Newborn's Delivery Information

CSTE Comment - v5

CSTE agrees with CDC's recommendation for this data element. 

CDC's Consolidated Comment for USCDI v5

Proposed change:

• Please CHANGE data element NAME to "Gestational Age at Delivery" - this data element applies to fetal deaths as well as live births.
• Please ADD a description: "The obstetric estimate of the infant’s gestation in completed weeks based on the birth/delivery attendant’s final estimate of gestation, which should be determined by all perinatal factors and assessments such as ultrasound, but not the neonatal exam.
• Please ADD to "Applicable Standard(s)": LOINC 76516-4 |Gestational age--at birth.
• Please ADD the following from "Additional Specifications" because they use this data element: Vital Records Common Profiles Library FHIR IG - http://hl7.org/fhir/us/vr-common-library/Vital Records Birth and Fetal Death Reporting - http://hl7.org/fhir/us/bfdr/l.
• Justification: Through active collaboration with State Vital Records Offices and electronic birth registration system vendors the Vital Records community has been testing within EHR sandbox environments and conducting birth reporting data quality projects accessing these data in hospital environments. Specific to these active projects in FHIR, Epic hospitals are identifying Gestational Age at Birth element with the LOINC code 76516-4 'Gestational age--at birth'.

CSTE Comment: CSTE agrees with CDC comment.

NACCHO Comment: Support, this will provide for greater clarity in the definition.

MedMorph's support of Gestational Age at Birth

To support the adoption of 'Gestation Age at Birth' into USCDI it is important to note that 57 jurisdictions are required to report data elements such as 'Gestational Age at Birth' nationally for birth and fetal death reporting, and birth defects reporting.  The National Center for Health Statistics guide to completing the facility worksheets for live birth and fetal death reports defines a newborn or fetus gestational age "As the obstetric estimate of the infant’s gestation in completed weeks based on the birth/delivery attendant’s final estimate of gestation."  For further details on documentation of calculating gestational age for a newborn or fetus can be found under item '30. Obstetric estimate of gestation at delivery'.  https://www.cdc.gov/nchs/data/dvs/GuidetoCompleteFacilityWks.pdf
 
Accurate pregnancy dating is important to improve outcomes and is a research and public health imperative. The best estimated due date should be documented clearly in the medical records. Additionally, given the current pandemic real time birth reporting for public health is paramount in assessing the medical care for both mothers and newborns.

Additionally, 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 Gestational Age at Birth 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

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:  https://build.fhir.org/ig/HL7/fhir-bfdr/index.html

Birth Defect Reporting FHIR IG: https://build.fhir.org/ig/HL7/fhir-birthdefectsreporting-ig/index.html

HL7 CDA® R2 Implementation Guide: Ambulatory and Hospital Healthcare Provider Reporting to Birth Defect Registries Release 1 , STU 2 -US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=428

LOINC codes exist for each of the proposed data element:
11884-4: Gestational age Estimated

The use of the Gestation Age at Birth 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

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)