Vital Records Common Library (VRCL) STU2-ballot
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Vital Records Common Library (VRCL) STU2-ballot, 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/vr-common-library/ and changes regularly. See the Directory of published versions

Vital Records FHIR Implementation Guide Harmonization Plan

National Vital Statistics System (NVSS) Modernization: Mortality and Birth

The Centers for Disease Control (CDC) National Center for Health Statistics (NCHS) Division of Vital Statics (DVS) is currently modernizing the submission of vital records to the National Vital Statistics System (NVSS). CDC/NCHS/DVS funds the development of the FHIR IGs for submission submission of death records – Vital Records Death Reporting (VRDR) – and birth and fetal death records – Birth and Fetal Death Reporting (BFDR), manages the NVSS Community of Practice (CoP), and holds quarterly testing events. Vital records offices (VROs) participate in these testing events with some on the path to pre-certification as a milestone for moving into production submission via FHIR to NVSS.

NCHS has begin the transition of submission of death records by VROs to NCHS based on VRDR STU2.2. The next vital records process planned for FHIR-based modernization is the submission of birth records. To support submission of birth records from VROs to NCHS requires extension of the BFDR and VRCL FHIR IGs. Both VRCL STU2 and BFDR STU2 were balloted in the January 2024 ballot cycle with the goal of enabling initial testing of birth record submission during 2024. This page describes the structural and content changes to BFDR and VRCL as they move from STU1.1 to STU2, and the motivation for making these changes.

CDC/NCHS Active Projects: Medicolegal Death Investigation

FHIR Implementation Collaborative led by the CDC Foundation is working with CDC/NCHS’s Collaborating Office for Medical Examiners and Coroners (COMEC) to test and pilot FHIR-based Application Programming Interface (API) enabled data exchange for medicolegal death investigation workflows. This effort is a collaboration with MDI offices and identified partners: state vital records offices, toxicology labs and/or other entities. It funds development of the Medicolegal Death Investigation (MDI) FHIR IG as well as collaborative testing events with MDI sites.

Goals of FHIR IG Harmonization

The goals of FHIR IG development and harmonization are:

  • Support known/anticipated use cases
    • direct (death, birth, fetal death, MDI) vital records use cases
    • ancillary (birth defects) vital records use cases
  • Enable BFDR to support EBRS-NCHS and EBRS-EBRS Use Cases
  • Support all IJE fields in current/contemplated usage
  • Support full round trip IJE–>FHIR–>IJE without data loss
    • NCHS approach to race/ethnicity
    • Address coding
    • Clear distinction between No, Unknown, and Not Provided
    • Eliminate redundancy & improve consistency of representation among VR IGs
    • Consistent documentation style across vital records IGs to ease implementation

Harmonizing Vital Records Related FHIR IGs

To achieve the goals for harmonization listed above involves modification to the content of the current IGs, development of new content, and transition of content between the IGs. This will reduce the proliferation of content across the set of IGs due to redundancy and near-redundancy, simplify implementation of the IGs, and simplify adoption.

Figure 1 shows the current dependencies among published vital reocrds FHIR IGs. Figure 2 shows the dependencies after harmonization. Harmonization will result in significant simplification of the MDI IG, and consolidation of all general Vital Records specific content within the VRCL.

Figure 1: Current Vital Records FHIR IG Dependencies
Figure 2: Harmonized (Future) Vital Records FHIR IG Dependencies

Changing Dependencies - Birth Defects IG

Although it has not yet been balloted, the design of the VRCL STU1 was driven by consideration of a future Birth Defects FHIR IG. The dependencies of this not-yet-balloted IG would change as a result of the harmonization effort, since much birth-related content has been consolidated within The BFDR STU2 IG. This change should not impact the ability of the Birth Defects IG to leverage vital records content, but would change the precise dependencies. Figure 3 shows the current dependencies of a potential Birth Defects FHIR IG. Figure 4 shows the dependencies following the proposed harmonization.

Figure 3: Current Birth Defects FHIR IG Dependencies
Figure 4: Harmonized (Future) Birth Defects FHIR IG Dependencies

Approach to Harmonization

To implement the goals of harmonization described above, the following content changes are being made:

  • Birth-specific content –> BFDR STU2
    • Primary change:  move birth/fetal-death specific content VRCL –> BFDR STU2
  • Death specific content –> VRDR STU3
    • Primary change:  MDI STU2 dependency on VRDR STU3
  • Generalize VRDR STU2 content to support VRDR and MDI
  • Common demographic elements, extensions, valueSets –> VRCL STU2
    • Primary change:  VRDR STU3, MDI STU2, BFDR STU2 dependency on VRCL STU2
    • VRCL STU2 provides content supporting vital records approach to race, ethnicity, partial dates/times, addresses, education level