Vital Signs

Optional variables to qualify

Would be better if it allowed some optional (not required) variables to qualify some of the measures. For weight, the clothing worn. For blood pressure and pulse, the body position (sitting, standing, reclining), cuff size. Oxygen may be delivered as %O2 or as liters per minute, so having both variables for both delivery methods would be better.

Loinc code for Weight Percentile

This is regarding Weight for length percentile. Is it ok if we display weight for length percentile to only age 0-36 months then it reads value as WEIGHT %TILE OBS with LOINC  code 8336-0. LOINC – 77606-2 is the loin code for Weight for length Percentile. Is it required to display weight percentile or weight per length percentile as per USCDI. Also the Vital signs form is customized by the Customer. So if they have not chosen weight percentile is Vital signs form, then it will not appear in CCDA.

NCPDP Comment

NCPDP recommends ONC to add NCPDP SCRIPT Standard Version2017071 as an acceptable standard.

Pain

The CMS Data Element Library (DEL) Health IT Workgroup supports the importance of representing Pain as a multifaceted domain. We recommend that USCDI offer support for representing pain observations (both clinician observed and patient + care team member reported) using the common structure of Observations (e.g. Observation.code, Observation.value, Observation.performer). Such a structure, using codes from LOINC to identify the observations, offers a consistent pattern for representing the many dimensions of importance in different contexts (frequency, effect on function, intensity, interference with activities, etc). Pain observations across these dimensions are included the assessments used in post acute care settings.

CDC Unified Comment: California Department of Public Health

The California Department of Public Health recommends adding the following data elements for the Patient Profile in exchange between EHRs:    

• Vital Signs: Expand to include social/mental assessment 
• Last reported blood pressure (both systolic and diastolic if possible) 

• Last PHQ-9 >10 consistent with moderate to severe depression 
• Last BMI >30 consistent with medical obesity 
• Pregnancy Status (if pregnant, estimated date of delivery) 
• CDPH recommends that providers screen patients for signs of loneliness as per the three-item loneliness scale in the journal article "Social Isolation and Loneliness: The New Geriatric Giants: Approach for Primary Care" at  Can Fam Physician. 2020 Mar;66(3):176-182. PMID: 32165464. 
• For patients older than 65 years of age: Last asked about cognitive impairment/Last memory assessment (e.g., Mini-Cog© S. Borson) administered. 

• Results of Adverse Childhood Experiences screening questions (i.e., number and type of ACEs) 
• Referrals made based on ACEs screening results/score 
• Resources provided based on ACEs screening results/score 
• Was patient referred to child welfare services as a result of the screening results/score 
• Number and type of Positive Childhood Experiences (PCEs)