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

Data File Links

Related Links

National Center for Health Statistics
3311 Toledo Road
Hyattsville, MD 20782
Phone:
1-800-232-4636
nchsquery@cdc.gov

Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, U.S.A
Tel: (404) 639-3311 / Public Inquiries: (404) 639-3534 / (800) 311-3435