Data used to categorize individuals for identification, records matching, and other purposes.

Data Element
Birth time
Submitted By: Kensaku Kawamoto, MD, PhD, MHS / University of Utah
Data Element Information
Rationale for Separate Consideration Birth date is part of the USCDI. Birth time is also important for newborns, e.g., for neonatal bilirubin management and avoidance of neurotoxicity. Both the capture and exchange of this data element are important for neonatal care within and between systems and organizations, and the data element may support business processes related to identity management and patient matching/record linkage.
Use Case Description(s)
Use Case Description To support higher quality care for newborns, where the number of hours and minutes elapsed since birth can be important, e.g., for neonatal bilirubin management and avoidance of neurotoxicity. Both the capture and exchange of this data element are important for neonatal care within and between systems and organizations, and the data element may support business processes related to identity management and patient matching/record linkage.
Estimate the breadth of applicability of the use case(s) for this data element This data element would affect all newborns, or approximately 4 million babies a year.
Link to use case project page https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2755484
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) FHIR birthTime extension
https://www.hl7.org/fhir/extension-patient-birthtime.html
Additional Specifications N/A
Current Use Extensively used in production environments
Supporting Artifacts This data element is already supported in the FHIR interface of major EHR systems such as Cerner.
https://fhir.cerner.com/millennium/dstu2/individuals/patient/#extensions, https://fhir.cerner.com/millennium/r4/individuals/patient/#extensions
Extent of exchange 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 This data element can be exchange across institutions, but a primary use case is expected to be use within an institution by standards-based tools such as SMART on FHIR apps and CDS Hooks services. Most neonates continue to be cared for where they are born, and once it has been several days, the time of birth generally provides little additional value clinically compared to the birth date. Some newborns must be transferred from labor & delivery to the NICU, pediatrics, or referred to a specialist soon after birth; the exchange of this data element would be valuable.  
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) No relevant restrictions are anticipated.
Restrictions on Use (e.g. licensing, user fees) No relevant restrictions are anticipated.
Privacy and Security Concerns No relevant concerns are anticipated.
Estimate of Overall Burden Because birth time is already routinely captured in structured form in many EHRs, and it would be fine for this information to only be made available if already captured in structured form, there should be minimal burden compared to the current state with regard to 1) supporting the data elements in the EHR and 2) users collecting the information.
With regard to adding this information to the current Patient Demographics information when available, the overall burden is expected to be limited as the data element is already widely captured in structured form in EHRs today. For example, it took our group only a few days to implement support for this data element within the Epic FHIR API.
Other Implementation Challenges No other challenges to implementation are anticipated.

Comment

Submitted by nedragarrett_CDC on

CDC's Comment for draft USCDI v6

CDC is requesting that Birth Time be added for consideration to USCDI V6 to inform hospital and ambulatory medical care survey data collection efforts.

Justification: National Healthcare Surveys includes a newborn indicator as a data element in public use data files. This newborn indicator allows users to easily exclude or identify newborn hospitalizations and ED visits in the public use data files. Inclusion of this data element would improve accuracy in creating this newborn indicator, thereby improving reporting of health care survey information on newborns in official federal statistics produced by National Healthcare Surveys data.

Submitted by nedragarrett_CDC on

CDC's Consolidated Comment for USCDI v5

Proposed change: Please ADD to the "Additional Specifications" entries: 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/.

NACCHO supports CDC's comment.

 

Submitted by LisaRNelson on

Why not add Death Time at the same time you add Birth Time?

Why not add Death Date/Time at the same time you add Birth Date/Time? These seem like they make a perfect pair of data elements. Wouldn't it be efficient to clarify both of these in a single effort?  

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