Submitted by nachcinformatics on
Need for USCDI support for pregnancy episode data model in USCDI
Health Status – Pregnancy Status and Pregnancy Episode | Women’s Health
Maternal morbidity and mortality remain significant public health concerns in the United States, particularly among medically underserved and uninsured populations that community health centers serve. Standardizing critical pregnancy-related data in electronic health records (EHRs) is crucial for informing care decisions, coordinating maternal care, and improving care quality.
The CDC's Division of Reproductive Health, in collaboration with the National Association of Community Health Centers (NACHC), has made substantial progress in enhancing the quality of pregnancy and postpartum care within Federally Qualified Health Centers (FQHCs). By leveraging Health Information Technology (HIT) systems, they have successfully tracked and analyzed pregnancies, identified high-risk cases, and improved data standardization in EHRs. The initiative has revealed significant gaps in maternal care quality in community health centers.
The inclusion of standardized data elements like Pregnancy Status, Estimated Date of Delivery, and Pregnancy Outcome in the U.S. Core Data for Interoperability (USCDI) is crucial for improving maternal healthcare, research, and quality measurement. This is especially important for conditions like hypertensive disorders of pregnancy, which disproportionately affect certain demographics, including Black and Native American/American Indian individuals. NACHC has worked with multiple national health center-controlled networks to implement and extend the pregnancy episode as a longitudinal concept in multiple certified health IT products and therefore should we believe be considered at full maturity in Level 2.
Pregnancy Episode was previously proposed and submitted by NACHC in coordination for consideration to ONC since 2022. While NACHC agrees that there is a critical need for the pregnancy status data element, the currently submitted concept profile We recommend updating the submission which does not harmonize with electronic case reporting (eCR) LOINC code for pregnancy status (LOINC 82810-3) with its terminology bound answer codes (LOINC LL4129-4), and with SNOMED-CT terminology bindings. This code is referenced in the federally supported Family Planning Annual Report (FPAR) program and data system from HHS, which we believe should be included as a reference in version 5. The currently accepted IPS “Pregnancy Status” submission standards specifications is missing the recommended 82810-3 LOINC code in its text.
NACHC would strongly recommend that the pregnancy status data element become a component of a larger model that supports the pregnancy episode. Proposed concepts in this model are contained below. NACHC supports these formal definitions and additional women’s health data elements as components of the pregnancy episode.
Data element
DefinitionPregnancy status: Pregnancy Status = LOINC 82810-3, with its terminology bound answer codes (LOINC LL4129-4)
Indicator that patient is currently pregnant, not pregnant, or that their pregnancy status is unknown currently
Identify pregnancy episodes to help health care providers make informed decisions for the care of the patient and to inform quality improvement initiatives to improve the follow-up and documentation of peri- and postpartum care services. This data element is captured and used by providers using electronic health records or self- reported by patient as patient generated health data. However, this data is not standardized, and data exchange is not interoperable across many settings. Capturing the data related to pregnancy status in a standardized way will support the collection of sufficient pregnancy information to identify cases and measure the burden and outcomes of pregnancy on a population level.
Estimated Date of Delivery: Estimated Delivery Date (EDD) = 2.16.840.1.113762.1.4.1221.131
Date representing the expected delivery date of a pregnancy
Estimate accurate pregnancy start date to provide pregnancy information and provide key birth statistics that identify public health trends. This data element is critical for supporting maternal care coordination and care provisions. The use case will be relevant for all maternal health patients, all providers involved in maternal health care, and all consumers of maternal health data used for research, public health and patient care and quality outcomes.
Estimated Gestational Age: Age of Gestation = 2.16.840.1.113762.1.4.1221.148
The gestational age (in weeks, or weeks and fraction of week) of the pregnancy at time of pregnancy outcome
Estimate due date to inform obstetrical care and testing and evaluate the fetal growth and infant’s health at birth. The use case will be relevant for all maternal health patients and infants, all providers involved in maternal and infant health care, and all consumers of maternal and newborn health data used for research, public health and patient care and quality outcomes.
Gravidity: [#] Pregnancies = LOINC 11996-6
Total number of times the patient has been pregnant including the present pregnancy. This element supports obstetric risk and patient history.
Parity: [#] Parity = LOINC 11997-6
Total number of times the uterus has been emptied of viable offspring.
Multiple Gestation: Multiple Gestation = 2.16.840.1.113762.1.4.1045.106
This grouping of value sets contains a diagnoses that represent the delivery of twins and higher order multiples.
Pregnancy outcome: Pregnancy Outcome – CDC = 2.16.840.1.114222.4.11.7494
The outcome of the pregnancy: 1) live birth; 2) still birth or intrauterine fetal death (>20 weeks gestation); 3) miscarriage/spontaneous abortion (<20 weeks gestation); 4) termination (elective, medical, surgical, or induced abortion); 5) ectopic pregnancy; 6) non-live birth, not otherwise specified
Document pregnancy outcomes to assess care processes and develop effective approaches to maternal care. Linkages between mother and infant records will also be beneficial for clinical care as well as for public health (important to link data on mothers and infants especially for diseases such as Zika, Hep B, and others). This data is also routinely exchanged for birth certification, fetal death reporting, and birth defect reporting. Standardization will benefit the data exchange between EHR systems and public health, specialized registries, national health care survey systems, and research entities.
Date of pregnancy outcome:
Date when an event occurred relative to pregnancy outcome. This concept links to the actual date of delivery or any other pregnancy outcome and would be the element generated as a pregnancy episode is closed.
Document date of when the pregnancy outcome occurred. The use case will be relevant for all maternal health patients, all providers involved in maternal health care, and all consumers of maternal health data used for research, public health and patient care and quality outcomes.
Pregnancy complications: Complications of Pregnancy, Childbirth and the Puerperium = 2.16.840.1.113883.3.464.1003.111.12.1012
Complications of pregnancy that include physical and mental conditions that affect the health of the pregnant or postpartum person, the infant, or both.
Identify adverse pregnancy complications that 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. The use case will be relevant for all maternal health patients, all providers involved in maternal health care, and all consumers of maternal health data used for research, public health and patient care and quality outcomes.
Postpartum status:
The time period after delivery up to 12-months
Identify time period subsequent to pregnancy episode and patients who should receive specific postpartum care services. The use case will be relevant for all maternal health patients, all providers involved in maternal health care, and all consumers of maternal health data used for research, public health and patient care and quality outcomes.
NACHC also recommends the consideration of additional concepts (Value sets available in VSAC)
Postpartum care visit
Postpartum care visit (occurring within 3-12 weeks after delivery)
Increase the proportion of all postpartum patients who receive initial postpartum care from -their obstetrician–gynecologists or primary care providers based on current or existing guidance and recommendations. Underutilization of postpartum care impedes management of chronic conditions, such as mental health, diabetes, hypertension, and obesity, and access to effective contraction, which increases the risk of short interval pregnancy and preterm birth. The use case will be relevant for all maternal health patients, all providers involved in maternal health care, and all consumers of maternal health data used for research, public health and patient care and quality outcomes.
Postpartum care visit quality services
Provide evidence-based quality postpartum care services at visit: 1) contraceptive counseling and provision of a contraceptive method (LOINC 86654-1); 2) postpartum depression screening within 8 weeks of delivery (LOINC 89211-7); 3) postpartum depression treatment for those diagnosed with postpartum depression (LOINC 71354-5); 4) postpartum diabetes screening for women with GDM-affected pregnancy; 5) pregnancies with chronic or gestational hypertension (ICD 10 O13.9; 6) pregnancies with hypertension in pregnancy and subsequent preeclampsia (ICD 10 O14.95), eclampsia (ICD 10 O14.90) and HELLP syndrome (ICD-10 code O14.24) outcomes; 7) breastfeeding (LOINC 63895-7); 8) infant feeding and care; and 9) other evidence-based recommendations for postpartum care services
Track postpartum care service provision to reduce gaps in care and improve adherence to evidence-based guidelines. The use case will be relevant for all maternal health patients and infants, all providers involved in maternal health care, and all consumers of maternal health data used for research, public health and patient care and quality outcomes.
Delivery Encounters
A set of standardized delivery encounters could be used to trigger automated structured ADT messages already required by CMS at the beginning and the end of the encounter. Reuse of well constructed code sets from deployed quality measures can assist in care coordination.
Submitted by david_rocha on
Pregnancy Status
"Pregnancy status data element is a primary driver of the collection of Pregnancy Information. This is a well-established data element already carried in C-CDA R3.0 and should be included in the USCDI Level-0 Pregnancy Information Data Class."