VRDR FHIR IG use of US Core Profiles

The purpose of this paper is to provide an assessment of the use of US Core Profile as base profiles for resource profiles defined within the VRDR FHIR IG. The Vital Record Death Reporting (VRDR) FHIR IG is the work product of project #1475. The project was approved by the USRSC as a US Realm project. The project completed the development of the guide and successfully balloted the guide as an STU in May 2019.

The guide has been used to inform implementation by the NCHS and in six public health agency jurisdictions for use in reporting certified deaths to the NCHS.  The guide has been adopted by IHE as a base specification for an international death reporting FHIR IG.

The process of ballot reconciliation introduced technical complications that took considerable effort and time to address. All ballot comments have been addressed and the guide is now seeking publication approval. When seeking approval by the sponsoring workgroup, PHWG, the project team was informed of a requirement to explain not using US Core profiles where possible. We now understand that this is a requirement for all US realm projects.

The following VRDR IG resource profiles have been identified as ones for which an explanation for not using US Core profiles as a base is requested:

US Core Profile

VRDR Profile

Condition

VRDR-Cause-Of-Death-Condition.xml

 

VRDR-Condition-Contributing-To-Death.xml

 

 

DocumentReference

VRDR-Death-Certificate-Reference.xml

 

 

Location

VRDR-Death-Location.xml

 

VRDR-Disposition-Location.xml

 

VRDR-Injury-Location.xml

 

 

Observation

VRDR-Autopsy-Performed-Indicator.xml

 

VRDR-BirthRecordIdentifier.xml

 

VRDR-Death-Date.xml

 

VRDR-Decedent-Age.xml

 

VRDR-Decedent-Disposition-Method.xml

 

VRDR-Decedent-Education-Level.xml

 

VRDR-Decedent-Employment-History.xml

 

VRDR-Decedent-Pregnancy.xml

 

VRDR-Decedent-Transportation-Role.xml

 

VRDR-Examiner-Contacted.xml

 

VRDR-InjuryIncident.xml

 

VRDR-Manner-of-Death.xml

 

VRDR-Tobacco-Use-Contributed-To-Death.xml

 

 

Organization

VRDR-Funeral-Home.xml

 

VRDR-Interested-Party.xml

 

 

Practitioner

VRDR-Certifier.xml

 

VRDR-Death-Pronouncement-Performer.xml

 

VRDR-Mortician.xml

 

 

PractitionerRole

VRDR-Funeral-Home-Director.xml

 

 

Procedure

VRDR-Death-Certification.xml

 

 

We understand that the purpose behind explaining non-use is to ensure that the US Realm project conduct due diligence in assessing the US Core profiles as fit for purpose to aid in identifying potential areas of improvement and to ensure compatibility among all US realm FHIR specifications. Here are our findings:

The following US Core profiles are free of any impediments to their use:

  • Location
  • PractionerRole
  • Procedure

The VRDR project will adopt these as base profiles where applicable.

The following US Core Profiles contain mandatory elements not utilized by VRDR that present an impediment to their use.

  • Condition. category
  • DocumentReference .category
  • DocumentReference. subject
  • Organization. active
  • Practitioner. identifier

If the requirement for these elements were reduced to optional the VRDR would be able to use these US Core profiles.

The US Core Observation profile is used for vital sign observations only. The VRDR Observation profiles are not related to vital signs. Perhaps a more generic use of the observation resource should be defined within the US Core IG.

The US Core Practitioner and PractitionerRole resources require support of the US National Provider Identifier (NPI) as one of many identifier types. The IHE international implementation of the VRDR IG would have difficulty with the requirement to support the use of NPI.

These profiles would be more easily adopted if the requirements to support NPI was removed.