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Birth Defects DAM and FHIR IG
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1532
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No
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No
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1f. Name of standard being reaffirmed
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1h. ISO/IEC Standard to Adopt
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Project Services
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Craig Newman, Thanh Cheng
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AbdulMalik Shakir
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Craig Newman
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Shu McGarvey
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2i. Domain Expert Representative
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Thanh Cheng, Mike Yaskanin
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Craig Newman
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State of Michigan
Henry Ford Health System
Allscripts
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This project will be performed in several stages, some of which may happen concurrently. Any products (DAM, implementation guides, etc) will be officially balloted through HL7.
○ Phase 1 will being with an existing analysis of data requirements in the state of Michigan and expand to collect reporting requirements from the CDC and as many jurisdictions as possible to create a comprehensive birth defect reporting domain analysis model (DAM). This part of the project will also document use cases jurisdictions have beyond the existing ambulatory and hospital reporting use cases.
○ Phase 2 will focus on developing FHIR specifications for exchanging birth defect content between providers and registries. This will allow trading partners to select the format that works best for them. A variety of different FHIR workflows (messaging, SMART apps, RESTful services, etc) will be considered. US Core profiles will be used in the FHIR IG. If phase 1 indicates the US Core profiles are not appropriate to use, we will clearly document the need to diverge from US Core. This phase will also include updating the existing CDA IG if gaps are found during the creation of the DAM.
○ Phase 3 will investigate data exchanges beyond the initial reporting of birth defects. This could include responses from registries back to providers requesting more information or offering treatment guidance and additional resources. The use of a FHIR subscription model where a registry subscribes to receive updates on specific patients of interest as new data is collected could also be explored. Other areas of investigation that come up during the earlier phases may also be investigated.
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Over 40 jurisdictions in the United States have a birth defect registry. To date, a CDA implementation guide for reporting birth defects has been developed based on input from the CDC and 14 jurisdictions, but it is largely based on requirements and workflows gathered several years ago. While the CDA IG has been HL7 balloted, the data model underlying it has not. From experience with case reporting, we know that some EHR vendors prefer to implement FHIR IGs rather than CDA IGs. Before embarking on the development of a FHIR IG, we need to develop a broadly based domain analysis model (DAM) and perform a gap analysis between the DAM and the CDA IG. We will then develop one or more FHIR IGs, ensuring that consistent content and vocabularies are define regardless of the product family selected for use.
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No
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This PSS will cover the first 2 phases. If Phases 3 look like it will produce ballotable material then an additional PSS will be developed and submitted.
Phase 1 - Birth Defect DAM
Prepare and submit HL7 Project Scope Statement - May-Aug 2019
Gather input from Jurisdictions and prepare DAM - July 2019-March 2020
Ballot Informative DAM - May 2020*
Complete ballot reconciliation - September 2020
Publish DAM October 2020
*Because of the timing of the HL7 ballot periods in 2020, it may be possible to make the January/February 2020 ballot cycle which would accelerate the reconciliation and publishing timelines.
Phase 2 - Birth Defect FHIR IG
Prepare FHIR IG (and if necessary) update the existing CDA IG - January-Aug 2020
Ballot STU IG - September 2020
Complete ballot reconciliation - January 2021
Publish IG(s) - February 2021
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Birth Defects, Ambulatory Reporting, Hospital Reporting
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Sibling of the existing birth defect reporting CDA IG
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https://confluence.hl7.org/display/PHWG/Public+Health+Registries+Reporting and child pages
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N/A
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No
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Not a V3/CDA project
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Yes
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LOINC, SNOMED, ICD10, RxNorm
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Domain Analysis Model (DAM), FHIR Extensions, FHIR Implementation Guide, FHIR Profiles
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Likely R4
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Create new standard, Implementation Guide (IG) will be created/modified
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No
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5a. Revising Current Standard Info
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Informative, STU to Normative
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DAM will be informative; IG will be STU to Normative
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No
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no
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Reporting requirements will be gathered from state and local jurisdictions and likely the CDC as well. The National Birth Defect Prevention Network is also interested in participating.
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No
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No
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Yes
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Other
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Public Health birth defect registries
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EHR, PHR
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U.S. Realm Specific
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May 21, 2019
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FHIR
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May 22, 2019
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Jun 03, 2019
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5 Comments
Anthony Julian
RE: Project ballot type: Since this project includes multiple deliverables, it should define which artifacts will be balloted at which level.
RE: Implementers: Only 1 is defined, the second is vague. The STU ballot depends on two defined implementers. Approval should be contingent on discovering a second.
RE: Project intent: Scope includes DAM, extensions, and IG. Project intent only states "Implementation Guide (IG) will be created/modified "
Austin Kreisler
There's no mention of the FHIR IG conforming to the FHIR US Core profile. The question for USRSC is should it?
Craig Newman
This is a possibility but we'd need to do more investigation (presumably as part of the DAM work) to make sure US Core will work for us. Plus, there seems to be discussion on Zulip about "must support" on the US Core profiles causing problems for other use cases that want to reuse those profiles. I think out goal will be to use US Core if appropriate.
Craig Newman
US Realm also suggested that we construct a CDA to FHIR mapping once both IGs are available. This could be done but we should work with SOA and their cross-transformation project (see May 2019 ballot) and leverage their work where possible.
Craig Newman
There is a separate PSS (previously approved) that covered the creation of the CDA IG. If we find that updates to that CDA IG are required (due to issues found during DAM creation and/or FHIR IG authoring), we will update the CDA IG as part of that pre-existing PSS so that this PSS can focus solely on the DAM and FHIR IG (which are not part of any other PSS). We have removed CDA as a work product for this reason.