Hetty KhanHealth Informatics Specialist

Centers for Disease Control and Prevention

National Center for Health StatisticsSeptember 29, 2010

Vital Records:

◦ Have established standards for national Birth and Death Certificate, and Fetal Death Report data collection

U.S. Standard Certificate of Live Birth U.S. Standard Certificate of Death U.S. Standard Report of Fetal Death

◦ Collects much of the same data that are inherent in Electronic Health Record Systems (EHR-S)

Mother’s and infant’s medical records serve as the source for more than ½ of all data items collected on the 2003 U.S. Standard Certificate of Live Birth and the U.S. Standard Report of Fetal Death

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Recent activities to support meaningful use of EHRs using national standards may lead to increased use of EHR-S

◦ Final Rule: Issued on July 13, 2010 Initial Set of Standards, Implementation Specifications, and

Certification Criteria for Electronic Health Record Technology

As efforts towards developing and implementing EHRs continue, VR must lay the foundation for standardizing transmission of vital records (birth and death events)

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Sub-set of the HL7 EHR-S Functional Model, derived specifically for the Domain of Vital Records

Specifies the functional requirements that will facilitate the point-of-contact or point-of-care capture of selected U.S. vital records data via EHR systems that could be utilized to populate jurisdictional vital record systems

Developed by Domain Experts:◦ Federal, state and local vital records representatives ◦ Electronic Health Records experts◦ Vital records systems developers◦ Healthcare providers◦ Subject matter experts

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It is not intended to instruct how to collect vital records data or to require the collection of vital records data

How such a system is actually used will likely be the result of many influences including local law and regulation, organizational policy, and personal preference

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Supported by funding from CDC/NCHS

Sponsored by: HL7 Electronic Health Records (EHR) Work Group

(WG) HL7 Public Health and Emergency Response

(PHER) WG

Project began in May, 2008• Bi-Weekly conference calls• Off-line discussions to reach consensus on various

critical issues• Formal voting process on Functional Requirements

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Other VR Stakeholders

American College of Nurse MidwivesAmerican College of PediatricsAmerican Health Information Management Association (AHIMA)DP SoftwareMedical Charting SolutionsNAPHSISNCHSNetsmart TechnologiesQuantumMark, LLCScheier Consulting

Facilitators

Hetty Khan

Michelle Williamson

John RitterState/Jurisdictions

CaliforniaDistrict of ColumbiaMarylandMinnesotaNew JerseyNew YorkPennsylvaniaVermontWest VirginiaWisconsin

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VRFP WG:

Developed the VRFP in compliance with the 2003 U.S. standards for birth, death and fetal death certificates

Reviewed the Model Vital Events Registration System (MoVERS) business functional requirements, identified related functions and criteria within the EHR-S FM, and accepted or modified them to meet the needs of VR. New functions and criteria were created as necessary

Reviewed the NCHS/NAPHSIS Birth, Death and Fetal Death Edit Specifications

Reviewed all other functions and criteria in the EHR-S Functional Model to determine their applicability to VR9/29/2010 8

Limit the scope to a subset of the vital records data items for the first iteration of the developing HL7 EHR-S VRFP

Priority for the death certificate will be on determining the information needed to more accurately determine the cause of death

The initial goal is to monitor and assess the quality of the data that will be exchanged between electronic health record and vital records systems and implement demonstration projects utilizing this initial set of functional requirements

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U.S. Standard Certificate of Live Birth

Requirements for Prenatal Care Information

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•Item Title: DATES OF FIRST AND LAST PRENATAL CARE VISIT

•Item Number: 29a Certificate, 6a Facility Worksheet29b Certificate, 6b Facility Worksheet

•Description: Date that the mother had her first prenatal care visit

Date that the mother had her last prenatal care visit

•Preferred Source: Prenatal care record•Other Source: Initial physical exam

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Vital Records Functional ProfileAdd functions and criteria to meet the needs of VR

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Vital Records Functional Profile

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Modify Description; Add new criteria to meets the needs of VR

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Modify description; change SHOULD to SHALL

Vital Records Functional Profile

Remove functions and criteria that do not apply to the VR Domain

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Keep all SHALL’s; add new criteria; remove criterion;

HL7 EHR-S VRFP Reader’s Guide

HL7 EHR-S VRFP Overview Chapter ◦ Appendix 1: Direct Data Entry by Mother or Mother’s Designee of Selected Items

on Mother’s Worksheet ◦ Appendix 2: VRFP Scope Document for the U.S. Standard Certificate of Live Birth ◦ Appendix 3: VRFP Scope Document for the U.S. Standard Certificate of Death ◦ Appendix 4: VRFP Scope Document for the U.S. Standard Fetal Death Report

HL7 EHR-S VRFP Chapters:◦ Direct Care◦ Supportive Services◦ Information Infrastructure

Ballot Review Spreadsheet

VRFP Supporting Documents:◦ http://www.hl7.org/documentcenter/ballots/2010sep/downloads/EHR_VRFP_R1_SupportingDocuments.zip

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HL7 EHR-S VRFP has been balloted as an informative standard during the present ballot cycle (Sept, 2010)

HL7 Electronic Health Record WG will participate in a ballot reconciliation process to review and discuss all comments and proposed changes for the VRFP (Oct, 2010)

CDC/NCHS VRFP Work Group developers will also work to review and reconcile comments

Each submitter will be notified if additional information or clarification is needed to resolve a comment

All comments will be resolved/addressed before the standard is published

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