Official Website of the Office of the National Coordinator for Health Information Technology
Physiologic measurements of a patient that indicate the status of the body’s life sustaining functions.
Data Element |
Applicable Vocabulary Standard(s) |
|---|---|
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Systolic Blood Pressure
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Both standards are required.
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Diastolic Blood Pressure
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Both standards are required.
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Heart Rate
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Respiratory Rate
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Body Temperature
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Body Height
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Body Weight
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Pulse Oximetry
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Inhaled Oxygen Concentration
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BMI Percentile (2 - 20 years)
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Weight-for-length Percentile (Birth - 36 Months)
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Head Occipital-frontal Circumference Percentile (Birth - 36 Months)
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Data Element |
Applicable Vocabulary Standard(s) |
|---|---|
|
Systolic Blood Pressure
|
Both standards are required.
|
|
Diastolic Blood Pressure
|
Both standards are required.
|
|
Heart Rate
|
|
|
Respiratory Rate
|
|
|
Body Temperature
|
|
|
Body Height
|
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Body Weight
|
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Pulse Oximetry
|
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|
Inhaled Oxygen Concentration
|
|
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BMI Percentile (2 - 20 years)
|
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|
Weight-for-length Percentile (Birth - 36 Months)
|
|
|
Head Occipital-frontal Circumference Percentile (Birth - 36 Months)
|
|
Data Element |
Applicable Vocabulary Standard(s) |
|---|---|
|
Systolic Blood Pressure
|
Both standards are required
|
|
Diastolic Blood Pressure
|
Both standards are required
|
|
Heart Rate
|
Both standards are required
|
|
Respiratory Rate
|
Both standards are required
|
|
Body Temperature
|
Both standards are required
|
|
Body Height
|
Both standards are required
|
|
Body Weight
|
Both standards are required
|
|
Pulse Oximetry
|
Both standards are required
|
|
Inhaled Oxygen Concentration
|
Both standards are required
|
|
BMI Percentile (2 - 20 years)
|
Both standards are required
|
|
Weight-for-length Percentile (Birth - 24 Months)
|
Both standards are required
|
|
Head Occipital-frontal Circumference Percentile (Birth - 36 Months)
|
Both standards are required
|
Data Element |
Applicable Vocabulary Standard(s) |
|---|---|
|
Systolic Blood Pressure
|
Both standards are required
|
|
Diastolic Blood Pressure
|
Both standards are required
|
|
Heart Rate
|
Both standards are required
|
|
Respiratory Rate
|
Both standards are required
|
|
Body Temperature
|
Both standards are required
|
|
Body Height
|
Both standards are required
|
|
Body Weight
|
Both standards are required
|
|
Pulse Oximetry
|
Both standards are required
|
|
Inhaled Oxygen Concentration
|
Both standards are required
|
|
BMI Percentile (2 - 20 years)
|
Both standards are required
|
|
Weight-for-length Percentile (Birth - 24 Months)
|
Both standards are required
|
|
Head Occipital-frontal Circumference Percentile (Birth - 36 Months)
|
Both standards are required
|
Data Element |
Applicable Vocabulary Standard(s) |
|---|---|
|
Systolic Blood Pressure
|
Both standards are required.
|
|
Diastolic Blood Pressure
|
Both standards are required.
|
|
Average Blood Pressure
Arithmetic average of systolic and diastolic components of two of more blood pressure readings in a specified time period or according to a specified algorithm or protocol. Examples include but are not limited to 3-day morning and evening home monitoring, clinical encounter repeat average, and 24-hour ambulatory measurement. |
Both standards are required.
|
|
Heart Rate
|
Both standards are required
|
|
Respiratory Rate
|
Both standards are required
|
|
Body Temperature
|
Both standards are required
|
|
Body Height
|
Both standards are required
|
|
Body Weight
|
Both standards are required
|
|
Pulse Oximetry
|
Both standards are required
|
|
Inhaled Oxygen Concentration
|
Both standards are required
|
|
BMI Percentile (2 - 20 years)
|
Both standards are required
|
|
Weight-for-length Percentile (Birth - 24 Months)
|
Both standards are required
|
|
Head Occipital-frontal Circumference Percentile (Birth - 36 Months)
|
Both standards are required
|
Data Element |
Applicable Vocabulary Standard(s) |
|---|---|
|
Systolic Blood Pressure
|
Both standards are required.
|
|
Diastolic Blood Pressure
|
Both standards are required.
|
|
Average Blood Pressure
Arithmetic average of systolic and diastolic components of two of more blood pressure readings in a specified time period or according to a specified algorithm or protocol. Examples include but are not limited to 3-day morning and evening home monitoring, clinical encounter repeat average, and 24-hour ambulatory measurement. |
Both standards are required.
|
|
Heart Rate
|
Both standards are required.
|
|
Respiratory Rate
|
Both standards are required.
|
|
Body Temperature
|
Both standards are required.
|
|
Body Height
|
Both standards are required.
|
|
Body Weight
|
Both standards are required.
|
|
Pulse Oximetry
|
Both standards are required.
|
|
Inhaled Oxygen Concentration
|
Both standards are required.
|
|
BMI Percentile (2 - 20 years)
|
Both standards are required.
|
|
Weight-for-length Percentile (Birth - 24 Months)
|
Both standards are required.
|
|
Head Occipital-frontal Circumference Percentile (Birth - 36 Months)
|
Both standards are required.
|
Data Element |
Applicable Vocabulary Standard(s) |
|---|---|
|
Systolic Blood Pressure
|
Both standards are required.
|
|
Diastolic Blood Pressure
|
Both standards are required.
|
|
Average Blood Pressure
Arithmetic average of systolic and diastolic components of two of more blood pressure readings in a specified time period or according to a specified algorithm or protocol. Examples include but are not limited to 3-day morning and evening home monitoring, clinical encounter repeat average, and 24-hour ambulatory measurement. |
Both standards are required.
|
|
Heart Rate
|
Both standards are required.
|
|
Respiratory Rate
|
Both standards are required.
|
|
Body Temperature
|
Both standards are required.
|
|
Body Height
|
Both standards are required.
|
|
Body Weight
|
Both standards are required.
|
|
Pulse Oximetry
|
Both standards are required.
|
|
Inhaled Oxygen Concentration
|
Both standards are required.
|
|
BMI Percentile (2 - 20 years)
|
Both standards are required.
|
|
Weight-for-length Percentile (Birth - 24 Months)
|
Both standards are required.
|
|
Head Occipital-frontal Circumference Percentile (Birth - 36 Months)
|
Both standards are required.
|
Data Element |
Applicable Vocabulary Standard(s) |
|---|---|
|
Systolic Blood Pressure
|
Both standards are required.
|
|
Diastolic Blood Pressure
|
Both standards are required.
|
|
Average Blood Pressure
Arithmetic average of systolic and diastolic components of two of more blood pressure readings in a specified time period or according to a specified algorithm or protocol. Examples include but are not limited to 3-day morning and evening home monitoring, clinical encounter repeat average, and 24-hour ambulatory measurement. |
Both standards are required.
|
|
Heart Rate
|
Both standards are required.
|
|
Respiratory Rate
|
Both standards are required.
|
|
Body Temperature
|
Both standards are required.
|
|
Body Height
|
Both standards are required.
|
|
Body Weight
|
Both standards are required.
|
|
Pulse Oximetry
|
Both standards are required.
|
|
Inhaled Oxygen Concentration
|
Both standards are required.
|
|
BMI Percentile (2 - 20 years)
|
Both standards are required.
|
|
Weight-for-length Percentile (Birth - 24 Months)
|
Both standards are required.
|
|
Head Occipital-frontal Circumference Percentile (Birth - 36 Months)
|
Both standards are required.
|
Data Element |
|---|
Data Element |
|---|
Submitted by rdillaire on
CMS CCSQ supports CDC’s recommendation to revise the Vital Signs data class description to include the following: “Usage note: in addition to the reported value, may include information on body site, method, reference range low/high/age, and component reference range low/high/age.”
Submitted by NCQA on
NCQA appreciates the addition of average blood pressure to USCDI v4. However, in order for the element to be usable in population health contexts and for hypertension management, additional context for how average blood pressure was calculated is required. Specifically, the time intervals between readings used to calculate average are critical, and the measurement device used for the readings supports appropriate interpretation. We encourage ONC to continue to refine the element with input from stakeholders working on specific interoperability use cases.
Submitted by jenna.stern on
BMI: Inclusion of BMI would allow for quicker querying of patients in FHIR via BMI rather than having to calculate BMI from the data elements Body height and Body weight. A potential benefit to patients is that addition of BMI would provide more health information, especially as certain patients may not do the calculations themselves (e.g., patients outside of the 2-20 years range for which BMI percentile is included currently).
Vital Sign Results: date and timestamps: The addition of dates and time stamps would allow for trending of vital signs over time from various visits rather than relying on the date that the vital sign results were uploaded. This information could be especially helpful when initially adding patient data into FHIR databases. For example, if 3 blood pressures from different visits across 3 different months were all uploaded at once into a FHIR server, they would all show the same date that they were uploaded rather than having a reference date from when they were actually recorded.
Submitted by aphillips@imoh… on
Data Class: Vital Signs
Level 2 Data Element: BMI
Level 2 Data Element: Vital sign results: date and timestamps
Level 2 Data Element: Average Blood Pressure
Level 2 Data Element: Oxygen delivery device
IMO supports the inclusion of the proposed Level 2 data elements for the Vital Signs data class in USCDI V3. The Level data elements included in the submission are incorporated in eCQMs reported in CMS quality programs, represented in implemented terminology specifications such as the, CDA R2 C-CDA Templates for Clinical Notes R2.1, and C-CDA Document Types for History and Physical and Care Plan, documented in structured data, and incorporated in interoperability requirements for ONC certified HIT.
Submitted by mrallins on
The Regenstrief Institute supports the addition of average/mean Blood pressure as a distinct and additional data element within the vital signs class of USCDI V3. Including average blood pressure to the USCDI is critically important in supporting health care providers with diagnosing high blood pressure and more effectively assessing blood pressure control.
The Regenstrief institute has been working with the American Medical Association to ensure that there is a broad set of LOINC content to express BP readings. Included in this set are LOINC concepts to encode the average systolic and average diastolic blood pressure over a defined time period or number of readings to more robustly represent a patient’s true blood pressure for clinical decision making. The specific panel that includes average diastolic and systolic can be found here: Average Blood Pressure Panel.
Submitted by jhall@msm.edu on
I support the promotion of Average Blood Pressure into the draft USCDI v4.
Submitted by mrallins on
The Regenstrief Institute supports the addition of average/mean Blood pressure as a distinct and additional data element within the vital signs class of USCDI V3. Including average blood pressure to the USCDI is critically important in supporting health care providers with diagnosing high blood pressure and more effectively assessing blood pressure control.
The Regenstrief institute has been working with the American Medical Association to ensure that there is a broad set of LOINC content to express BP readings. Included in this set are LOINC concepts to encode the average systolic and average diastolic blood pressure over a defined time period or number of readings to more robustly represent a patient’s true blood pressure for clinical decision making. The specific panel that includes average diastolic and systolic can be found here: Average Blood Pressure Panel.
Submitted by CDC_DSMH_WG on
The California Department of Public Health recommends adding the following data elements for the Patient Profile in exchange between EHRs:
Last reported blood pressure (both systolic and diastolic if possible)
Last PHQ-9 >10 consistent with moderate to severe depression
Last BMI >30 consistent with medical obesity
Pregnancy Status (if pregnant, estimated date of delivery)
CDPH recommends that providers screen patients for signs of loneliness as per the three-item loneliness scale in the journal article "Social Isolation and Loneliness: The New Geriatric Giants: Approach for Primary Care" at Can Fam Physician. 2020 Mar;66(3):176-182. PMID: 32165464.
For patients older than 65 years of age: Last asked about cognitive impairment/Last memory assessment (e.g., Mini-Cog© S. Borson) administered.
Results of Adverse Childhood Experiences screening questions (i.e., number and type of ACEs)
Referrals made based on ACEs screening results/score
Resources provided based on ACEs screening results/score
Was patient referred to child welfare services as a result of the screening results/score
Number and type of Positive Childhood Experiences (PCEs)
Submitted by dvreeman on
The CMS Data Element Library (DEL) Health IT Workgroup supports the importance of representing Pain as a multifaceted domain. We recommend that USCDI offer support for representing pain observations (both clinician observed and patient + care team member reported) using the common structure of Observations (e.g. Observation.code, Observation.value, Observation.performer). Such a structure, using codes from LOINC to identify the observations, offers a consistent pattern for representing the many dimensions of importance in different contexts (frequency, effect on function, intensity, interference with activities, etc). Pain observations across these dimensions are included the assessments used in post acute care settings.
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Submitted by CDC_DSMH_WG on
CDC recommends that ONC should for the Vital Signs data class, include the following language in the data class description: Usage note: in addition to the reported value, may include information on body site, method, reference range low/high/age, and component reference range low/high/age. Rationale: The current definitions for the data elements under the Vital Signs definitions data class do not clearly indicate which contextual elements accompany the measurement. Body site, method, and age-specific reference ranges can be necessary to accurately interpret vital sign results. Explicitly including these elements usage notes would improve consistency with FHIR/QI-Core and support clinical interpretation, quality measurement, and reporting.
FHIR path(s):
Observation.bodySite (VS),
Observation.method (VS),
Observation.referenceRange.low (VS), Observation.referenceRange.high (VS), Observation.referenceRange.age (VS), Observation.component.referenceRange.low (VS), Observation.component.referenceRange.high (VS), Observation.component.referenceRange.age (VS)