Reporting Death Records to Public Health Agencies

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Federally required	Cost	Test Tool Availability
Implementation Specification	HL7® Vital Records Death Reporting (VRDR) FHIR Implementation Guide 2.0.0 - STU 2.2	Balloted Draft	Production	No	Free	Yes
Implementation Specification	IHE Quality, Research and Public Health Technical Framework Supplement Vital Records Death Reporting (VRDR) R 3.2	Balloted Draft	Pilot	No	Free	Yes
Implementation Specification	Medicolegal Death Investigation (MDI) 1.1.0 - STU 1.1	Balloted Draft	Pilot	No	Free	Yes

Limitations, Dependencies, and Preconditions for Consideration	Applicable Security Patterns for Consideration
Since November 2023 The National Center for Health Statistics (NCHS) has been onboarding State vital records offices in FHIR This effort includes the transmission of FHIR messages using HL7 Vital Records Death Reporting (VRDR) FHIR Implementation Guide 2.2.0 - STU 2. The following standards have been deprecated: HL7 Version 2.6 Implementation Guide: Vital Records Death Reporting, Release 1 STU R2.1 - US Realm HL7 CDA® R2 Implementation Guide: Vital Records Death Reporting, Release 1 STU 2.1 - US Realm The HL7 Medicolegal Death Investigation (MDI) FHIR implementation guide (IG) provides guidance on the exchange of information with medical examiner and coroners offices. This guide provides MDI case management system developers with the technical details and best practices to standardize MDI fields and interfaces. The Vital Records Common Library is a US Realm specific framework that provides common data elements between the birth and fetal death reporting and birth defects reporting FHIR® implementation guides. The purpose of this library is to avoid defining the same profiles multiple times within respective implementation guides.	Feedback requested.

Limitations, Dependencies, and Preconditions for Consideration

Applicable Security Patterns for Consideration

Since November 2023 The National Center for Health Statistics (NCHS) has been onboarding State vital records offices in FHIR This effort includes the transmission of FHIR messages using HL7 Vital Records Death Reporting (VRDR) FHIR Implementation Guide 2.2.0 - STU 2.
The following standards have been deprecated:
- HL7 Version 2.6 Implementation Guide: Vital Records Death Reporting, Release 1 STU R2.1 - US Realm
- HL7 CDA® R2 Implementation Guide: Vital Records Death Reporting, Release 1 STU 2.1 - US Realm
The HL7 Medicolegal Death Investigation (MDI) FHIR implementation guide (IG) provides guidance on the exchange of information with medical examiner and coroners offices. This guide provides MDI case management system developers with the technical details and best practices to standardize MDI fields and interfaces.
The Vital Records Common Library is a US Realm specific framework that provides common data elements between the birth and fetal death reporting and birth defects reporting FHIR® implementation guides. The purpose of this library is to avoid defining the same profiles multiple times within respective implementation guides.

Feedback requested.

Comment

Submitted by cbush on 2023-09-29

CDC/NCHS Updates

HL7® Vital Records Death Reporting (VRDR) FHIR Implementation Guide 2.0.0 - STU 2 - Latest version is 2.2.0 - STU 2.2 – expected to be published through HL7 during the time of this submission to ISA.

IHE Quality, Research and Public Health Technical Framework Supplement Vital Records Death Reporting (VRDR) R 3.2 - No active development since 2021 and no future planned development on this standard.

Update for Limitations, Dependencies, and Preconditions for Consideration:

State vital records offices will be working with The National Center for Health Statistics (NCHS) to move to production end of 2023. This effort will include the transmission of FHIR messages using HL7 Vital Records Death Reporting (VRDR) FHIR Implementation Guide 2.2.0-STU 2.2

The Vital Records Common Library (http://hl7.org/fhir/us/vr-common-library/STU1/) is a US Realm specific framework that provides common data elements among the vital records, Vital Records Death Reporting (VRDR), Birth and Fetal Death Reporting (BFDR) and Medicolegal Death Investigation (MDI) FHIR® implementation guides. The purpose of this library is to avoid defining the same profiles multiple times within respective implementation guides.

Submitted by cbush on 2022-10-06

CDC/NCHS Updates and Retirement of the v2 and CDA standards

Change emerging standard titled – “Vital Records Death Reporting v0.1.0 - STU Ballot #1” to an Implementation Specification – “HL7 Vital Records Death Reporting (VRDR) FHIR Implementation Guide 2.0.0 - STU 2”. Please note that ballot #1 for STU 1 was published. However, since the last ISA update VRDR FHIR STU 2 was balloted and published and will remain the active STU for implementation with the National Vital Statistics System (NVSS). The HL7 FHIR VRDR STU 1 will be retired. Type: Implementation Specification, #1: Standards Process Maturity: Balloted Draft, #2: Implementation Maturity: Pilot, #3: Adoption Level: Medium, #4: Federally Required: No, #5: Cost: Free, #6: Test Tool Availability: Yes (GitHub - nightingaleproject/canary: A FHIR VRDR testing framework for both data providers and consumers.)

The following can be removed from the “Limitations, Dependencies, and Preconditions for Consideration” section:

The National Center for Health Statistics (NCHS) had previously developed HL7® messaging and document standards for mortality reporting. NCHS has recently made the decision to move to the FHIR® standards for exchange of data between jurisdictions and NCHS and is in the process of developing an HL7® FHIR® IG for Death Reporting which should be published by January 2020. This will be tested at the IHE Connectathon in January 2020 and piloted at NCHS during that same year.

HL7® balloted HL7® Version 2.6 Implementation Guide: Vital Records Death Reporting, Release 2 (US Realm - Standard for Trial Use) in May 2019. Publication is expected by December 2019.

The V2 test tools above are found under "Tool scope: Vital Records"

The following can be added to the “Limitations, Dependencies, and Preconditions for Consideration” section:

State vital records offices will be working with The National Center for Health Statistics (NCHS) to move to production beginning in early 2023. This effort will include the transmission of FHIR messages using HL7 Vital Records Death Reporting (VRDR) FHIR Implementation Guide 2.0.0 - STU 2.

The following specifications are being retired to allow implementers to concentrate on the FHIR IG that has been created to support death reporting requirements. There are no current or planned standards development activity within NCHS for these standards; which may no longer be in use, or which should not be considered for use for these specifications.:

HL7® Version 2.6 Implementation Guide: Vital Records Death Reporting, Release 1 STU R2.1 - US Realm
HL7® CDA® R2 Implementation Guide: Vital Records Death Reporting, Release 1 STU 2.1 - US Realm

The Vital Records Common Library is a US Realm specific framework that provides common data elements between the birth and fetal death reporting and birth defects reporting FHIR® implementation guides. The purpose of this library is to avoid defining the same profiles multiple times within respective implementation guides.

Submitted by csnewman on 2022-09-29

Retirement of the v2 and CDA standards

The HL7 Public Health Work Group has officially retired the v2 and and CDA implementation guides. These should be removed from this list as implementers should focus on the FHIR standard.

Submitted by chris.baumgart… on 2022-09-20

WA State Department of Health Death Record Comments

Washington State Department of Health appreciates having the standards listed on the “Reporting Death Records to Public Health Agencies” page and does not have any new standards to recommend. We do have some comments about the standards listed:

The value binding link for VRDR Decedent address.district appears to be broken. The text of the hyperlink is correct but encoding the URL has broken the functionality of ‘?’ and ‘=’. Similar bugs appear in multiple places.
The change history indicates decedent.address.city should be numeric (presumably for city FIPS), but the resource profile says text. Which is correct?
We are unable to locate some profile elements listed in the terminology bindings page: Certifier role (observation.code and observation.valueCodeableConcept) & Death Certificate.Informant (contact.relationship)
The terminology bindings page seems to indicate that usual industry, usual occupation, and military service are part of a profile called Decedent Employment History, but the artifacts indicate resources of ‘Decedent Military Service’ and ‘Decedent’s Usual Work’.

Submitted by chris.baumgart… on 2021-09-29

WA State Department of Health Death Records Comments

Washington State Department of Health appreciates having the standards listed on the “Reporting Death Records to Public Health Agencies” page and does not have any new standards to recommend. We do have some comments about the standards listed:
- The value binding link for VRDR Decedent address.district appears to be broken. The text of the hyperlink is correct but encoding the URL has broken the functionality of ‘?’ and ‘=’. Similar bugs appear in multiple places.
- The change history indicates decedent.address.city should be numeric (presumably for city FIPS), but the resource profile says text. Which is correct?
- We are unable to locate some profile elements listed in the terminology bindings page
  - Certifier role (observation.code and observation.valueCodeableConcept)
  - Death Certificate.Informant (contact.relationship)
- The terminology bindings page seems to indicate that usual industry, usual occupation, and military service are part of a profile called Decedent Employment History, but the artifacts indicate resources of ‘Decedent Military Service’ and ‘Decedent’s Usual Work’.