Birth And Fetal Death (BFDR) - 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-Preview1 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

Change Log

Post-Ballot Changes

Major

• FHIR-43458 - Improve support for birth, transfer-from, and transfer-to locations. Added new BFDR Location Profile, and updated EncounterMaternity and EncounterBirth to reference the new profile. Data dictionary has been updated to correctly document mapping of SFN and FNPI fields, and all other facility-related fields.
• FHIR-43473 - To improve consistency with VRDR the key reporting identifiers (birth cert no, fetal death report number, local file numbers, and overall record identifier) were moved from the Composition.identifier to the Bundle.identifier and were updated to use standardized extensions. The definitions of these extensions will also be moved to the Vital Records Common Library.

Minor

• FHIR-44679 Clarified precedence of QuestionnaireResponse data in patient_worksheet_questionnaries(patient_worksheet-questionnaires.html)
• Added PractitionerBirthAttendant and PractitionerBirthCertifier profiles with corresponding extensions that distinguish these two types of Practitioner
• FHIR-44554 Corrected FetalPresentationsVS and [FetalPresentationsCM] added a max binding that includes all abnormal presentations.
• FHIR-44555 Extended ObservationGestationalAgeAtDelivery for partial weeks and added two examples of its usage.
• Removed composition references to ObservationPlannedToDeliverAtHome profile. Reporting of home delivery plan relies on EncounterMaternity and EncounterBirth (using BirthDeliveryOccurredVS)
• FHIR-43506 - Added forms mappings for ObservationNoneOfSpecifiedCongenitalAnomoliesOfTheNewborn
• Fixing broken links in IJE mapping tables (PR)
• FHIR-43403 - Constrained units of all quantity values – ObservationBirthWeight, ObservationGestationalAgeAtDelivery, ObservationMotherDeliveryWeight, [ObservationMotherDeliveryHeight], ObservationMotherPrepregnancyWeight.
• reinstate missing Observation - Birth Plurality of Pregnancy FHIR-43383
• Added narrative content to clarify indicating ‘Y’, ‘N’, and ‘U’ for TRAN and ITRAN in the data dictionary usage page FHIR-43414
• Added missing IJE mappings for RelatedPersonFatherNatural profile
• Added roleVitalRecords to EncounterMaternity and EncounterBirth to make them easily queryable from the bundles with a simple FHIRPath expression without traversing Composition references.
• Concept maps added - BirthWeightEditFlagsCM, EstimateOfGestationEditFlagsCM, NumberPreviousCesareansEditFlagsCM, PregnancyReportEditFlagsCM
• Edit Flag Valueset cleanup: Edit flag codes were renamed to use consistent naming convention, which includes the IJE value in the name. Where possible, valuesets use the edit flag codes located in VRCL. For edit flag codes specific to BFDR, EditFlagsCS codesystem was added. Valueset and concept maps for FathersDateOfBirthEditFlags, MothersDateOfBirthEditFlags, and PluralityEditFlags were relocated to VRCL, since they are of general utility in the Patient and RelatedPersons profiles.
• Removed ‘None’ value from valueset NewbornCongenitalAnomaliesVS since ObservationNoneOfSpecifiedCongenitalAnomoliesOfTheNewborn is used for indicating ‘none’ and included ‘Other’ value in valueset for general utility with documentation in Usage page that it’s not allowed for NCHS submission
• PatientDecedentFetus made to reference ValueSetSexAssignedAtBirthVitalRecords
• Consolidated miscellaneous local codesystems into a single codesystem called LocalBFDRCodesCS
• Drop prefixes in titles so words like codesystem, valueset, extension, and conceptmap don’t appear twice
• renamed ObservationMethodOfDisposition to ObservationFetalRemainsDispositionMethod to help clearly distinguish it from DecedentDispositionMethod
• minor narrative corrections (FHIR-43953,FHIR-43951,FHIR-43950)

STU2 Ballot, January 2024

Major Changes

• Reorganization and harmonization of vital records FHIR IG content across BFDR, VRCL and VRDR to reduce redundancy, ease implementation, and reduce maintenance effort. See Vital Records IG Harmonization, and BFDR content changes.
• Incorporate the vital records approach to capturing race and ethnicity, and reporting coded race and ethnicity to support BDRS to NCHS use cases. See ObservationCodedRaceAndEthnicityVitalRecords, ObservationInputRaceAndEthnicityVitalRecords, and CompositionCodedRaceAndEthnicity.
• Incorporate the vital records approach to capturing usual work for mother and father, including adding an extension called roleVitalRecords to distinguish between mother and father. See ObservationUsualWorkVitalRecords.
• Incorporation of edit flags as extensions within profiles, rather than as standalone observations. This follows the path taken by VRDR STU2 that is in production use. See ObservationBirthWeight, ObservationGestationalAgeAtDelivery, ObservationMotherDeliveryWeight, ObservationMotherHeight, ObservationMotherPrepregnancyWeight, ObservationNumberPrenatalVisits, ObservationNumberPreviousCesareans, PatientDecedentFetus, ObservationEducationLevelVitalRecords, PatientVitalRecords, PatientMotherVitalRecords, RelatedPersonMotherVitalRecords, RelatedPersonFatherVitalRecords, RelatedPersonParentVitalRecords.
• Consistent support for groups of responses that have a ‘none-of-the-above’ response using Observations and categories. See categories. This includes resolution of FHIR-43001.
• Improved documentation of mapping of IJE fields to BFDR and VRCL profiles and fields. See Natality Data Dictionary and Fetal Death Data Dictionary.

Minor Changes

• Body Height LOINC Code 8302-2 Body Height Measured –> 3137-7 Body Height, based on new publication requirements. Mother’s Body Height based on USCoreBodyHeightProfile.
• Profile ID’s were changed for ObservationFetalDeathTimePoint, CoveragePrincipalPayerDelivery, and ObservationAntibioticsAdministeredDuringLabor to be made consistent with their profile names. EncounterMaternity profile name was changed from Encounter_Maternity to EncounterMaternity to be consistent with naming convention of EncounterBirth.

STU 1.1 Update, July 2023