1. Development of HL7 Standards for Vital Records NCHS/NAPHSIS Annual Meeting June 3, 2009 Hetty Khan, RN, MS, MGA Michelle Williamson, RN, MS Health Informatics Specialists CDC/National Center for Health Statistics

2. Topics Overview of VR Landscape NCHS Standards Initiatives HL7 Vital Records Domain Analysis Model HL7 EHR-S Vital Records Functional Profile

3. Current Vital Records Landscape A significant number of data items on birth and death certificates and the Fetal Death Record are captured in medical records Facility Worksheet: oContains major categories of data collection about the birth event and fetal death oMany of these data items can be collected from the medical records of the mother or child

4. Standards to Support Capturing Vital Records (VR) Data at the Point of Care or Contact Department of Health Registrar Electronic Medical Record

5. Laying the Foundation Debates abound about the: Use of EHRs as a source for VR information Benefits of EHR approach to VR community Improvements in quality and timeliness of VR data Reductions in the redundancy of data captured

6. Laying the Foundation It is worthwhile to lay the foundation for standardizing transmission of birth and death events as efforts towards developing and implementing EHRs continues

7. Health Level Seven (HL7) Internationally oriented Standards Development Organization (SDO) Accredited by the American National Standards Institute (ANSI) Produces standards for the exchange of healthcare information

8. HL7 Standards HL7 standards include : – Healthcare-related data/information/routing Standards Messaging Standards (V2.x and V3) Document Standards (CDA) – Healthcare-related Functional Standards (EHR-S FM) – Other Standards (CCOW, Vocabulary, Security, Healthcare Devices, etc.)

9. NCHS Standards Initiatives HL7 Vital Records Domain Analysis Model HL7 EHR-S Vital Records Functional Profile

10. Collaborators Vital Statistics Standards Committee (VSSC) EHR-S VR Functional Profile Workgroup Both groups include: –NCHS (DVS and CPHDSS) –NAPHSIS –State DOH –EHR vendors and vital record systems developers –Healthcare Providers

11. HL7 Vital Records Domain Analysis Model (VR DAM) Serves to identify the birth and death registration work flow processes and stakeholders utilizing an HL7 recognized format – unified modeling language (UML) Serves to guide future design and implementation efforts for standardizing the electronic data exchanges between EHR and VR systems, NCHS and other public and private information systems

12. VR DAM Project Plans Consistency in naming convention across all models (birth, death and fetal death) (July, 2009) Solicit broader stakeholder review and finalize VR DAM (Sept, 2009) Solicit VR requirements from international stakeholders to internationalize the VR DAM (Dec, 2009) Identify scope for future development of messages and/or structured documents (Dec, 2009) Ballot VR messages/documents for approval as national standards (May, 2010) Pilot Projects with States to implement draft VR standards (July, 2010)

13. HL7 EHR-S Functional Model Standard Presents a superset of functions for an EHR system from which a user/setting specific subset can be generated Lists all of the functions that an EHR-S SHALL, SHOULD or MAY perform Assigns the priority for possible implementation of those requirements: Essential Now or Essential Future

14. Overview of the EHR-S FM Standard The HL7 EHR-S FM standard is: Consensus-based Internationally-oriented Approved as an International Standards organization (ISO) standard EHR-S FM Release 2 in process

15. Overview of the EHR-S FM Standard Functions describe the behavior of a system in user- oriented language so as to be recognizable to the key stakeholders of an EHR System Source: HL7 EHR-S FM Overview Chapter Direct Care DC.1Care Management DC.2Clinical Decision Support DC.3Operations Management and Communication Supportive S.1Clinical Support S.2Measurement, Analysis, Research and Reports S.3Administrative and Financial Information Infrastructure IN.1Security IN.2Health Record Information and Management IN.3Registry and Directory Services IN.4Standard Terminologies & Terminology Services IN.5Standards-based Interoperability IN.6Business Rules Management IN.7Workflow Management

16. Overview of the EHR-S FM Standard IDTypeType NameStateme nt Description D C. 1. 5 FManage problem list Create and maintain patient- specific problem list A problem list may include, but is not limited to: Chronic conditions, diagnoses, or symptoms, functional limitations, visit or stay-specific conditions, diagnoses, or symptoms. Problem lists are managed over time, whether over the course of a visit or stay… See Also Conformance Criteria IN.2. 5.1 IN.2. 5.2 1. The system SHALL display all active problems associated with a patient. 2. The system SHALL create a history of all problems associated with a patient. 3. The system SHALL retrieve a history of all problems associated with a patient. 4. The system SHALL provide a user interface to deactivate a problem. 5. The system MAY provide the ability to re-activate a previously deactivated problem. 6. … Source: HL7 EHR-S FM Direct Care Chapter

17. Application of the Standard Create a subset or “profile” of functions sought or available for certain EHR Systems, or healthcare delivery settings Profiles conform to the Functional Model EHR systems conform to a Profile Profile NameSponsor Emergency Department Information Systems (EDIS) American College of Emergency Physicians Behavioral Health US Health and Human Services (HHS) Substance Abuse & Mental Health Services Admin (SAMHSA) Child HealthHL7 Pediatric Data Standards SIG Long Term CareAHIMA Electronic Health Records/Clinical Research EClinicalForum Behavioral Health Netherlands

18. HL7 EHR-S VR Functional Profile Goals of VR Functional Profile are to: facilitate EHR systems capturing selected vitals-related data at the point of contact or point of care in a standardized format specify the functional requirements needed for data exchange among providers, states, local registrars and Federal agencies

19. VR Functional Profile Will list all of the functions that an EHR-S SHALL, SHOULD or MAY perform if it meets the needs of vital records Creates a common platform for providers, vendors, payers and others to describe needed EHR-S functionality for vital records

20. Federal Data Requirements for VR Functional Profile Data Uniform collection of data: Birth Edit Specifications for the 2003 Revisions of the U.S. Standard Certificate of Birth; Death Edit Specifications for the 2003 Revision of the U.S. Standard Certificate of Death; Fetal Death Edit Specifications for the 2003 Revision of the U.S. Standards Report of Fetal Death

21. Vital Record WG Consensus Approach Functional requirements must fully adhere to the NCHS/NAPHSIS edit specification Vendor systems can be tailored to meet state specific requirements depending on each jurisdiction’s statutes, rules and policies

22. HL7 Review Feedback provided from HL7 EHR-Working Group: Positive feedback on draft functions and criteria with modifications Supported tight constraints to the Edit Specifications Identified 4 major areas where VR functions will be elevated to inclusion into the Functional Model Stressed HL7’s international initiatives and HHS/ONC direction for greater use of clinical systems

23. Next Steps for the VR Functional Profile Finalize draft functions and criteria for remaining items within the ES (July, 2009) Review all other functions and criteria not addressed within the Edit Specifications for applicability to vital records (Jan, 2010) Ballot profile as an HL7 Informative Standard ( May, 2010) Get on the Roadmap for the Certification Commission for Health Information Technology (CCHIT) to develop certification criteria for EHR-S VR products (Dec, 2010)

24. NCHS/NAPHSIS Leading the Way for VR Standards NCHS with the support of NAPHSIS is leading the development of VR Standards by participating in the HL7 process Collaborating with VR stakeholders (states, vendors, informaticists, etc..) on VR Standards development Strong interest in internationalizing the VR Standards work Keeping Public Health engaged at the standards development table!!

25. Contacts Hetty Khan (NCHS) –hkhan@cdc.govhkhan@cdc.gov –301 458-4311 Michelle Williamson (NCHS) –mwilliamson@cdc.govmwilliamson@cdc.gov –301-458-4618