Pregnancy Information

Pregnancy Information

The Texas Health Services Authority Interoperability Collaborative is a vendor agnostic, multidisciplinary stakeholder group with a focus on removing barriers to safe, secure exchange of clinical information.  Electronic exchange of clinical content should be consistent, standardized and presented in a clinically relevant, user-friendly manner. 

There is not a widely adopted Antepartum Summary Progress Note Document with minimal data elements supporting the transition from prenatal to obstetrical delivery.  Due to this, there is a high reliance on faxed documents, care is delayed with administrative management burdens impacting patient safety and cost. 

C-CDA Document: Antepartum Summary Progress Note Document (LOINC - 57082-0 Antepartum Note):

1. Recommend adding the term 57055-6 Antepartum Note to the C-CDA value set ProgressNoteDocumentTypeCode defined in the NLM Value Set AuthorityCenter here: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.11.20.8.1/expansion
2. Recommend inclusion of Antepartum Summary Progress Note in USCDI Clinical Notes for narrative antepartum notes.  These narrative notes and data elements outlined below should be considered the minimum content for an Antepartum Summary Progress Note Document. 
   1. Gravida {0-99} C-CDA R2.1 Supplemental Templates for Pregnancy Status (Jan 2019). Pregnancy Summary Organizer

Minimum Data Elements to include:

1. Para {0-99} C-CDA R2.1 Supplemental Templates for Pregnancy Status (Jan 2019). Pregnancy Summary Organizer
2. EDC (estimated date of confinement “due date”) {mm/dd/yyyy} C-CDA R2.1 Supplemental Templates for Pregnancy Status (Jan 2019). Pregnancy “Status” Observation
3. Labs

Blood Type {A, B, AB, O} Result Organizer. Result Observation

RH {positive, negative} Result Organizer. Result Observation

GBS (group b strep) {positive, negative} Result Organizer. Result Observation

Hep B Result Organizer. Result Observation

Hep C Result Organizer. Result Observation

HIV Screening Result Result Organizer. Result Observation

Syphilis Screening Result Result Organizer. Result Observation

Chlamydia Result Organizer. Result Observation

Gonorrhea Result Organizer. Result Observation

1. Social drivers / determinants of health 

Food Social History Observation

Housing Social History Observation

Transportation Social History Observation

Additional key data elements to be considered as minimal elements requested by stakeholders: 

6.  Blood pressure and Weight 
7.  50 gm glucose screen (Glucola)
8. CBC 
9. Rubella
10.  Fetal EGA (weeks)
11. Maternal Diabetes Yes or No 
12. Maternal Pre-eclampsia Yes or No
13. Prior cesarean deliveries Yes or No and How many
14. Obesity (BMI)
15. Opioid use disorder – Yes or No 

Level 0 Data Elements in the Pregnancy Information Data Class

Submitted 7/31/2024 by Lisa R Nelson, MS, MBA

As a subject matter expert in the data standards space, my comments contribute insight into the classification and grouping of data elements. I also provide a perspective on the maturity of implementation guidance demonstrating the feasibility of representing these data elements to support data exchange.

The views and opinions expressed in this document are solely those of the author and do not necessarily reflect the official policy or position of the author's employer unless indicated so explicitly. Furthermore, any organizations mentioned or participated in by the author do not endorse or support the ideas expressed herein unless indicated so explicitly.

USCDI Level-0 Feedback- Pregnancy Data Class and associated Data Elements.

Certain “data elements” represent component parts of a single “data element”. Combining these elements into a single element or adding a way to "couple them together" may make it easier for people to understand what information needs to be collected and exchanged as a whole object that has the essential parts needed to make the information make sense.

Number of Fetal Deaths

This is not well defined. What is being counted? How does this differ from Fetal Deaths this delivery?

Fetal Deaths this delivery

This is not well defined. What is being counted?

Number of prenatal visits

This data element only makes sense in the context of one specific pregnancy.

Mother's delivery weight

This is just a vital sign for weight at a specific point in time but should be preserved with the set of information collected for each pregnancy.

Mother's pre-pregnancy weight

This is just a vital sign for weight at a specific point in time but should be preserved with the set of information collected for each pregnancy.

Pregnancy Intention Screening

Need to distinguish the screening from the screening result

Corrected Estimated Due Date

This should not be a new data element. This is just an Estimated Due Date made at a later date.

In working to clarify these data elements and other tightly associated data elements currently in USCDI+ Maternal Health Domain, Pregnancy Information Data Class, ONC should consider current work being done within the August 2024 C-CDA Implementation-A-Thon Maternal Health Track. The track will highlight additional clarification for many of these data elements and provide a demonstration of EHR readiness to exchange many of these data elements.

USCDI+ Comments 20240731 v2.pdf

Adding Pregnancy Outcomes to Pregnancy Status

Unified Comment on behalf of the Maternal Health Consortium, funded by the Office of the Secretary’s Patient-Centered Outcomes Research Trust Fund (OS-PCORTF)

The rates of maternal mortality have been rising in the United States since 1987. Yet this measure does not capture data related to maternal health and well-being. Understanding maternal health before, during, and after delivery is foundational for developing safer, more effective approaches to maternal care. Clinical data relevant to understanding this trend are not standardized, and data exchange is not interoperable across many relevant settings. Furthermore, maternal health and associated child health are inextricably linked – what happens during gestation, delivery, and after informs health outcomes of both mother and child – but relevant data is often held in separate, unconnected records. These issues impede research on maternal morbidity and longitudinal maternal care and associated impacts to infant health. Research on root causes of maternal mortality, poor outcomes, pediatric developmental problems, and effective treatments requires exchange of information stored in disparate sources, such as electronic health record (EHR) systems, disease registries, and public health agencies (PHAs).

Research use case populations as described in the draft Longitudinal Maternal & Infant Health -FHIR Implementation Guide (https://build.fhir.org/ig/HL7/fhir-mmm-ig/):

• Pregnancy and subsequent death within a specific time frame: This cohort includes individuals who died within a year (365 days) of a pregnancy regardless of cause of death or pregnancy outcome.
• Hypertensive Disorders of pregnancy: This use case focuses on individuals with a diagnosis of hypertensive disorders of pregnancy.

We strongly promote and support the addition of the pregnancy status data element to the health status data class. In addition, the Consortium also recommends either an additional data element to capture pregnancy outcomes, such as live birth, stillbirth or intrauterine fetal demise, miscarriage or spontaneous abortion, or addition to provision of best practice guidance to document the pregnancy outcomes in the cases where the pregnancy status indicator was “currently pregnant”. It is important to identify and collect pregnancy outcomes. Adverse pregnancy outcomes  can have lifelong effects on the pregnant individual’s health, such as developing hypertension or cardiovascular disease post-delivery, as well the infant’s health.

Element and links to suggested existing resources.  

https://browser.ihtsdotools.org/?perspective=full&conceptId1=404684003&edition=MAIN/SNOMEDCT-US/2022-03-01&release=&languages=en

https://www.healthit.gov/isa/taxonomy/term/771/draft-uscdi-v3

http://www.hl7.org/fhir/us/mihr/ValueSet/PregnancyNonLive

http://www.hl7.org/fhir/us/mihr/ValueSet/pregnancy

http://terminology.hl7.org/CodeSystem/condition-ver-status

http://www.hl7.org/fhir/us/mihr/ValueSet/PregnancyProcedureDelivery-CPT

Level 2 Data Class: Pregnancy Information

IMO supports the inclusion of Pregnancy Status in USCDI V3 but would like to note that the technical specifications cited in the proposal for inclusion in USCDI V3 as a level 2 data element are not currently implemented in production environments.

IMO would support the inclusion of a data element specified with LOINC coding for Pregnancy status 82810-3. The use of LOINC 82810-3 is aligned with the current version of FHIR R4 International Patient Summary Implementation Guide (v1.0.0 CI Build) as well as ISA recommendations for Representing Patient Pregnancy Status, which incorporates the LL4129-4 answer codes in the correct format. ONC certified HIT can exchange this data element.