Laying the Foundation for Vital Records Standards

1. Laying the Foundation for Vital Records Standards VSCP Project Directors’ Annual MeetingMay 13, 2008 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 are captured in medical records • Facility Worksheet: • Contains 41 major categories of data collection about the birth event and fetal death • 36 of these data items can be collected from the medical records of the mother or child

4. Proposed Future VR Landscape Registrar Department of Health Electronic Medical Record Capturing VR Data at the Point of Care or Contact

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. Building with Data Standards Essential Building Blocks of Information Systems • Classification Systems and Terminologies (e.g., ICD, ICF, SNOMED) • Core Data Sets (vital statistics, hospital discharge data) • Identifiers (provider, plan, individual) • Message formats, structured documents, modeling (e.g., HL7 and X12) • Implementation Guides • Privacy and Security

8. Health Level 7 HL7 is one of several American National Standards Institute (ANSI) accredited Standards Developing Organizations (SDO) producing standards for the exchange of healthcare information 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. Vital Statistics Standards Committee (VSSC) Participants include NCHS (DVS and Informatics), NAPHSIS, State DOH representatives and other interested stakeholders Projects will aim to support development of HL7 electronic standards for transmission of data to and from VR systems to facilitate capturing VR data at the point of contact or point of care

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

12. HL7 Domain Analysis Model The artifact produced from requirements analysis is a Domain Analysis Model that provides a synthesis of both information and behavioral requirements in a formal language (UML) using a common style Source: HL7 Development Framework www.hl7.org

13. HL7 VR Domain Analysis Model Serve to identify the birth and death registration work flow processes and stakeholders Provide an HL7 recognized format for representing the model to facilitate standards efforts Serve to guide future design and implementation efforts for standardizing the electronic data exchanges between VR systems and other public and private information systems

14. VR Birth Activities Model

15. VR Death Class Model

16. Next Steps for the HL7 VR DAM Continue to refine the model Incorporate modifications from the VSSC & HL7 Public Health and Emergency Response SIG Map and modify for consistency with MoVERS terminology Broader outreach through NCHS sponsored pilot project webinar Identify scope for future development of messages and/or structured documents

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

18. EHR-S Functional Model Standard The EHR-S FM presents a superset of functions for an EHR system from which a user/setting specific subset can be generated It lists all of the functions that an EHR-S SHALL, SHOULD or MAY perform Creates a common platform forproviders, vendors, payers and others to describe needed EHR functionality

19. Overview of the EHR-S FM Standard • The HL7 EHR-S FM standard is: • Consensus-based • Internationally-oriented • Harmonized with predecessor healthcare-related efforts such as: • Committee é Européen de Normalisation (CEN 13606) • Institute Of Medicine • openEHR • ISO/TC 215 International Standards Organization Technical Specification 18308 • ASTM E31 Source; John Ritter, HL7 EHR-TC co-chair

20. 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

21. Overview of the EHR-S FM Standard

22. 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

23. Benefits of EHR-S Functional Profile • Creates a common platform for providers, vendors, partners, stakeholders and others to describe needed EHR functionality • The VR profile will facilitate EHR systems capturing vital records data at the point of contact or point of care • The VR profile will specify the functional requirements needed to support messaging among providers, states, local registrars and Federal agencies • The 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

24. EHR-S Vital Records FunctionalProfile Project Timeline • January 2008 • Project officially approved by HL7 • February – March 2008 • Call for Participation • 76 participants • Federal, state and local vital records representatives • Electronic Health Records and vital records systems developers • Funeral directors • Healthcare providers • Subject matter experts • Other stakeholders

25. EHR-S Vital Records Functional Profile Project Timeline • April 2008 – May 2009 (until complete) • Profile Development • Weekly conference calls • Wednesdays: 1:00-3:00 pm Eastern time • April 2008 • Workgroup formed • Orientation to EHR-S FM • Orientation to Creating a Functional Profile • Process and logistics • May 2008 • Begin to create profile

26. EHR-S VR Functional Profile Workgroups • Taskgroups: • Birth Records • Death Records • Each group meets bi-weekly • Tasks: • Review the EHR-S Functional Model • Identify vital record functions and conformance criteria • Assess and map MoVERS functional requirements to profile • Identify gaps and incorporate into VR profile • Obtain consensus on VR functions

27. Next Steps for VR Functional Profile • Register the Profile with HL7 • Consider balloting profile as an HL7 informative standard • Conduct outreach, explaining the value proposition to partners and key stakeholders • Consider presenting a proposal to the Certification Commission on Health Information Technology to explore developing certification criteria for EHR-S VR products

28. Contacts • Hetty Khan (NCHS) • hkhan@cdc.gov • 301 458-4311 • Michelle Williamson (NCHS) • mwilliamson@cdc.gov • 301-458-4618

29. Links for more information • HL7 EHR Technical Committeewww.hl7.org/ehr • National Institute of Standards and Technology www.nist.gov/profileregistry

30. Questions?