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HL7 Child Health Work Group

WebcastJune 10, 2009

Dial In: (770) 657-9270 passcode: 324598

Child Health Work Group Meeting June 10, 2009 9:00-10:30 central

General Business and National Updates

11:00-12:30 centralLeapFrog Flight Simulator Project Update

1:00-2:30 centralUnderstanding CDA, CCD and CCR

Overview of Sessions

General Business and Project

Updates9:00-10:30 AM Central Agenda Introductions Ground Rules Objectives Approval of Jan 2009 Minutes and

DMG National HIT Activities and the

CHWG

Agenda

General Business and Project

Updates9:00-10:30 AM Central Agenda Introductions Ground Rules Objectives Approval of Jan 2009 Minutes and

DMG National HIT Activities and the

CHWG

Agenda

1. Use mute feature on phone2. Avoid “hold”; Hang up if

necessary3. Introduce self when speaking4. Stay on schedule

• Stay on topic• Collect electronic questions• Use parking lot

Ground Rules

Meeting Objectives

Approve Jan 2009 minutes Decision making guide approval Participants are able to talk

comfortably at a high level about national pediatric HIT activities

Draw interest from potential volunteers

January 2009 Minutes Approval

Please see meeting minuteshttp://www.hl7.org/Library/Committees/pedsdata/minutes/ChildHealth_Minutes_HL7WGM_Jan09.doc

DMG Approval

Please see decision making guidehttp://www.hl7.org/Library/Committees/pedsdata/Child%20Health%20HL7%20WG%20DMP%20v2.0.doc

General Business and Project

Updates9:00-10:30 AM Central Agenda Introductions Ground Rules Objectives Approval of Jan 2009 Minutes and

DMG National HIT Activities and the

CHWG

Agenda

Alliance for Pediatric Quality – Joy HL7 Child Health Work Group – Andy HL7 and Professional Societies –

Andy AAP Council on Clinical Info Tech –

Beki HIMSS Pediatric SIG – Jennifer NACHRI HIT Advisory Group – Allan HIT Standards Panel – Rob Certification Commission for HIT –

Aileen NQF Health Info Tech Expert Panel –

Paul Immunization Messaging IG – Rob Other

National HIT Activities

Alliance for Pediatric Quality(AAP, ABP, CHCA &

NACHRI)

Joy Kuhl

Overview

Alliance for Pediatric Quality

Founded: 2005Leadership: American Board of Pediatrics

American Academy of PediatricsChild Health Corporation of AmericaNational Association of Children’s Hospitals

and Related Institutions Mission: To establish a unified voice for improving the

quality of pediatric health care

Alliance forPediatricQuality

Identify Requirements

Influence Adoption

Set National Agenda

HIMSS Pediatric Health Informatics & Technology SIG

eHealth CollaborativeHealth Level Seven (HL7) Child HealthWork Group

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

Support work, convene, build

consensus, endorse and

advocate

HHS: Coordinator

Alliance HIT Strategy for Influence

Develop and Pilot Standards

HL7, SNOMED…

NHINS andCollaboratives

Integrating the Healthcare Enterprise

NQF HIT Expert Panel

Vendor Consortia

Certify Products

CCHIT

Harmonize Standards

HIT Standards Panel

NACHRI Pediatric Advisory Council

CHCA CIO and CMIO Forums

Alliance forPediatricQuality

Identify Requirements

Influence Adoption

Set National Agenda

HIMSS PHIT SIGAllan Castro (NACHRI)

Jennifer Gedney (CHCA)Feliciano Yu, MD

eHealth CollaborativeLisa Simpson, MD, Policy: Marc

Probst, MD, Standards TBDHL7 Child HealthDavid Classen, MDJoy Kuhl (Alliance)Andy Spooner, MDFeliciano Yu, MD

AAP COCITEugenia Marcus, MDBeki Marshall (AAP)

Joseph Schneider, MD

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

Support work, convene, build

consensus, endorse and advocate

Joy Kuhl (Alliance)Beki Marshall (AAP)

Jennifer Gedney (CHCA)Allan Castro and Michael

Ellwood (NACHRI)

Leadership RepresentationConnecting the Community

Develop and Pilot

HL7 (see left column)

NHIN Projects

IHE

NQF HIT Expert PanelPaul Fu, MD, David Stumpf,

MD, Brian Jacobs, MD

Vendor Consortia

Certify Products

CCHIT 09-10 TBD

Harmonize

HIT Standards Panel

NACHRI HIT Advisory Council

TBD

CHCA CIO FORUMJennifer Gedney (CHCA)CIOs: Pam Arora, Allana Cummings, Dan Nigrin,

Albert Oriol, Denise Zabawski

IOM EHR Collaborative: Data Sharing NetworkChristopher Forrest (CHOP)

Core Team TBD

Link with HL7 Child Health WG

Provide administrative co chair Support and endorse work

HL7 Child HealthWork Group

Andy Spooner, MD

Overview

HL7 Child Health Work Group

Founded: 2003Leadership: David Classen, MD, Andy Spooner, MD

and Feliciano Yu, MDParticipation: Primarily CMIOs, physicians, medical

informatics experts and vendor representatives

Distribution: 100+ previously on email; listserv unknown

Operations: One in person meeting and two webcast meetings in conjunction with HL7 work group meetings; Other calls and webcasts as needed

Emphasis To-Date

Functional Data Standards Standards for EHR systems include critical child health functions Published EHR system standards for general pediatrics Work is baseline for CCHIT child health certification criteria Started identifying functionality important for pediatric specialties (e.g.

pediatric critical care)

Terminology Data Standards Explored opportunity to improve terminology systems for pediatrics using

AAP policy statements (e.g. SNOMED) Seeking funding to move work forward

Messaging Data Standards Created immunization activity diagrams and story boards – now part of

HL7 messaging standards Provided incubation and leadership in HL7 to develop standard for

reporting quality measure data – Quality Reporting Document Architecture

Strategic Plan UpdateJan Mtg Action Items

SWOT analysis updated; will revisit in future meeting Strategic plan updated per January suggestions Recruited pediatric representation in HL7 ED work;

future update Participating in LeapFrog project as advisors; update

and input today Pediatrics HIT supplement made accessible Co chairs reviewed framework for actionable plan

and put priority work in motion Expressed interest to COCIT in development of

policy statement on HIT needs for medical home

Strategic Plan: UpdateJan Mtg Action Items

Andy exploring IHE link Exploring HITSP and HITEP links Recruited pediatric participation in HITSP

immunization work; discussing HL7 today; Possible future education session on gaps in standards, etc.

Participating in public comment opportunities Andy providing update on HL7 clinical meeting Not started: collect findings on ambulatory

EMR failures through AAP

Strategic Plan Update5 Focus Areas

Identify pediatric HIT priorities HIT standards crash course Ensure involvement in immunizations efforts Support one new HL7 standards development

effort EHR FM Child Health Profile and CCHIT gap

analysis and call for action

HL7 and Intentions with Professional Societies

Andy Spooner, MD

Bridging the Chasm Meeting

HL7 CIC Healthcare professional societies: no organized voice in

national data standards activities Desired output: proposal to organize that involvement

“Bridging the Chasm” meeting on data standards and professional societies, April 19-21, Washington, DC Over 100 societies represented. ACP, ABIM, AAFP, ABFP,

ACOG, ABP; large number of specialists in areas like refractive ophthalmic surgery, rheumatology, radiology, and neurosurgery; a few non-physician groups

Attendee list & meeting materials posted at http://www.hl7.org/btc.htm

BTC: Meeting Conclusion

Form a group focused on data standards How to fund/organize? Jim Dove, MD, of Springfield Illinois, former president of

the American College of Cardiology, agreed to be leader Plans are to reconvene in a few months

Engage in political advocacy missions that would help the data standards effort Government mandate to employ existing standards Unique patient identifier National Heath Information Network.

Work on clinical content projects Terminologies? CCD?

AAP Council on Clinical Information Technology

Beki Marshall

AAP Council on Clinical Information Technology

(COCIT)

Serves as the “home” for health information technology initiatives within the AAP

About 600 members with special interest or training in applying information technology to pediatric practice

An 11-member volunteer Executive Committee oversees COCIT activities

COCIT Strategic Plan

Developed June 2007-April 2008

Will guide COCIT activities in 2008-2010

COCIT Mission

The mission of COCIT is to provide strategic direction and leadership to promote affordable, child-friendly health information technology (HIT) and health information exchange (HIE) solutions that support quality care; and to drive the creation and successful deployment of systems which have these characteristics.

COCIT Vision

Every infant, child and adolescent would be cared for in every venue with the necessary health information technology that is both cost effective and improves the quality of health care, regardless of socio-economic status.

Goal #1: Ensure Health IT solutions are child-friendly, affordable, cost

effective, and support quality care.

Advising the Certification Commission on Health Information Technology on Requirements for Child Health

Develop an implementation strategy based on the results of the AAP Periodic Survey of Fellows addressing pediatrician adoption of electronic health records

Goal #2: Support the usage of pediatric HIT and HIE in actual practice, with a particular

focus on addressing the Child Health Priorities identified in the AAP Strategic Plan.

Develop two electronic health passport test cases for children and youth in foster care

Establish a work plan to address the intersection between electronic health records and immunization information systems

Develop a plan for continuously improving the following COCIT offerings: Pediatric Office of the Future (Exhibit at AAP National

Conference & Exhibition) Pediatric Documentation Challenge (At NCE and TEPR) Council Program for Council Members (At NCE, includes

scientific abstract program) Technology Learning Center (At NCE) EMR Review Web Site (including Buddy List)

Goal #3: Increase the visibility and effectiveness of the efforts of COCIT and the

AAP in providing HIT and HIE direction and leadership.

Establish a schedule of topics and authors to write a monthly article on health information technology for a non-COCIT AAP publication

Develop a policy statement on the role of HIT and HIE in pediatrics

Create a 1-2 page concept paper on COCIT’s activities to inform the work of the AAP Chief Quality Officer

Develop a concept and/or grant proposal to develop an institute for HIT within the AAP whose mission would be to provide strategic direction and leadership in promoting affordable, child-friendly health IT and HIE solutions that support quality care and drive the creation and successful deployment of these solutions

Goal #4: Provide high value for COCIT members.

Establish a COCIT mentoring program to assist the general membership in getting involved with COCIT initiatives and HIT/HIE projects

Develop a welcome kit for new members Develop a two-page checklist for COCIT members that

summarizes recommendations from the “Special Requirements for Electronic Health Records Systems in Pediatrics” clinical report, the Implementing an Electronic Health Record toolkit, and other resources for pediatricians to use in the vendor selection process

Next Steps

Recruit volunteers from COCIT membership to form teams to address objectives

To establish a work plan and concrete tasks to address objectives

To recruit additional volunteers from COCIT membership to complete specific tasks within the work plan

To review the Strategic Plan annually and update as objectives are completed

Children’s Health Insurance Program Reauthorization Act

(CHIPRA)

$5 million/year for 5 years to develop a model electronic health record format for children in Medicaid and CHIP

Funding to be distributed through Agency for Healthcare Research and Quality

American Recovery and Reinvestment Act of 2009

(ARRA)

$19 Billion in incentives through Medicare and Medicaid for “meaningful use” of HIT

Established Health IT Policy and Standards Committees

Office of the National Coordinator for Health IT

AAP Vision

“The American Academy of Pediatrics (AAP) views the implementation of the Medical Home (MH), the deployment of health information technology (HIT), and the reform of healthcare as parallel and intertwined processes.

To achieve this potential, HIT must be designed, deployed, implemented, and managed effectively, not only as a simple documentation tool for payment, but as the ongoing, organized source of information for future evidence-based medicine.”

Meaningful Use

Potential for each state Medicaid agency to develop its own definition

Legislation requires e-prescribing, quality reporting, and health information exchange

Meaningful use in pediatrics may be different than for adults Fewer meaningful quality measures ADHD meds cannot be e-prescribed Various state laws/policies on adolescent privacy limit

health information exchange opportunities

HL7 Child Health Linkages

Potential opportunities to explore Standards for electronic health passports for children

in foster care Standards for model electronic health record format

for children Supporting state and regional immunization

information systems in adopting HL7 immunization transactional standards

Others?

HIMSS Pediatric Healthcare and

Informatics Technology (PHIT) SIG

Jennifer Gedney

HIMSS PHIT SIG Overview

Leadership Membership

103 members

Mission Statement To serve as the “information hub” for addressing the special

interests of pediatric health informatics and technology (PHIT) professionals within HIMSS.

Goal To unify pediatric health informatics and technology (PHIT)

professionals within HIMSS and provide *pediatric-specific* input on the major challenges facing the HIT industry, as well as information on recent advances that benefit the pediatric HIT community.

ChairCo-Chair Co-Chair

PHIT Leadership Liaison

Membership and

Communications

Education and Projects

Pele Yu, MD

Dexter D’CostaDarlene Carr

Allan CastroJennifer Gedney

Paul Zlotnik, MD

Leadership

Alliance forPediatricQuality

Identify Requirements

Influence Adoption

Set National Agenda

HIMSS Pediatric Health Informatics & Technology SIG

eHealth CollaborativeHealth Level Seven (HL7) Child HealthWork Group

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

Support work, convene, build

consensus, endorse and

advocate

HHS: Coordinator

HIMSS PHIT SIG Link with Alliance

Develop and Pilot Standards

HL7, SNOMED…

NHINS andCollaboratives

Integrating the Healthcare Enterprise

NQF HIT Expert Panel

Vendor Consortia

Certify Products

CCHIT

Harmonize Standards

HIT Standards Panel

NACHRI Pediatric Advisory Council

CHCA CIO and CMIO Forums

Priorities and Challenges

Strengthen pediatric voice in HIMSS Increase membership and committee

members PHIT SIG contribution to Regional and National

Health IT efforts Promote pediatric educational sessions

PHIT SIG Webcasts Pediatric sessions at annual HIMSS Conference

PHIT eNEWS

Current/Possible Linkages to HL7 Group

Use HIMSS PHIT SIG to solicit input for standards

Promote HL7 priorities through education webinars or articles in PHIT eNews

NACHRI HIT Advisory Group

Allan Castro

Overview

The NACHRI/N.A.C.H. HIT Advisory Group provides guidance to NACHRI/N.A.C.H. in their public policy efforts in the area of pediatric health information technology

Formed May 2009 18 members – CIO’s and CMIO’s of children’s

hospitals

Link with Alliance

Partner with Alliance for input to appropriate agencies

Recent examples of collaboration - meaningful use comments to NCVHS, comments on regional extension centers to ONC

We seek to enhance collaboration with the Alliance

Priorities

Bring awareness of pediatric health IT issues at the federal level

ARRA Medicaid Incentives Meaningful use Collaborate with other similar organizations

Healthcare Information Technology Standards

Panel

Rob Savage

Healthcare InformationTechnology Standards Panel

Overview HITSP is an effort to identify existing standards

that promote interoperability between health information systems

The Players American Health Information Community (AHIC)

is now National eHealth Collaborative (NeHC) Nationwide Health Information Network(NHIN) Certification Commission for Healthcare IT

(CCHIT)

HITSP Previous Process

AHIC and its workgroups release “Use Cases” with priorities for interoperability

HITSP and its Technical Committees develop Interoperability Specifications (IS)

IS draw upon existing standards from HL7, IHE, others

Efforts like NHIN and CCHIT rely on these IS

ONC provides staff support

HHS Secretary

AHIC

ONC

HITSP

HL7 IHE CHIMITA PHIN

CCHIT

NHIN

HITSP New Process

ARRA defined a Policy and Standards Committee which have recently formed with WGs

HITSP continues under contract to ONC

NIST now has testing role Not clear where HITSP

priorities come from Status of NeHC (AHIC

Successor) uncertain

HHS Secretary

ARRA PolicyCommittee

ONC

HL7 IHE CHIMITA PHIN

CCHIT

NHIN

ARRAStandardsCommittee

HITSP

NeHC?

???

NIS

T

Link with Alliance

Previous Alliance helped recruit volunteer participation in

work groups Alliance participated in public comments on behalf of

pediatric community

Future TBD

HL7 Child Health Linkages

Previous Minimal formal connection: some participants heavily

involved in HITSP work

Future TBD

CCHIT Child Health Work Group

Certification Criteria

Aileen Sedman, MD

CCHIT Overview

CCHIT is an independent, nonprofit organization that has been recognized by the federal government as an official certification body for electronic health record products

Its mission is to accelerate the adoption of health information technology by creating a credible, sustainable product certification program

More information on CCHIT and CCHIT Certified products is available at www.cchit.org

CCHIT and Child Health

Child Health Expert Panel formed 2007 Asked to create criteria that could be added to

ambulatory, inpatient, ED (i.e. a company could ask for this special designation along with foundational requirements)

First criteria created 2007 for testing in 2008 - growth tracking and age specific vital signs

First testing and certified products late 2008 26 vendors applied for 2008 child health certification;

anticipate completion by June 30, 2009 (41% of ambulatory certification)

Certified vendors: http://www.cchit.org/choose/ambulatory/08/

Panel completed gap analysis with HL7 Child Health functional profile – gaps as foundation for future criteria development

Alliance Link

Alliance lobbied CCHIT to form Child Health Work Group

Submits letters of endorsement for pediatric work group volunteers

Coordinates pediatric community input into public comment periods

HL7 Child Health Linkages

Previous A number of participants are volunteers on CCHIT

work groups Joy, Aileen and Pele performed gap analysis to

ensure consideration of HL7 child health functional profile

Participants invited to submit comments to Alliance Future

More of the same Other?

National Quality Forum and Health

Information Technology Expert

Panel

Paul Fu, Jr., MD, MPH

HITEP - I Overview

In 2007, AHRQ commissioned NQF HITEP - I to address the ability of EHRs to create and aggregate data for quality measurement Recommended a high-priority set of quality measures

(84) Identified a set of required data categories (11) and data

types (39) to be incorporated into HITSP IS06 Quality Identified gaps

AHIC Quality Workgroup recommended further development of these data types into a quality data set (QDS) and an environmental scan of workflows needed to generate data for measures

HITEP – II Overview

Focus of HITEP - II is on identifying workflows and data sources and making recommendations for a standardized quality data set (QDS)

Expert Panel and two workgroups Workflow workgroup (Paul Fu, Jr., MD, MPH; Brian

Jacobs, MD) – describe efficient capture of standard data elements from appropriate authoritative sources

QDS workgroup (David Stumpf, MD, PhD) – expands on the data categories, types, and elements from HITEP – I and HITSP by adding data concepts, identifying code sets, and describing common value thresholds

Current Status

HITEP – I final report “Recommended Common Data Types and Prioritized

Performance Measures for Electronic Healthcare Information Systems”

HITEP – II draft report “Health IT Enablement of Quality Measurement – the

Quality Data Set (QDS) and Dataflow” Open for public comments until June 30, 2009 http://www.qualityforum.org/projects/ongoing/

HITEP2/comments/index.asp Alliance submitting joint pediatric HIT comments

(send comments to Joy by June 24)

Health Quality Measure Format

NQF issued a subcontract to: Create a Health Quality Measure Format (HQMF) for the

electronic representation of measure specifications, and Write an HL7 Structured Document to facilitate

implementation of the new format, resulting in successful balloting and approval by a standards development organization

Awarded to Alschuler Associates in May 2009 Same vendor who worked with HL7 Child Health on HL7

Quality Reporting Document Architecture (QRDA) Alliance lobbying for inclusion of pediatric measure/s

HITEP Recommendations for Future Work

Ongoing maintenance of the QDS Maintenance of reusable code lists Development of a measure authoring tool Enhanced coordination with SDOs and EHR

certification bodies to encourage incorporation of quality data types into EHR data sets

HL7 Immunization Messaging

Implementation Guide

Rob Savage

American Immunization Registry Association

Information systems are important tools supporting full immunization

Overview

IIS is population based data source IIS source of complete immunization record IIS support for assessing coverage IIS support for VFC usage and soon ordering of

vaccine IIS using HL7 to share data with EHR-S

Millions of HL7 transactions in 2008

Priorities

Improving interoperability through new HL7 Implementation Guide Goals include

Accurate, tightly constrained IG Support for better query Support for use of profiles

Assuring that functionality provided by IIS is included in any future evolution

Challenges

Existing implementations are successful but not consistent across vendors

Upgrading and aligning will cost money/ effort Landscape is changing (less silos) Version 2.x is where we are. Some want to

move to version 3 (messages vs documents)

HL7 Child Health Linkages

Support in ballot process Work with your EHR-S to interact with IIS Work with your IIS to support upgrading

Other Updates, Q&A and Discussion

Thank You!

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