Birth And Fetal Death (BFDR) FHIR Implementation Guide, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-bfdr/ and changes regularly. See the Directory of published versions

Usage

Child and Decedent Fetus Name

Natality: When the child's name is not chosen, a dataAbsentReason should be provided with code "temp-unknown."
Fetal Death: When the decedent fetus is not named, a dataAbsentReason should be provided with code "unknown."

Mother or Infant Transferred

If mother transferred for delivery, hospitalization.admitSource in the EncounterMaternity profile should be provided with code "hosp-trans" (from HL7 admit-source codesystem). Any other admitSource code will be interpreted as 'N', with "other" being the recommended code to express mother did not transfer. The absence of a code will be interpreted as Blank (NCHS may interpret as Unknown). If source of transfer is unknown, hospitalization.admitSource should be set to "hosp-trans" and hospitalization.origin.name should be set to "UNKNOWN" in the EncounterMaternity profile.

Similarly, if the infant transferred within 24 hours of delivery, hospitalization.dischargeDisposition in the EncounterBirth profile should be provided with code "other-hcf" (from HL7 discharge-disposition codesystem) Any other dischargeDisposition code will be interpreted as 'N', with "oth" being the recommended code to express infant did not transfer. The absence of a code will be interpreted as Blank (NCHS may interpret as Unknown). If destination of transfer is unknown, hospitalization.destination.name should be set to "UNKNOWN" in the EncounterBirth profile.

Partial Dates

While IJE supports individual components of a date, FHIR dateTime supports partial dates only when the components with greater units than the missing component are included. That is, YYYY, YYYY-MM, and YYYY-MM-DD are supported by default, while YYY-XX-DD, for example, would not be.

Specifying None of the Above and Missing Data

See the discussion of categories.

Abnormal Conditions of Newborn

If ObservationNoneOfSpecifiedAbnormalConditionsOfNewborn is present in bundle, then the interpretation is that all individual Abnormal Conditions of the Newborn are 'N'

Maternal Morbidities

If ObservationNoneOfSpecifiedMaternalMorbidities is present in bundle, then the interpretation is that all individual Maternal Morbities are 'N'

Characteristics of Labor and Delivery

If ObservationNoneOfSpecifiedCharacteristicsOfLaborAndDelivery is present in bundle, then the interpretation is that all individual Characteristics of Labor and Delivery are 'N'

Pregnancy Risk Factors

If ObservationNoneOfSpecifiedPregnancyRiskFactors is present in bundle, then the interpretation is that all individual Pregnancy Risk Factors are 'N'

Congenital Anomalies of Newborn

If ObservationNoneOfSpecifiedCongenitalAnomoliesOfTheNewborn is present in bundle, then the interpretation is that all individual Congenital Anomolies of the Newborn are 'N' and ConditionCongenitalAnomalyOfNewborn should not be used.

Infection Present During Pregnancy

If ObservationNoneOfSpecifiedInfectionsPresentDuringPregnancy is present in bundle, then the interpretation is that all Infections During Pregnancy are 'N' and ConditionInfectionPresentDuringPregnancy should not be used.

Method of Delivery

If ObservationUnknownFinalRouteMethodDelivery is present in bundle, then the interpretation is that the method of delivery is unknown, and ProcedureFinalRouteMethodDelivery should not be used.

Obstetric Procedures

If ObservationNoneOfSpecifiedObstetricProcedures is present in bundle, then the interpretation is that external cephalic procedure was not performed, and ProcedureObstetric should not be used.

'Other' in InfectionsDuringPregnancyLiveBirth and NewbornCongenitalAnomalies

Since other infections and congenital anomalies could be of interest/value for use cases outside of natality, the value 'Other' is included in these valuesets (see InfectionsDuringPregnancyLiveBirthVS and NewbornCongenitalAnomaliesVS). However, use of #OTH is not allowed for submissions to NCHS.

Handling of Edit Flags

Edit flags supports validation as part of the Jurisdiction to NCHS use case and can be ignored for the provider to jurisdiction use case. The validation checks are done at the jurisdiction prior to sending to the National Statistical Agency and are based on the item specific edit criteria specified in the Edit Specifications for the 2003 Revision of the U.S. Standard Certificate of Birth and the Edit Specifications for the 2003 Revision of the U.S. Standard Report of Fetal Death.