Electronic Health Record System-Vital Records
Functional Profile
HL7 EHR Technical Committee
March 12, 2008
Revised June 18, 2008
Call for Participation:
We are recruiting volunteers to serve on the Electronic Health Record
System (EHR-S) Vital Records (VR) Functional Profile Work Group.
Federal, state and local vital records representatives, Electronic
Health Records and vital records systems developers, funeral directors,
healthcare providers, subject matter experts and other stakeholders are
encouraged to join this work group.
Background:
- A significant number of data items on birth and death
certificates are captured in medical records. Currently, the
capturing of these items at the facility or provider level for entry
into the states electronic systems are occurring through manual
processes. As an example, the Facility Worksheet for revised
Certificate of Live Birth and Report of Fetal Death show 41 major
categories of data collection about the birth event. Of these
categories, the Worksheet suggests that 36 of these data items be
collected from the medical records of the mother or child.
- The process of capturing this information may be labor intensive
and lead to errors, adversely affecting the quality of the health
and medical information captured on certificates and the labor costs
of hospitals in capturing this information. The current birth and
death registration processes continue to demonstrate:
- Progressively constrained schedules for reporting to federal
agencies
- Higher expectations of data quality and timeliness by
stakeholders and public
- Separate costly re-engineering projects in various jurisdictions
- Very little integration with other stakeholder systems
- Need for a standards-based uniform, systematic approach to vital
records data collection and exchange.
- Debates abound about the use of
electronic medical records data as a source for vital registration
information, the benefits of this approach to the vital records
community, the improvements in quality and timeliness of vital
records, and the reductions in the redundancy of data captured.
However, while these debates and research continue, it is worthwhile
to lay the foundation for standardized transmission of birth and
death events as work towards electronic medical and health records
proceed in this country.
- Some excellent work on the electronic vital records system has
already been done through the Model Vital Events Reengineered System
(MoVERS) project conducted in 2003. The Centers for Disease Control
and Prevention’s National Center for Health Statistics (NCHS), the
National Association for Public Health Statistics and Information
Systems (NAPHSIS) and the Social Security Administration (SSA) have
developed a partnership to improve the timeliness, quality, and
sustainability of state vital registration systems by adopting
national, consensus-based standards and guidelines. The partners
have already collaborated to identify and develop functional
requirements for reengineered, electronic birth and death
registration systems. A goal of these requirements was for them to
serve as the initial foundation for the design, development, and
implementation of web-based vital records systems for states. Many
states are well into the development of web-based reengineered
systems. Their expertise will be essential in guiding the
development of national standards to support vital registration
activities.
- Building on existing work, this is an excellent opportunity to
create an HL7 EHR-S Vital Records Functional Profile that will
facilitate electronic health record (EHR) systems to capture vital
records data at the point of contact or point of care.
Scope and Objectives:
- The scope of the EHR-S VR Functional Profile Project is to create an
HL7 EHR-S VR Functional Profile that conforms to the HL7 EHR-S
Functional Model. The HL7 EHR-S Functional Model defines a
standardized model of the functions that may be present in EHR
systems. A Functional Profile is a specification which uses the
functional model to indicate which functions are required, desired
or implemented for certain EHR systems, healthcare delivery
settings, or for other purposes. The HL7 EHR-S VR Functional Profile
will facilitate EHR systems capturing vital records data at the
point of contact or point of care. The VR profile must articulate
the functional requirements needed to support messaging between EHR
systems and states, local registrars and Federal agencies. The
project will initially be U.S. Realm based; however it may be
expanded to include international affiliates.
- The EHR-S VR Functional Profile Work Group will not duplicate
the work already accomplished on the national consensus-based
standards and guidelines, but will use those efforts to inform the
development of the functional profile as outlined in the Charge
below.
The intent of this project is to improve the timeliness, data
quality, data dissemination and reduction of data errors by decreasing
duplicate vital registration data entries. The current vital
registration process supports the development of stand alone systems
that foster duplicative data entry and lack of standards. Furthermore,
the EHR-S VR profile may serve as a source of reference for the
Certification Commission for Health Information Technology (CCHIT) to
consider for future certification of EHR systems that include
functionality to better support vital registration. CCHIT is a
recognized certification body for electronic health records and their
networks, whose mission is to accelerate the adoption of health
information technology.
The following are reasonable principles for certification of EHR-S that
includes vital records functionality:
- There should be a unified set of functional requirements for managing
data collection and exchange across the vital records community that can
be used by all the key stakeholders.
- The processes and formats used for sharing data should support the
development of easier and timelier communication among the local data
sources that provide the data, state and territorial agencies that
receive and process the data, and the internal and external
organizations that make use of the data.
- The solutions developed should be standards based and should utilize
industry standards and best practices.
Proposed Work Group Structure:
One EHR-VR Functional Profile Work Group is proposed. Hetty Khan and
Michelle Williamson from the Centers for Disease Control and
Prevention/National Center for Health Statistics (CDC/NCHS) will serve
as the Co-Leads for this work group. If you are interested in
participating in this work group, please contact
Hetty Khan at hkhan@cdc.gov
The work group will be active from April, 2008 to May, 2009 (estimated
completion of work). Work will be done: (1) by conference calls and
email, (2) using tools provided by HL7 and (3) at the HL7 Working Group
meetings until work is completed.
Work Group Charge:
- Educate volunteers on project and assignments
- Educate volunteers regarding the HL7 EHR-S Functional Model
- Conduct assessment of the vital records functional requirements
previously done through the Model Vital Events Reengineered System (MoVERS)
project
- Map these functional requirements to the EHR Functional Model
- Identify vital record functions and conformance criteria within the EHR
Functional Model and create Vital Records Profile
- Refine identified vital records functions and conformance criteria
within the profile
- Define functional priorities and timeframes
- Identify gaps and incorporate any additional functional requirements
- Refine identified VR functions and conformance criteria for additional
functions
- Define functional priorities and timeframes for additional functions
- Register the VR Functional Profile on the HL7 web site following review
by the HL7 EHR Technical Committee (EHR-TC)
- Prepare drafts of a VR ballot profile and reconcile ballot comments (if
the Technical Committee agrees that a VR profile should be balloted).
Balloting is a thorough consensus process in which the functional
profile has been subjected to rigorous review
- Collaborate and provide ongoing feedback with NAPHSIS on the development
of the EHR-S VR Functional Profile through participation in the Vital
Statistics Standards Committee (VSSC).
- Develop white papers, reports, and articles for publication, and conduct
outreach, explaining the value proposition to consumers and key
stakeholders