Vital Records Death Reporting (VRDR) FHIR Implementation Guide
2.0.0 - STU 2 US

This page is part of the Vital Records Mortality and Morbidity Reporting FHIR IG (v2.0.0: STU 2) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Change Log

VRDR STU 2 Publication Version (Fall 2022)

General Changes

  • Scope: The VRDR IG now supports standards-based interoperable exchange of death record information that is information-content equivalent with the legacy IJE, MRE, TRX, and Mortality Roster formats. The mapping of legacy IJE fields to the FHIR profiles is clearly documented. Profiles that did not support any data fields used for submission of death records to NCHS or for inter-jurisdictional exchange were eliminated.
  • Documentation: A death record data dictionary that maps IJE fields has been added, and each profile includes the data dictionary elements that the profile supports. A separate mortality roster data dictionary is also included.
  • Use Case Documentation: Documentation is provided for the four use cases the VRDR is intended to support, and how the IG’s profiles are used in support of each use case.
  • Inclusion of FHIR Profiles for Coded Content: Eight new profiles, seven of which are Observations, have been added to support interoperable exchange of the decedent’s coded race, ethnicity and cause of death.
  • Race and Ethnicity: The Race and Ethnicity submitted as part of death registration are now represented accurately with respect to the NCHS process. Separate profiles are provided for submission of sending race and ethnicity to NCHS, and to represent coded race and ethnicity.
  • Additional Bundles: In addition to the DeathCertificateDocument new bundles have been defined for exchange of coded demographic, cause of death, and mortality roster information. The new bundles are information content equivalent to their legacy counterparts. All four bundles use the same set of identifiers.
  • Examples: Examples are included for all profiles and extensions.
  • Consistent Naming and Identifiers: The names and identifiers have been changed to achieve consistency.
  • USCore: Now depends on USCore 5.0.1, and the included USCoreRelatedPersonProfile. RelatedPerson.active = true.

Terminology Changes

  • Standard Terminologies: An attempt has been made to use standard terminologies and code systems (e.g., SNOMED-CT, LOINC, HL7) wherever possible.
  • Non-Standard Terminologies: Non-standard terminologies are represented within the IG, rather than by reference to PHINVADs.
  • ValueSets: All valuesets are included within the IG, rather than by reference to PHINVADs. Concept maps are provided to enable client software to map from legacy codes to the codes used in the IG’s valuesets.
  • States, Territories, Jurisdictions, Provinces and Countries: All of these geographic entities are represented consistently throughout the IG using 2-letter postal abbreviations.

Notable Changes to Profiles

  • Part1 and Part2 Causes of Death: The Part1 and Part2 Cause of Death profiles are now profiles of Observation, rather than Condition. The association of the Part1 causes of death with line numbers is now explicit as part of the profile, rather than implicit based on order in a list.
  • Deleted Profiles: Profiles for Death Pronouncement Perfomer, Cause of Death Pathway, Death Certificate Reference, Mortician, Funeral Home Licensee, and Transportation Role have been deleted.
  • Location Profiles and References: The three location profiles (Death, Disposition, Injury) are now clearly distinguished by their type field. The extensions that were previously used to link from other profiles to these locations were no longer needed and have been deleted. The Location profiles include some detailed address components as extensions.
  • Injury Incident: This profile now incorporates the tranportation role as a component, eliminating the separate Transportation Role Observation profile.
  • Certifier: The Certifier profile now incorporates extensions for detailed components of the Certifier’s address.
  • Death Date: The Death Date now incorporates the characterization of the place of death as a component. Previously this mapped to the type field of the Death Location, which was inapprorpiate.
  • Decedent: The Decedent profile now incorporates extensions to represent the birth jurisdiction, sex at time of death, and detailed components of residence address. The race and ethnicity needs of death registration are now met by a separate profile since the USCore-provided fields lack the granularity needed.
  • Death Certificate Document: The DeathCertificateDocument Composition profile has defined sections for the different types of information included in the death certificate.

Ballot Reconciliation - Changes By Jira Ticket

  • FHIR-22430 : Make ordering of Part1 Causes of Death Explicit in Profile, Eliminate CausesOfDeathPathway Profile, since it adds no value
  • FHIR-26584 : Manner of Death Value Set Corrected
  • FHIR-26587 : Coding for SSN IDentifier corrected
  • FHIR-28131 : Added Sex At Death
  • FHIR-28247 : Age at Death spelling
  • FHIR-28247 : Constrain relationship in DecedentMother
  • FHIR-32873 : DeathLocation.extension[location-jurisdiction-id] cardinality 1..1
  • FHIR-32879 : Make extension urls consistent.
  • FHIR-32904 : Provide examples of all extensions
  • FHIR-32905 : Provide examples of all extensions
  • FHIR-32906 : Observation-Location.value[x] constrained to Reference(Location)
  • FHIR-32957 : Require meta.profile on all extensions
  • FHIR-32995 : Eliminate example bindings on must support fields (e.g., CauseOfDeathCondition.code)
  • FHIR-32998 : Valuesets bound to wrong element. No valueset now bound.
  • FHIR-33051 : Move from PHINVADs-hosted value sets to locally defined valuesets
  • FHIR-33113 : Delete outdated UML diagrams
  • FHIR-33114 : Mapping of fields to IJE and DCF at the global and per-profile/extension level. ==> only IJE needed. At profile level is complete.
  • FHIR-33115 : Document Terminologies
  • FHIR-33116 : Definition and use of Must Support
  • FHIR-33117 : Guidance on missing data
  • FHIR-33149 : Avoid PHINVADs terminologies where possible. All except PHVSDivisionVitalStatisticsCounty, PHVSDecedentBirthplaceCountry, PHVSDecedentResidentCountry
  • FHIR-33151 : avoid patternFixed
  • FHIR-33152 : Defined VS for states, provinces, territories and jurisdictions.
  • FHIR-33168 : Decedent.address.city.extensioncitycode bound to PHVS_CityPlaces_NCHS, address.district.extension[countyCode] bound to PHVS_DivisionVitalStatistics__County (FIPS-6-4 County Codes)
  • FHIR-33179 : Standardize address encodings
  • FHIR-33193 : Changes to BirthRecordIdentifier including binding to jurisdiction, and requiring jurisdiction and year.
  • FHIR-33194 : difference between BirthRecordIdentifier.component.birthstate and the Decedent.extension.birthPlace. Where is state a jurisdiction, and where is it a state/province/territory.
  • FHIR-33204 : Document partial date/time
  • FHIR-33208 : Constrain all components of Date-Part-Absent Reason extension to 1..1
  • FHIR-33210 : COnventional Encoding for Addresses. Value set for country????
  • FHIR-33211 : Update examples to avoid PHINVADs codes except where necessary
  • FHIR-33221 : Date of Death DOcumentation
  • FHIR-33344 : Dependency on latest USCore (4.0.0)
  • FHIR-33347 : Meaningful, complete examples
  • FHIR-33348 : Death certificate composition: sections, which profiles, complete examples
  • FHIR-33407 : Fixed VS binding for Country
  • FHIR-33425 : Extensions and valuesets for city/county – will reference CDC FTP files.
  • FHIR-33345 : Fix links to PHINVADS VS
  • FHIR-33426 : Add lat/long to death location and injury location – already there, but documented now.
  • FHIR-33714 : LImited gender values according to IJE
  • FHIR-33742 : Add extension for RACE1-23 flags/literals
  • FHIR-33403 : Fix language in overview (state PHA->JVRO)
  • FHIR-33404 : Fix language in overview (PHA->JVRO)
  • FHIR-33405 : Update Contributor list
  • FHIR-33406 : Corrected reference to and content of residence and birthplace country value sets
  • FHIR-33410 : Update USCore Dependency
  • FHIR-33411 : Update USCore Dependency
  • FHIR-33415 : Eliminate PHINVADS dependency where possible
  • FHIR-33424 : Fix PHINVADs valueset links
  • FHIR-34276 : Conformance Section Needed (duplicate)
  • FHIR-33427 : Same as FHIR-32873 (cardinality of jurisdiction ID)
  • FHIR-33428 : Same as FHIR-32906 (constrain observation location)
  • FHIR-34337 : Conformance Section Needed (duplicate)
  • FHIR-34338 : Conformance Section Needed (not clear how it differs from 34337) (duplicate)
  • FHIR-33691 : Restrict Decedent.gender to 3 values allowed by IJE
  • FHIR-33610 : Death Certificate structure needs to be specified. Profile has changed, but no examples. Can’t claim it is done without examples.
  • FHIR-33696 : City code as a supplement to city name.
  • FHIR-33697 : City code as a supplement to city name. City name not a controlled vocabulary.
  • FHIR-33700 : RELATE ==> will update messaging to support original, update, update-but-not-for-nchs
  • FHIR-33701 : INFORMRELATE / Coded value ==> contact.type.text
  • FHIR-33715 : SUpport for MFILED field (paper, electronic, mixed). Add extension to DeathCertificate.
  • FHIR-33717 : Document how to specify ‘other’ for place of death. Added usage.md Need to document wherever this is expected.
  • FHIR-33727 : Instructions for Replace
  • FHIR-33729 : AGE_BYPASS, MARITAL_BYPASS (+ EDUCATION_LEVEL and PREG). SEX Bypass intentially not implemented.
  • FHIR-33731 : Bypass codes handled.
  • FHIR-33732 : Extensions for city/county codes in addresses.
  • FHIR-33734 : Add extensions for address components (e.g., predir, postdir) where required
  • FHIR-33739 : Partial date should include partial time.
  • FHIR-33741 : Eliminate coding for INFORMRELATE since it is a literal string in IJE
  • FHIR-33742 : Extensions for Race literals/flags
  • FHIR-33743 : Resolution is INCORRECT. STATUS QUO IS CORRECT.
  • FHIR-33744 : Add data dictionary that includes mapping to IJE fields
  • FHIR-33818 : Support IJE requirements as well as NCHS (principle accepted, work in progress)
  • FHIR-33918 : Update ODH IG dependency to 1.0.1 (latest published)
  • FHIR-34062 : Use local instead of PHINVADs VS for Education Level HL7 education codes
  • FHIR-34149 : Make all bindings “required” to encourage compliance.
  • FHIR-34161 : Fix Phinvads links
  • FHIR-34163 : Remove meta.security and meta.source junk from all artifacts.
  • FHIR-34248 : Cause of Death Condition same as 35250
  • FHIR-34249 : Cause of Death Condition updated in unspecified way.
  • FHIR-34250 : Cause of Death Condition 120 characters.
  • FHIR-34251 : COndition Contributing to Death 240 characters.
  • FHIR-34268 : DeathCertificate Human Readable Section Names/cardinalities
  • FHIR-34269 : Death Certificate Example
  • FHIR-34270 : DeathCertificate Human Readable Section Names
  • FHIR-34273 : IJE-specific extensions for race/ethnicity (duplicate)
  • FHIR-34320 : LImit causes of death to 5
  • FHIR-34410 : TransportationRole VS and Map update
  • FHIR-34424 : LImit causes of death to 5 (same as 34320)
  • FHIR-34432 : Usage tables for mapping values in IJE to FHIR
  • FHIR-34492 : Delete unnecessary slicing
  • FHIR-34562 : 2022 IJE updates - parameters addition. Needs documentation
  • FHIR-34609 : Add COncept Maps for IJE->FHIR code mapping
  • FHIR-34992 : Cardinality of Decedent Race extension 0..1 (must support flags dealt with later)
  • FHIR-34993 : Cardinality of Decedent Ethnicity extension 0..1 (must support flags dealt with later)
  • FHIR-35934 : Support for custodial state AUXNO in VRDR IG
  • FHIR-35995 : Remove modifiers for time of death method
  • FHIR-36002 : Update IG Version Number
  • not ticketed : Simplified handling for AUXNO by adding an extension to DeathCertificateDocument and getting rid of InterestedParty and DeathCertificateReference.. See DeathCertificateDocument.
  • FHIR-36069 : Units of Age missing
  • FHIR-36071 : Required fields in DispositionLocation are unnecessary.
  • FHIR-36077CauseOfDeathCondition and ConditionContributingToDeath should be Observations, not Conditions (see LloydM on zulip) – see LOINC “cause of death” Renamed CauseofDeathPart1 and Part2
  • FHIR-36088: Gender/BirthSex/SEX: (related to FHIR-33692)
    • USCore Patient includes both BirthSex(M,F,unknown) and Gender(M,F,unknown, other). In an ideal world, information about the decedent would flow as USCore Patient info from an EHR into the EDRS.
    • NCHS is interested in SEX to be defined as “Sex on visual inspection at the time of death by the funeral home”, which is quite different than BirthSex (determined at birth) or Gender(determined by the patient/decedent).
    • Proposed Alternatives:
      • Alternatives:
        • Encode SEX in a SexAtTimeOfDeath extension to decedent with a codeable concept (M,F,unknown).
      • USCorePatient.extension[ birthSex] and USCorePatient.gender would not be profiled in decedent.
  • FHIR-36086 : Add an observation with code = 80992-1 Date and time of surgery to represent SUR_YR, SUR_MO, SUR_DY, and add it to the DeathCertificateDocument.
  • FHIR-36087: Address components for Decedent’s residence (STNUM_R, PREDIR_R, STNAME_R, STDESIG_R, POSTDIR_R, UNITNUM_R) as required for 2022
  • FHIR-33721 : Alternate resolution – Support for SPOUSELV
    • propose adding an extension to decedent in lieu of an observation
  • FHIR-36068 : Label for AgeAtDeath.effectiveTime ….incorrect
  • FHIR-36094 : Get rid of 4 profiles and replace with narrative explanation.
  • FHIR-36107: why is effective date required?
  • FHIR-36268 : Fix State/Jurisdiction Value Sets (work around IGP issue)
  • FHIR-36404 : Consistent encoding of States/Jurisdictions
  • FHIR-36585 : Remove Davinci Logo
  • FHIR-36688 : Moved Race and Ethnicity info from Decedent into a separate Observation profile
  • FHIR-36688 : Added Observation and a Parameter profiles to support all coded information
  • FHIR-36773 : Merge TransportationRole into Injury Incident as per FHIR-20774 and FHIR-22358
  • FHIR-37677 : Add Mortality Roster Support