Submitted by nedragarrett_CDC on
CDC comment on Estimated Date of Delivery
CDC requests this data element be considered for inclusion in USCDI V6. A recent CDC/NACHC postpartum care services project documented the feasibility of collecting the data element in EHRs, and the importance for interoperability standards to support data exchange between health organizations to enhance quality improvement initiatives to improve perinatal outcomes.
Justification: Estimated Date of Delivery is the date representing the expected delivery date of a pregnancy. It is a physician's best estimate of the date of delivery and is determined at the initial diagnosis of pregnancy and can be confirmed by an ultrasound, physical exam, or last menstrual period. This data element is critical for helping health care providers make informed decisions for the care of the patient (such as timing for recommended screenings and vaccinations), supporting maternal care coordination and care provision, and developing data and clinical care quality improvement initiatives. For data and clinical care quality improvement initiatives to be successful, there needs to be standardized documentation and follow-up based on stage of pregnancy and notifications for when postpartum care should begin. Despite the importance of data to successfully identify, treat, and follow up with patients, critical data on pregnancy status and pregnancy outcomes are not standardized across electronic health records (EHRs). The use case will be relevant for all maternal health patients, all providers involved in maternal health care, and all consumers of maternal health data used for research, public health and patient care and quality outcomes.
The Centers for Disease Control and Prevention, in partnership with the National Association of Community Health Centers (NACHC), worked to build capacity of Federally Qualified Health Centers to improve the health informatics infrastructure for perinatal care measures and use perinatal care measures to identify and address gaps in postpartum care (https://liebertpub.com/doi/10.1089/jwh.2024.0364). Partner health center-controlled networks (Alliance Chicago, Health Choice Network, OCHIN, and Aliados Health) and nine Community Health Centers, implemented strategies to integrate evidence-based recommendations into the clinic workflow and use data-driven health information technology (HIT) systems to improve data standardization for quality improvement of postpartum care services. The respective EHRs were able electronically capture, access and exchange this data element through adequate testing in staging and development EHR environments. NACHC has developed an implementation Guide (Improving Quality in Pregnancy and Postpartum Care to provide practical strategies to leverage data from electronic clinical data systems for improved maternal health care (NACHC-WHPP-Implementation-Guide-2024_3.pdf).
This data element is captured as active in Logical Observation Identifiers Names and Codes (LOINC®) ontology as: 11780-4: Delivery date Estimated from ovulation date, a quantitative scale type and 57060-6: Estimated date of delivery Narrative, a narrative scale type.
EDD is also captured in the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) as 161714006 and 738070007.
Interoperability in the clinical space is key to optimizing many processes including the diagnosis, management, and transition of care from obstetricians to primary care clinicians for people with hypertensive disorders of pregnancy. Accurately capturing active pregnancies, their ultimate outcomes, and pertinent dates is a major challenge within electronic health records (EHRs). This has at least a two-fold potential negative impact: 1) people may not receive the guideline-recommended care they need during their pregnancy and postpartum phases and 2) women may appear to be continuously pregnant for multiple years in EHRs. Below is some additional information for consideration:
An exploration of IQVIA Ambulatory Electronic Medical Record (AEMR) data demonstrates that estimated delivery date is not universally captured for pregnant patients, even within OB/GYN practices. In IQVIA AEMR data from 2022-2023, CDC identified pregnant patients using a complex algorithm* that incorporates five types of measures: diagnoses, measurements, observations, procedures, and drugs. When CDC examined pregnant patients being treated by all types of clinical providers, of 34,238 pregnant patients, 10,614 (31%) had an observation that specified estimated delivery date. When CDC examined pregnant patients being treated by OB/GYN providers, of 6,583 pregnant patients, 3,848 (58.5%) had an observation that specified estimated delivery date. Thus, even among OB/GYN providers, more than 40% of patients identified as being pregnant through the comprehensive pregnancy electronic phenotype* did not have an EDD in their EHR. Moreover, the capture of EDD is not standardized across EHRs of clinical providers contributing data to IQVIA and the native data have to be mapped into 5 OMOP observations:
- Delivery date estimated
- Estimated date of delivery
- Delivery date US composite estimate
- Delivery date Estimated from last menstrual period
- Estimated date of delivery from antenatal ultrasound
These findings speak to the need to include Estimated Delivery Date as a required USCDIv6 data element to provide a standardized, universally captured data point that allows for the characterization of pregnancy and calculation of gestational age (both of which have widespread implications for clinical practice across specialties).
*Matcho A, Ryan P, Fife D, Gifkins D, Knoll C, Friedman A. Inferring pregnancy episodes and outcomes within a network of observational databases. PLoS One. 2018 Feb 1;13(2):e0192033. doi: 10.1371/journal.pone.0192033.
Submitted by BLampkins_CSTE on
CSTE Comment - v6
CSTE supports inclusion of this data element in USCDI V6. Please see previously submitted CSTE comments for additional recommendations.