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D S SIG

Pediatric Data Standards

SIG Meeting

Atlanta, GASeptember 21, 2007

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D S SIG Meeting Objectives

Q1: SIG Business, QRDA Project Overview Agree upon agenda and meeting objectives Approve May 2007 WGM minutes Get to know each other a little better Celebrate a few recent successes Explain “QRDA project” and review status

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D S SIG Meeting Objectives

Q2: QRDA Project Working Session Confirm approach Improve upon work based on group input Review next steps and gather feedback

Q3: Terminology Work Identify overall group interests Discuss immediate opportunity Determine possible next steps

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D S SIG Meeting Objectives

Q4: SIG Business, Plans for 2008 Co-Chair opportunity Select dates/times for standing monthly calls New: Vote on balloting Child Health-FP Draft plans for 2008 (and beyond) Determine plan for addressing parking lot

items Determine priorities and assignments for next

steps Draft agenda for January 2008 meeting

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D S SIG Meeting Objectives

Q1: SIG Business, QRDA Project Overview Agree upon agenda and meeting objectives Approve May 2007 WGM minutes Agree upon ground rules Get to know each other a little better Celebrate a few recent successes Explain “QRDA project” and review status

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D S SIG

1. Stay on schedule2. Stay on topic; Use parking lot 3. Silence mobiles and pagers 4. Get out of your comfort zone5. Expect to contribute6. Silence is agreement7. Be constructive

Ground Rules

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D S SIG 30-second Introductions

Name, Organization, Role At dinner yesterday: What is one

thing you learned about someone? Not at dinner yesterday: What is

one thing you would have shared about yourself?

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D S SIG

Congratulations!

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D S SIGWhy We Exist

Problem: Children represent nearly one third of the U.S. population. They can receive care through HIT systems from a variety of individuals in a variety of settings. Initiatives are largely adult-focused.

Opportunity: Work through HL7 to improve quality of data standards for child health care.

Numerous National HIT Initiatives Underway to SupportPresident’s Goal to Make EHR Systems Accessible by 2014

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D S SIG

Alliance forPediatricQuality

Identify Requirements

Influence Adoption

Validate Standards

HIMSS Pediatric Health Informatics & Technology SIG

Nationwide Health Information Network

Office of the National Coordinator

American Health Information Community

HIT Standards Panel

Certification Commission for HIT

Systematized Nomenclature

of Medicine

Vendor PediatricConsortia

Health Level Seven (HL7)

Pediatric Data Standards SIG

AAPCouncil on

Clinical Information

Technology

Adopt Standards

Health InformationTechnology

vendors

Child health practitioners,

cliniciansand hospitals

Desired Outcomes

Reduce system implementation

costs due to duplication and customization

Enable pediatric performance

measurement by improving

interchange of standardized information

Support safe care for children

PeDSSIG is Part of National Pediatric HIT Community

Support workgroups,

buildconsensus and

adoption

HL7

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D S SIG Example: HIT Workflow

AAP PeDSSIG HL7 CCHIT

EMR Position Papers

Pediatric EHR Functions

EHR-FM Standard

EHR Vendor Certification

Criteria

Alliance Support and Endorsement

Vendor Compliance & Certification;

Provider Adoption

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D S SIG What We Look Like

Founded: 2003

Parent: Patient Care Technical Committee

Leadership: Andy Spooner, MD and David Classen, MD

Support: Alliance for Pediatric Quality provides Administrative Co Chair and some financial support

Participation: Primarily CMIOs, physicians, medical informatics experts and vendor representatives

Distribution: 100+ on email distribution list

Operations: Work group meetings, monthly calls, webcasts and project meetings as needed

Recruitment: Presentations at national conferences, HIMSS PHIT SIG, AAP, CHCA, NACHRI, vendors, etc.

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D S SIG Emphasis To-Date

Functional Standards EHR-S FM includes critical child health functions Child Health-FP registered with HL7 Contributing to PHR-S FM Exploring derived profiles (e.g. neonatology)

Messaging Standards Immunization Activity Diagrams and Story Boards part of

Care Provision DSTU Quality Reporting Document Architecture (QRDA) project

exploration

Terminology Standards Exploring opportunities

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D S SIG

HL7 EHR System Functional Model

Example – Pediatric Impact

Manage Immunization Administration

Statement: Capture and maintain discrete data concerning immunizations given to a patient including date administered, type, manufacturer, lot number, and any allergic or adverse reactions. Facilitate the interaction with an immunization registry to allow maintenance of a patient’s immunization history.

Description: During an encounter, recommendations based on accepted immunization schedules are presented to the provider. Allergen and adverse reaction histories are checked prior to giving the immunization. If an immunization is administered, discrete data elements associated with the immunization including date, type, manufacturer and lot number are recorded. Any new adverse or allergic reactions are noted. If required, a report is made to the public health immunization registry.

1. The system SHALL provide the ability to recommend required immunizations, and when they are due, during an encounter based on widely accepted immunization schedules.

2. The system SHALL provide the ability to recommend required immunizations based on patient risk factors.

3. The system SHALL perform checking for potential adverse or allergic reactions for all immunizations when they are about to be given.

4. The system SHALL provide the ability to capture immunization administration details, including date, type, lot number and manufacturer.

5. The system SHALL provide the ability to capture other clinical data pertinent to the immunization administration (e.g. vital signs, adverse reactions).

6. The system SHALL record as discrete data elements data associated with any immunization.

7. The system SHOULD provide the ability to associate standard codes with discrete data elements associated with an immunization.

8. The system SHALL provide the ability to update the immunization schedule.

E.g. Function requested by PeDSSIG (#1) is now a standard

Red text represents PeDSSIG edits to the EHR-S FM as reflected in the HL7 Child Health Functional Profile for EHR systems

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D S SIG

HL7 Pediatric Data Standards SIG Tactical Plan2007

Objective Tactics

Ensure EHR Technical Committee Functional Model addresses critical functions for child health care Determine strategy for addressing functions not included in EHR-FM; Child Health Profile Recruit one-to-two vendors at a minimum to commit to adopt Child Health Profile

Prioritize functions not in the EHR-FM Support liaison to EHR-TC Continue to work with EHR TC to include critical functions in the model Publish profile document to the model Invite vendors to participate in meetings/SIG activities Develop marketing plan for a released child health profile (vendors, conformance organizations other stakeholders); Mailing and personal calls/meetings with vendors

Provide value to HL7 and other initiatives

Match functions with functions outlined in AAP EHR white paper; Prepare letter stating to what extent the functionality outlined in the AAP paper is addressed in the EHR FM Match functions with CCHIT ambulatory and inpatient certification criteria for 2007 Participate in HL7 immunization project Explore opportunities to collaborate on international level Present at relevant industry meetings to build credibility Publish articles/updates in HL7 newsletters

Broad representation and participation in HL7 and other national initiatives

Support National Child Health Data Standards Work Group Support AAP Council on Clinical Information Technology Support Council on Certification of Health Information Technology Communicate with Child Health Corporation of America CIO Forum Participate in joint HL7 work group sessions Present at relevant industry meetings to recruit participants Continue to recruit participation from pediatric community

Secure support and leadership (financial and otherwise) from pediatric organizations

Receive endorsement from CHCA, NACHRI, AAP and ABP Develop budget and secure financial support for PeDSSIG activities

Influence adoption of pediatric requirements

Establish PeDSSIG credibility

Build pediatric consensus

Earn commitment from pediatric stakeholders

Goal

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D S SIG Congratulations!

EHR-S FM includes 90% of requests Child Health-FP registered with HL7CCHIT to use Child Health-FPLed QRDA exploration projectPublic comments addressedMarketing successRecruitment success

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D S SIG

QRDA Overview

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D S SIG

Planning2008

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D S SIG Meeting Objectives

Q4: SIG Business, Plans for 2008 Co-Chair opportunity Select dates/times for standing monthly calls Vote on balloting Child Health-FP Draft plans for 2008 (and beyond)

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D S SIG Co Chair Opportunities

Co Chair Term

Andy Spooner, MD

Jan 2006 - Jan 2008

David Classen, MD

Jan 2007 – Jan 2009

Joy Kuhl (Admin) May 2006 – May 2008

Open Chair (New)

Jan 2008 – Jan 2010

Status

Will seek re-election

Not seeking re-election

Will seek re-election

Vote at Jan 2008 mtg

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D S SIG

Proposed Monthly Calls2008

Second Week of Each Month: Rotating Tues/Thurs Thursday, January 10, 1-2 PM Central Tuesday, February 12, 9-10 AM Central Thursday, March 13, 1-2 PM Central Tuesday, April 8, 9-10 AM Central Thursday, May 8, 1-2 PM Central Tuesday, June 10, 9-10 AM Central Thursday, July 10, 1-2 PM Central Tuesday, August 12, 9-10 AM Central Thursday, September 11, 1-2 PM Central Tuesday, October 14, 9-10 AM Central Thursday, November 13, 1-2 PM Central Tuesday, December 9, 9-10 AM Central

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D S SIG Balloting the Child Health-FP

Decisions to Make Today1. Do we want the profile to become a standard?2. If so, what kind?

1. Informativea. Requires 60% approvalb. EHR TC and PeDSSIG votes

2. Normativea. Requires 90% approvalb. Open to HL7 membership for votingc. Approval makes it ANSI standardd. Requires two ballot cycles

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D S SIG Balloting the Child Health-FP

Next Steps Complete intent to ballot form by October 15 Inform EHR TC (and Patient Care) of intention and seek

approval Submit documentation to EHR TC and publications

workgroup to create ballot documents Publicize ballot opportunity Ballot – November/December Recruit reconciliation volunteers January Work Group reconciliation session EHR TC accepts reconciliation document Second ballot period likely March 2008 Opportunity to become HL7 ANSI standard May 2008

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D S SIG

Alliance forPediatricQuality

Identify Requirements

Influence Adoption

Validate Standards

HIMSS Pediatric Health Informatics & Technology SIG

Nationwide Health Information Network

Office of the National Coordinator

American Health Information Community

HIT Standards Panel

Certification Commission for HIT

Systematized Nomenclature

of Medicine

Vendor PediatricConsortia

Health Level Seven (HL7)

Pediatric Data Standards SIG

AAPCouncil on

Clinical Information

Technology

Adopt Standards

Health InformationTechnology

vendors

Child health practitioners,

cliniciansand hospitals

Desired Outcomes

Reduce system implementation

costs due to duplication and customization

Enable pediatric performance

measurement by improving

interchange of standardized information

Support safe care for children

PeDSSIG is Part of National Pediatric HIT Community

Support workgroups,

buildconsensus and

adoption

HL7

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D S SIG

Objective Tactics

Build pediatric consensus on new data standards Maintain broad representation and participation in HL7 initiatives on behalf of child health care Strong participation in relevant national HIT data standards public comment periods on behalf of child health care

Bring Child Health Functional Profile for EHR systems through normative HL7 ballot Continue to work with EHR TC to include critical functions in the EHR-S FM model; Participate in opportunities for public comment Provide input into EHR TC quality functions work Explore and encourage development of derived profiles to the Child Health-FP (e.g. neonatology) with educational toolkit Explore collaborative opportunities with the HL7 Pharmacy SIG Participate in HL7 public health immunizations domain analysis model project by providing pediatric input Test clinical-context template method for addressing terminology problems in pediatrics and publish results Explore opportunities to collaborate on international level Support CCHIT Child Health Expert Panel work by coordinating responses to public comment periods Support recommendations of the Quality Reporting Document Architecture project; Work TBD Explore relationships between AAP guidelines and data standards

Impact vendor awareness and adoption of pediatric standards Impact provider awareness and adoption of pediatric standards Improve public awareness of value of pediatric data standards

Influence vendor adoption of Child Health-FP; Help educate vendors about the profile, and make ourselves available for questions, etc. as they work to conform, including a checklist of the SHALL criteria Vote on most essential functions in child health profile to share with Child Health Expert Panel Work through AAP to invite specialty sections to work with us on derived profiles? Explore opportunities for industry conference presentations Invite vendors to participate in meetings/SIG activities Publish articles/updates in HL7 newsletters Coordinate closely with the Alliance for Pediatric Quality (AAP, ABP, CHCA & NACHRI) as well as the HIMSS Pediatric Healthcare Informatics Technology SIG and vendor-specific pediatric work groups Present at HL7 and other relevant industry meetings to spread awareness of efforts and to recruit participants Explore opportunities to publicize successes to the general public

Secure support and leadership (financial and otherwise)

Develop budget and secure financial support for PeDSSIG activities Receive endorsement for work from Alliance for Pediatric Quality (AAP, ABP, CHCA & NACHRI)

Influence adoption of pediatric requirements

Improve data standards for child health care

Earn commitment from pediatric stakeholders

Goal

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D S SIG

PediatricTerminology

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D S SIG Meeting Objectives

Q3: Terminology Work Identify overall group interests Discuss immediate opportunity Determine possible next steps

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D S SIG

Next Steps Jan 2008 Agenda

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D S SIG

Next Meeting: January 13-18, 2008

San Antonio, TX

Which days are preferred? Monday, January 14? Tuesday, January 15?