FPAR on FHIR Implementation Guide (IG)

Background

The U.S. Department of Health and Human Services’ Office of Population Affairs (OPA) has administered the National Family Planning Program since 1970. This program, authorized under Title X of the Public Health Service Act, is the only federal program dedicated solely to the provision of family planning and related preventive health care. The program is designed to provide contraceptive services and information to all who want and need them. In addition to offering a broad range of effective contraceptive methods on a voluntary and confidential basis, Title-X clinics provide contraceptive education and counseling; breast and cervical cancer screening; sexually transmitted disease (STD) and human immunodeficiency virus (HIV) testing, referral, and prevention education; and pregnancy diagnosis and counseling. The program is implemented through grants to over 90 public health departments and community health, family planning, and other private nonprofit agencies in all 50 states and U.S. Territories. These grants support delivery of Title X services in approximately 4,000 clinical sites. The program serves approximately four (4) million women and men of reproductive age each year through over seven (7) million patient encounters.

OPA currently collects aggregate data from Title X grantees on an annual basis. The data are compiled and published each year in the Family Planning Annual Report (FPAR). The FPAR is the only source of uniform reporting by all Title X services grantees, and results are used to monitor compliance with statutory requirements, comply with accountability and federal performance reporting requirements for Title X family planning funds, guide strategic and financial planning, respond to inquiries from policy makers and Congress about Title X, and estimate the impact of Title X-funded activities on key reproductive health outcomes, including prevention of unintended pregnancy, infertility, and invasive cervical cancer.

Current aggregate data collected through FPAR reporting processes limit OPA’s capacity to monitor data quality and to conduct patient-level analyses that are more informative and useful to service delivery efforts. OPA has been assessing the feasibility of implementing an interoperable data reporting system since 2012. A CDA-based Family Planning Profile has been developed and tested in collaboration with IHE International.

OPA has created this FHIR standard and implementation guide to collect a set of standardized and agreed upon data elements from all encounters across the 4,000 Title X clinical sites. The goals of this standard are as follows:

1. Improve the quality of data sent to OPA to improve the ability to assess key performance metrics related to family planning and reproductive health;
2. Contribute to a learning healthcare environment by sending quality improvement-related information back to Title X providers;
3. Reduce the burden of annual reporting requirements on the Title X network; and,
4. Make the FHIR standard publicly available to all reproductive health providers outside of the Title X network so they can collect standardized family planning data and calculate performance metrics on their own.

Overview

Family planning and related reproductive health services are essential elements of preventive health care, yet many aspects are not integrated and captured within electronic health record (EHR) systems. Measuring pregnancy intention, sexual activity history, and counseling related to contraception or achieving pregnancy are important health indicators that are not consistently captured by EHRs, yet are desired by clinicians, healthcare administrators, academic researchers, and government programs. The lack of standardized data capture for reporting, monitoring, and evaluation of family planning services to public health authorities places a burden on already stretched clinical providers. Additionally, many data elements important to family planning providers are critical to other clinical domains (e.g., blood pressure), while others are currently used primarily in family planning settings (e.g., client’s pregnancy intention). Standardized capture and recording of these variables across multiple clinical settings and diverse medical record documentation would facilitate more efficient reporting, adherence to clinical guidelines, and efforts to improve quality of service provision.

Within the Title X family planning program network, many of the 4,000 clinical service sites have an EHR capable of recording discrete patient data. Over 100 EHR vendors are represented across this network, however, necessitating the creation of interoperability standards that include standardized data elements using common terminologies. To cast a broad net, OPA has developed a CCDA-based profile with IHE International, in addition to this FHIR standard. All attempts were made to align the CCDA and FHIR standards and to use common terminologies.

Authors

Overview