - http://build.fhir.org/ig/HL7/fhir-vr-common-ig/branches/master/index.html
Birth Defect Reporting FHIR IG - https://build.fhir.org/ig/HL7/fhir-birthdefectsreporting-ig/index.html
Vital Records Birth and Fetal Death Reporting - https://build.fhir.org/ig/HL7/fhir-bfdr/index.html
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Supporting Artifacts This data is exchanged routinely as part of birth certification, fetal death reporting and birth defect reporting, however these workflow typically are executed on paper or via flat files rather than through electronic interoperability.
Extent of exchange N/A
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns No concerns over and above the typically privacy and security considerations associated with any health related data.
Estimate of Overall Burden These data elements are straightforward in nature and should not present a large burden to implement provided the EHR system is capturing the data as part of caring for the woman.

Comment

Submitted by nedragarrett_CDC on

CDC's comment on behalf of CSTE for USCDI v5

  • https://www.healthit.gov/topic/federal-advisory-committees/collaboration-health-it-policy-and-standards-committees (See May 19 transmittal letter to the NC.  Click on charge 1 - Capturing Pregnancy Status, see MS Excel Spreadsheet)
  1. Pregnancy Status - Yes, No, Possible, Unknown
  2. Date pregnancy status recorded
  3. Estimated delivery date
  4. Pregnancy outcome
  5. Date of pregnancy outcome, and optionally 
  6. Postpartum status (this is important since if the mother recently gave birth and is diagnosed with a condition that could affect the neonate, public health action might be indicated).
  • Currently there are large gaps in the ability for data from electronic health records or ELR to capture sufficient pregnancy information to identify cases and measure the burden and outcome of medical conditions and infections in pregnancy on a population level. Standardizing these data for exchange would be a substantial step forward.
  • CSTE strongly urges ONC to include Estimated due date and not just gestational age as an element in USCDI since data are exchanged at points in time and gestational age at the time of recording may differ from gestational age at the time of the data transmission or receipt. Including estimated due date fixes the maturity of the pregnancy in time, as opposed to gestational age. If gestational age is favored as a variable to use, then it must be accompanied by a date of recording of the gestational age which requires additional data capture.
  • Finally, it is very important for electronic health records to develop a way to link the mother and infant records. A unique identifier for the mother which can be included in the infant's record, and a similar unique identifier for the infant which can be included in the mother's records would help to rectify this problem, which would be beneficial for both clinical care as well for public health when we receive data on mothers and infants but cannot link them (important for diseases such as HIV, listeria, Zika, syphilis, Hepatitis B, and others)

Submitted by nedragarrett_CDC on

CDC's Consolidated Comment for USCDI v5

Proposed change:

  1. Please REMOVE the following from "Applicable Standard(s)" because they are not relevant to this data element:8665-2 - Last menstrual period start date56077-1 - Body weight --pre current pregnancy.
  2. Please KEEP the following in "Applicable Standard(s)": The LOINC code for the data element is:11778-8 - Delivery date Estimated (https://loinc.org/)
  3. Please REMOVE the following from "Additional Specifications" because they do not use this data element: Vital Records Common Profiles Library FHIR IG - http://build.fhir.org/ig/HL7/fhir-vr-common-ig/branches/master/index.htmlVital Records Birth and Fetal Death Reporting - https://build.fhir.org/ig/HL7/fhir-bfdr/index.html.

 

NACCHO supports removing this from the Estimated Delivery Date data element, but this should be kept in some form (either as a new data element or under another term). These details are critical to LHDs understanding what preventative programs they need to put into place to ensure a supported pregnancy and reduce negative newborn outcomes.

 

  • Kindly see the attachment.

DHDSP comments_USCDIv5_8-31-23_FINALv2_0.docx

Submitted by nedragarrett_CDC on

CDC's comment on behalf of CSTE

CSTE Comment:

  • CSTE strongly recommends that pregnancy status be included in USCDI v4. However, a single variable is not sufficient to capture critical data that is needed for a large variety of conditions affecting the public's health, including maternal mortality, Hepatitis B and C, COVID-19, Zika, syphilis, and influenza, to name only a few.
  • CSTE urges the inclusion of the following variables in the core data  for exchange - as defined by the ONC Public Health Task Force on Capturing Pregnancy Data in Electronic Health Records and found here https://www.healthit.gov/sites/default/files/facas/HITJC_PHTF_Meeting_Slides_2017-03-30_0.pdf
  1. Pregnancy Status - Yes, No, Possible, Unknown
  2. Date pregnancy status recorded
  3. Estimated delivery date
  4. Pregnancy outcome
  5. Date of pregnancy outcome  and optionally
  6. Postpartum status (this is important since if the mother recently gave birth and is diagnosed with a condition that could affect the neonate, public health action might be indicated).
  • Currently there are large gaps in the ability for data from electronic health records or ELR to capture sufficient pregnancy information to identify cases and measure the burden and outcome of medical conditions and infections in pregnancy on a population level. Standardizing these data for exchange would be a substantial step forward.
  • Finally, it is very important for electronic health records to develop a way to link the mother and infant records. A unique identifier for the mother which can be included in the infant's record, and a similar unique identifier for the infant which can be included in the mother's records would help to rectify this problem, which would be beneficial for both clinical care as well for public health when we receive data on mothers and infants but cannot link them (important for diseases such as listeria, Zika, syphilis, Hepatitis B, and others)

Submitted by nedragarrett_CDC on

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. Promote this data element as it is integral to understanding maternal and child health in relation to exposure to disease conditions
  • STD - congenital syphilis: this is very helpful for the reasons above (Treatment needed to start 30 days before delivery and risk of prematurity).  it would help care providers and HD know how close the female is to delivery and might help them prioritize cases.  Additionally, if the test date and due date are the same date and the female has no prior treatment, it will immediately let the HD know that there is an infant that needs follow.

CSTE Comment:

  • CSTE strongly recommends that pregnancy status be included in USCDI v3. However, a single variable is not sufficient to capture critical data that is needed for a large variety of conditions affecting the public's health, including maternal mortality, Hepatitis B and C, COVID-19, Zika, syphilis, and influenza, to name only a few. CSTE urges the inclusion of the following variables in the core data  for exchange - as defined by the ONC Public Health Task Force on Capturing Pregnancy Data in Electronic Health Records and found here https://www.healthit.gov/sites/default/files/facas/HITJC_PHTF_Meeting_Slides_2017-03-30_0.pdf
  1. Pregnancy Status - Yes, No, Possible, Unknown
  2. Date pregnancy status recorded
  3. Estimated delivery date
  4. Pregnancy outcome
  5. Date of pregnancy outcome,  and optionally
  6. Postpartum status (this is important since if the mother recently gave birth and is diagnosed with a condition that could affect the neonate, public health action might be indicated).

 

  • Currently there are large gaps in the ability for data from electronic health records or ELR to capture sufficient pregnancy information to identify cases and measure the burden and outcome of medical conditions and infections in pregnancy on a population level. Standardizing these data for exchange would be a substantial step forward.
  • Finally, it is very important for electronic health records to develop a way to link the mother and infant records. A unique identifier for the mother which can be included in the infant's record, and a similar unique identifier for the infant which can be included in the mother's records would help to rectify this problem, which would be beneficial for both clinical care as well for public health when we receive data on mothers and infants but cannot link them (important for diseases such as listeria, Zika, syphilis, Hepatitis B, and others)

 

Submitted by nedragarrett_CDC on

Unified Comment from CDC

  • CSTE supports inclusion of this measure into USCDI v3: It is not sufficient for pregnancy information to only be referenced in problem list or as snomed code as a condition

Submitted by nedragarrett_CDC on

Unified Comment from CDC

General Comment: Recommend moving this element to a new Mother's Pregnancy Information USCDI Class (not in the Observation class).

Submitted by maria.michaels… on

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 Estimated Date of Delivery 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 like Estimated Date of Delivery to local and nationally levels.  Consumption of these types of data are widespread and every jurisdiction in the country captures birth certification information. Accurate pregnancy dating is important to improve outcomes and is a research and public health imperative.  Among other things this type of delivery and pregnancy Information provide key birth 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 reporting for public health 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 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 Estimated Date of Delivery 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

The use of the Estimated Date of Delivery 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

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