Data Element
Estimated Date of Delivery
Description

The expected date of delivery (i.e. the due date).
Submitted By: Craig Newman / Altarum
Data Element Information
Data Element Description The expected date of delivery (i.e. the due date).
Use Case Description(s)
Use Case Description An expectant mother’s pregnancy attributes are crucial for providing the best possible pre-natal care. As well, after delivery, Public Health needs to capture this data as part of birth certification, fetal death reporting and birth defect reporting. In particular, birth certification forms the basis of the patient census required by a large number of other Public Health programs including newborn screening, birth defect reporting and immunization registries making it critical that birth certification is as automated, timely and accurate as possible.
Estimate the breadth of applicability of the use case(s) for this data element Consumption of this data is widespread. Every jurisdiction in the country captures birth certification information and immunization adminstration. Most also capture birth defects and fetal deaths. Healthcare systems which provide care for expectant mothers should be collecting this data.
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) LOINC codes exist for each of the proposed data elements:
8665-2 - Last menstrual period start date
11778-8 - Delivery date Estimated
56077-1 - Body weight --pre current pregnancy

https://loinc.org/
Additional Specifications Vital Records Common Profiles Library FHIR IG - http://build.fhir.org/ig/HL7/fhir-vr-common-ig/branches/master/index.html
Birth Defect Reporting FHIR IG - https://build.fhir.org/ig/HL7/fhir-birthdefectsreporting-ig/index.html
Vital Records Birth and Fetal Death Reporting - https://build.fhir.org/ig/HL7/fhir-bfdr/index.html
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Supporting Artifacts This data is exchanged routinely as part of birth certification, fetal death reporting and birth defect reporting, however these workflow typically are executed on paper or via flat files rather than through electronic interoperability.
Extent of exchange N/A
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns No concerns over and above the typically privacy and security considerations associated with any health related data.
Estimate of Overall Burden These data elements are straightforward in nature and should not present a large burden to implement provided the EHR system is capturing the data as part of caring for the woman.

Comment

Submitted by minigrrl on

What is the justification…

What is the justification for the demotion of the following Case Reporting data elements in USCDI, specifically:

• Exposure/Contact Information: Exposure/Contact Agent
• Exposure/Contact Information: Exposure/Contact Date
• Exposure/Contact Information: Exposure/Contact Direction
• Exposure/Contact Information: Exposure/Contact Source/Target Participant
• Exposure/Contact Information: Exposure/Contact Type
• Health Insurance Information: Medicare Patient Identifier
• Immunizations: Vaccination Administration Date
• Laboratory: Specimen Collection Date/Time
• Patient Demographics/Information: Patient Birth Place
• Patient Demographics/Information: Tribal Enrollment
• Pregnancy Information: Estimated Date of Delivery
• Pregnancy Information: Gestational Age
• Pregnancy Information: Last Menstrual Period (LMP)
• Provenance: Unique Identifier
• Social Determinants of Health: Housing Instability and Homelessness
• Social History: Congregate Living
• Work Information: Employment Status
• Work Information: Job Employer Address
• Work Information: Job Employer Name
• Work Information: Usual Industry
• Work Information: Usual Occupation

Currently, 21 certified EHR products exchange these elements using electronic Case Reporting (eCR) specifications demonstrating real-world adoption that typically supports promotion, not demotion, within the USCDI maturity model.

Collectively, these elements provide clinical, demographic, occupational, social, and epidemiological context essential to disease investigation and outbreak response for nationally notifiable conditions.

We urge ONC to either reverse this decision or publish a detailed, evidence-based rationale.

Submitted by BLampkins_CSTE on

CSTE Comment - v6

CSTE supports inclusion of this data element in USCDI V6. Please see previously submitted CSTE comments for additional recommendations.

Submitted by CDC_DSMH_WG on

CDC comment on Estimated Date of Delivery

CDC requests this data element be considered for inclusion in USCDI V6.  A recent CDC/NACHC postpartum care services project documented the feasibility of collecting the data element in EHRs, and the importance for interoperability standards to support data exchange between health organizations to enhance quality improvement initiatives to improve perinatal outcomes.

Justification: Estimated Date of Delivery is the date representing the expected delivery date of a pregnancy. It is a physician's best estimate of the date of delivery and is determined at the initial diagnosis of pregnancy and can be confirmed by an ultrasound, physical exam, or last menstrual period. This data element is critical for helping health care providers make informed decisions for the care of the patient (such as timing for recommended screenings and vaccinations), supporting maternal care coordination and care provision, and developing data and clinical care quality improvement initiatives. For data and clinical care quality improvement initiatives to be successful, there needs to be standardized documentation and follow-up based on stage of pregnancy and notifications for when postpartum care should begin.  Despite the importance of data to successfully identify, treat, and follow up with patients, critical data on pregnancy status and pregnancy outcomes are not standardized across electronic health records (EHRs). The use case will be relevant for all maternal health patients, all providers involved in maternal health care, and all consumers of maternal health data used for research, public health and patient care and quality outcomes.   

The Centers for Disease Control and Prevention, in partnership with the National Association of Community Health Centers (NACHC), worked to build capacity of Federally Qualified Health Centers to improve the health informatics infrastructure for perinatal care measures and use perinatal care measures to identify and address gaps in postpartum care (https://liebertpub.com/doi/10.1089/jwh.2024.0364). Partner health center-controlled networks (Alliance Chicago, Health Choice Network, OCHIN, and Aliados Health) and nine Community Health Centers, implemented strategies to integrate evidence-based recommendations into the clinic workflow and use data-driven health information technology (HIT) systems to improve data standardization for quality improvement of postpartum care services. The respective EHRs were able electronically capture, access and exchange this data element through adequate testing in staging and development EHR environments. NACHC has developed an implementation Guide (Improving Quality in Pregnancy and Postpartum Care to provide practical strategies to leverage data from electronic clinical data systems for improved maternal health care (NACHC-WHPP-Implementation-Guide-2024_3.pdf).   

This data element is captured as active in Logical Observation Identifiers Names and Codes (LOINC®) ontology as: 11780-4: Delivery date Estimated from ovulation date, a quantitative scale type and 57060-6: Estimated date of delivery Narrative, a narrative scale type.  

EDD is also captured in the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) as 161714006 and 738070007.  

Interoperability in the clinical space is key to optimizing many processes including the diagnosis, management, and transition of care from obstetricians to primary care clinicians for people with hypertensive disorders of pregnancy. Accurately capturing active pregnancies, their ultimate outcomes, and pertinent dates is a major challenge within electronic health records (EHRs). This has at least a two-fold potential negative impact: 1) people may not receive the guideline-recommended care they need during their pregnancy and postpartum phases and 2) women may appear to be continuously pregnant for multiple years in EHRs. Below is some additional information for consideration:

An exploration of IQVIA Ambulatory Electronic Medical Record (AEMR) data demonstrates that estimated delivery date is not universally captured for pregnant patients, even within OB/GYN practices. In IQVIA AEMR data from 2022-2023, CDC identified pregnant patients using a complex algorithm* that incorporates five types of measures: diagnoses, measurements, observations, procedures, and drugs. When CDC examined pregnant patients being treated by all types of clinical providers, of 34,238 pregnant patients, 10,614 (31%) had an observation that specified estimated delivery date. When CDC examined pregnant patients being treated by OB/GYN providers, of 6,583 pregnant patients, 3,848 (58.5%) had an observation that specified estimated delivery date. Thus, even among OB/GYN providers, more than 40% of patients identified as being pregnant through the comprehensive pregnancy electronic phenotype* did not have an EDD in their EHR. Moreover, the capture of EDD is not standardized across EHRs of clinical providers contributing data to IQVIA and the native data have to be mapped into 5 OMOP observations:  

  • Delivery date estimated 
  • Estimated date of delivery 
  • Delivery date US composite estimate 
  • Delivery date Estimated from last menstrual period 
  • Estimated date of delivery from antenatal ultrasound                       

 These findings speak to the need to include Estimated Delivery Date as a required USCDIv6 data element to provide a standardized, universally captured data point that allows for the characterization of pregnancy and calculation of gestational age (both of which have widespread implications for clinical practice across specialties). 

*Matcho A, Ryan P, Fife D, Gifkins D, Knoll C, Friedman A. Inferring pregnancy episodes and outcomes within a network of observational databases. PLoS One. 2018 Feb 1;13(2):e0192033. doi: 10.1371/journal.pone.0192033. 

Submitted by CDC_DSMH_WG on

CDC's comment on behalf of CSTE for USCDI v5

  • https://www.healthit.gov/topic/federal-advisory-committees/collaboration-health-it-policy-and-standards-committees (See May 19 transmittal letter to the NC.  Click on charge 1 - Capturing Pregnancy Status, see MS Excel Spreadsheet)
  1. Pregnancy Status - Yes, No, Possible, Unknown
  2. Date pregnancy status recorded
  3. Estimated delivery date
  4. Pregnancy outcome
  5. Date of pregnancy outcome, and optionally 
  6. Postpartum status (this is important since if the mother recently gave birth and is diagnosed with a condition that could affect the neonate, public health action might be indicated).
  • Currently there are large gaps in the ability for data from electronic health records or ELR to capture sufficient pregnancy information to identify cases and measure the burden and outcome of medical conditions and infections in pregnancy on a population level. Standardizing these data for exchange would be a substantial step forward.
  • CSTE strongly urges ONC to include Estimated due date and not just gestational age as an element in USCDI since data are exchanged at points in time and gestational age at the time of recording may differ from gestational age at the time of the data transmission or receipt. Including estimated due date fixes the maturity of the pregnancy in time, as opposed to gestational age. If gestational age is favored as a variable to use, then it must be accompanied by a date of recording of the gestational age which requires additional data capture.
  • Finally, it is very important for electronic health records to develop a way to link the mother and infant records. A unique identifier for the mother which can be included in the infant's record, and a similar unique identifier for the infant which can be included in the mother's records would help to rectify this problem, which would be beneficial for both clinical care as well for public health when we receive data on mothers and infants but cannot link them (important for diseases such as HIV, listeria, Zika, syphilis, Hepatitis B, and others)

Submitted by CDC_DSMH_WG on

CDC's Consolidated Comment for USCDI v5

Proposed change:

  1. Please REMOVE the following from "Applicable Standard(s)" because they are not relevant to this data element:8665-2 - Last menstrual period start date56077-1 - Body weight --pre current pregnancy.
  2. Please KEEP the following in "Applicable Standard(s)": The LOINC code for the data element is:11778-8 - Delivery date Estimated (https://loinc.org/)
  3. Please REMOVE the following from "Additional Specifications" because they do not use this data element: Vital Records Common Profiles Library FHIR IG - http://build.fhir.org/ig/HL7/fhir-vr-common-ig/branches/master/index.htmlVital Records Birth and Fetal Death Reporting - https://build.fhir.org/ig/HL7/fhir-bfdr/index.html.

 

NACCHO supports removing this from the Estimated Delivery Date data element, but this should be kept in some form (either as a new data element or under another term). These details are critical to LHDs understanding what preventative programs they need to put into place to ensure a supported pregnancy and reduce negative newborn outcomes.

 

  • Kindly see the attachment.

DHDSP comments_USCDIv5_8-31-23_FINALv2_0.docx

Submitted by CDC_DSMH_WG on

CDC's comment on behalf of CSTE

CSTE Comment:

  • CSTE strongly recommends that pregnancy status be included in USCDI v4. However, a single variable is not sufficient to capture critical data that is needed for a large variety of conditions affecting the public's health, including maternal mortality, Hepatitis B and C, COVID-19, Zika, syphilis, and influenza, to name only a few.
  • CSTE urges the inclusion of the following variables in the core data  for exchange - as defined by the ONC Public Health Task Force on Capturing Pregnancy Data in Electronic Health Records and found here https://www.healthit.gov/sites/default/files/facas/HITJC_PHTF_Meeting_Slides_2017-03-30_0.pdf
  1. Pregnancy Status - Yes, No, Possible, Unknown
  2. Date pregnancy status recorded
  3. Estimated delivery date
  4. Pregnancy outcome
  5. Date of pregnancy outcome  and optionally
  6. Postpartum status (this is important since if the mother recently gave birth and is diagnosed with a condition that could affect the neonate, public health action might be indicated).
  • Currently there are large gaps in the ability for data from electronic health records or ELR to capture sufficient pregnancy information to identify cases and measure the burden and outcome of medical conditions and infections in pregnancy on a population level. Standardizing these data for exchange would be a substantial step forward.
  • Finally, it is very important for electronic health records to develop a way to link the mother and infant records. A unique identifier for the mother which can be included in the infant's record, and a similar unique identifier for the infant which can be included in the mother's records would help to rectify this problem, which would be beneficial for both clinical care as well for public health when we receive data on mothers and infants but cannot link them (important for diseases such as listeria, Zika, syphilis, Hepatitis B, and others)

Submitted by CDC_DSMH_WG on

CDC's Consolidated Comment

  • Viral hepatitis: Due date is collected as part of routine case surveillance for acute Hepatitis A, B, C, and chronic hepatitis B and C. Promote this data element as it is integral to understanding maternal and child health in relation to exposure to disease conditions
  • STD - congenital syphilis: this is very helpful for the reasons above (Treatment needed to start 30 days before delivery and risk of prematurity).  it would help care providers and HD know how close the female is to delivery and might help them prioritize cases.  Additionally, if the test date and due date are the same date and the female has no prior treatment, it will immediately let the HD know that there is an infant that needs follow.

CSTE Comment:

  • CSTE strongly recommends that pregnancy status be included in USCDI v3. However, a single variable is not sufficient to capture critical data that is needed for a large variety of conditions affecting the public's health, including maternal mortality, Hepatitis B and C, COVID-19, Zika, syphilis, and influenza, to name only a few. CSTE urges the inclusion of the following variables in the core data  for exchange - as defined by the ONC Public Health Task Force on Capturing Pregnancy Data in Electronic Health Records and found here https://www.healthit.gov/sites/default/files/facas/HITJC_PHTF_Meeting_Slides_2017-03-30_0.pdf
  1. Pregnancy Status - Yes, No, Possible, Unknown
  2. Date pregnancy status recorded
  3. Estimated delivery date
  4. Pregnancy outcome
  5. Date of pregnancy outcome,  and optionally
  6. Postpartum status (this is important since if the mother recently gave birth and is diagnosed with a condition that could affect the neonate, public health action might be indicated).

 

  • Currently there are large gaps in the ability for data from electronic health records or ELR to capture sufficient pregnancy information to identify cases and measure the burden and outcome of medical conditions and infections in pregnancy on a population level. Standardizing these data for exchange would be a substantial step forward.
  • Finally, it is very important for electronic health records to develop a way to link the mother and infant records. A unique identifier for the mother which can be included in the infant's record, and a similar unique identifier for the infant which can be included in the mother's records would help to rectify this problem, which would be beneficial for both clinical care as well for public health when we receive data on mothers and infants but cannot link them (important for diseases such as listeria, Zika, syphilis, Hepatitis B, and others)

 

Submitted by CDC_DSMH_WG on

Unified Comment from CDC

  • CSTE supports inclusion of this measure into USCDI v3: It is not sufficient for pregnancy information to only be referenced in problem list or as snomed code as a condition

Submitted by CDC_DSMH_WG on

Unified Comment from CDC

General Comment: Recommend moving this element to a new Mother's Pregnancy Information USCDI Class (not in the Observation class).

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