1. Understanding the Vital Records Functional Profile (VRFP) Hetty Khan Health Informatics Specialist Centers for Disease Control and Prevention National Center for Health Statistics September 29, 2010

2.  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 9/29/20102

3.  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) 9/29/20103

4.  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 9/29/20104

5.  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 9/29/20105

6.  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 9/29/20106

7. Other VR Stakeholders American College of Nurse Midwives American College of Pediatrics American Health Information Management Association (AHIMA) DP Software Medical Charting Solutions NAPHSIS NCHS Netsmart Technologies QuantumMark, LLC Scheier Consulting Facilitators Hetty Khan Michelle Williamson John Ritter State/Jurisdictions California District of Columbia Maryland Minnesota New Jersey New York Pennsylvania Vermont West Virginia Wisconsin 9/29/20107

8. 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 VR 9/29/20108

9.  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 9/29/20109

10. U.S. Standard Certificate of Live Birth Requirements for Prenatal Care Information 9/29/201010

11. Item Title: DATES OF FIRST AND LAST PRENATAL CARE VISIT Item Number: 29a Certificate, 6a Facility Worksheet 29b 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 9/29/201011

12. Vital Records Functional Profile Add functions and criteria to meet the needs of VR 9/29/201012

13. Vital Records Functional Profile 9/30/201013 Modify Description; Add new criteria to meets the needs of VR

14. 9/30/201014 Modify description; change SHOULD to SHALL 2. The system SHOULD SHALL provide the ability to create customized views of summarized information based on sort and filter controls for date or date range, problem, or other clinical parameters 3. The system SHOULD SHALL provide the ability to access summarized information through customized views based on prioritization of chronology, problem, or other pertinent clinical parameters.

15. Vital Records Functional Profile Remove functions and criteria that do not apply to the VR Domain 9/30/201015

16. 9/30/201016 Keep all SHALL’s; add new criteria; remove criterion; 1.The system SHALL provide the ability to capture and communicate referral(s) to other care provider (s), whether internal or external to the organization. 2.The system SHALL provide the ability to capture clinical details as necessary for the referral. 6. IF required by the state, THEN the system SHALL provide the ability to record the act of notifying the medical examiner or coroner of a death (including the date and time of that notification event). 7. The system MAY provide the ability to capture clinical details as necessary for referrals to the medical examiner/coroner. 9. The system MAY provide guidelines to the provider about the appropriateness of a referral for a particular patient.

17.  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 http://www.hl7.org/documentcenter/ballots/2010sep/downloads/EHR_VRFP_R1_SupportingDocuments.zip 9/29/201017

18.  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 9/29/201018

19. 9/29/201019