Notification to Implementers
Workflow
The scope of the VRDR FHIR IG is the reporting of incidents of death by State Registrars to the National Center for Health Statistics (NCHS). The Death Certificate Document profile is based upon the FHIR STU3 Bundle resource. The bundle type is a document and the first entry in the bundle is the VRDR Death Certificate. VRDR Death Certificate profile is based upon the FHIR STU3 Composition resource. It includes sections and subsections that include all of the components of the death certificate document.
However, the profiles defined in this IG are designed in a manner that anticipates their use in tributary and secondary use exchanges. Tributary information exchanges are exchanges from originating data sources such as EMRs, ME/C CMS, and Funeral Homes to a jurisdictional Electronic Death Registration System (EDRS). These exchanges use a subset of the profiles defined in this IG and require for alternate profile groupings. Secondary use exchanges make us of the same bundle and composition of profiles as is used in the exchange between the EDRS and the NCHS. Secondary exchanges include communication of a draft of the death certificate with NCHS to enable standard encoding of key elements and exchanges from an EDRS or the NCHS to secondary users of the death certificate.
Parallel Work Efforts
The objective of this project is to prepare a standard for trial use version of the VRDR FHIR IG. However, this project is not being done in isolation. The following precursor, concurrent, and follow-on projects are directly related to and running in parallel to the development of this VRDR FHIR IG and assisting in its evolution from a trial use standard to a normative standard.
The following descriptions of these parallel work efforts contain hyperlinks and references that can aid implementers of this specification.
- Vital Records Domain Analysis Model
A prerequisite to this effort was a project to prepare a vital records domain analysis model (VR DAM). The VR DAM combines and harmonizes the information and processing requirements of birth, birth defect, fetal death, and death reporting into a single conceptual model. The VR DAM helped to inform the design of the profiles in this VRDR FHIR IG.
- Standard Death Record Implementation Guide
Concurrent with the development of the VR DAM was the development of the Standard Death Record Implementation Guide (SDR). SDR is a FHIR IG developed by The MITRE Corporation (MITRE) as a proof of concept on behalf of the CDC in cooperation with the Georgia Institute of Technology. The SDR FHIR IG uses tooling and builds on content developed by the Standard Health Record Collaborative. The source material and instructions for generating the SDR IG are available on GitHub.
- Nightingale Prototype EDRS Project
The profiles defined in the SDR FHIR IG were used to develop Nightingale, a prototype electronic death registration system (EDRS). Nightingale is built to both demonstrate basic EDRS capabilities and act as a foundation for exploring next-generation EDRS concepts. Features of Nightingale can be tested using the Canary EDRS Testing Framework. Canary is an open source testing framework that supports the development of systems that perform standards-based exchange of mortality data. Canary provides tests and tools to aid developers in implementing the FHIR death record format.
- VRDR Standard for Trial Use FHIR IG
The FHIR profiles defined in the SDR FHIR IG were used to influence the design of the profiles defined in the VRDR FHIR IG. They were combined with other perspectives of vital records reporting covered in the VR DAM. A mapping spreadsheet documents the traceability of concepts in the SDR FHIR IG and the VRDR DAM to the VRDR FHIR IG. The SDR and VRDR each use the same FHIR STU3 resources as the base specification for their respective profiles and use the same version of the U.S. Standard Certificate of Death. The difference between the two guides is that VRDR uses a lower level of granularity, avoids the use of FHIR extensions, and attempts to reuse the US Core profile for patient and terminology bindings.
- Refactoring the Nightingale Prototype EDRS
The next step in this space is refactoring the Nightingale prototype EDRS to use the VRDR FHIR IG profiles as a replacement for the current SDT FHIR IG profiles. The refactored prototype will be used to explore the needs of jurisdictional public health agencies and the tributary information feeds into the EDRS. The finding from this exploration is expected to identify weaknesses and defects in the design of the VRDR FHIR IG profiles. The project will document the resolution of these deficiencies as proposed changes to the VRDR. This process will continue throughout the two-year trial use period of the guide.
- VRDR Normative Standard FHIR IG
At the end of the two-year trial use period of the VRDR FHIR IG the guide will be updated using three main influences for change – the then current version of the VRDR DAM, the then current normative version of the FHIR standard, and the proposed changes to the VRDR FHIR IG posed by the Nightingale prototype implementation projects. This revised VRDR FHIR IG will then be balloted as an HL7 normative specification.