Welcome! HL7 Child Health Work Group Webcast June 10, 2009 Dial In: (770) passcode:

Child Health Work Group Meeting June 10, :00-10:30 central General Business and National Updates 11:00-12:30 central LeapFrog Flight Simulator Project Update 1:00-2:30 central Understanding CDA, CCD and CCR Overview of Sessions

General Business and Project Updates 9:00-10:30 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 Updates 9:00-10:30 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 phone 2. Avoid hold; Hang up if necessary 3. Introduce self when speaking 4. 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 minutes

DMG Approval Please see decision making guide

General Business and Project Updates 9:00-10:30 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: 2005 Leadership: American Board of Pediatrics American Academy of Pediatrics Child Health Corporation of America National Association of Childrens Hospitals and Related Institutions Mission: To establish a unified voice for improving the quality of pediatric health care

Alliance for Pediatric Quality Identify Requirements Influence Adoption Set National Agenda HIMSS Pediatric Health Informatics & Technology SIG eHealth Collaborative Health Level Seven (HL7) Child Health Work Group AAP Council on Clinical Information Technology Adopt Standards Health Information Technology vendors Child health practitioners, clinicians and 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 and Collaboratives 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 for Pediatric Quality Identify Requirements Influence Adoption Set National Agenda HIMSS PHIT SIG Allan Castro (NACHRI) Jennifer Gedney (CHCA) Feliciano Yu, MD eHealth Collaborative Lisa Simpson, MD, Policy: Marc Probst, MD, Standards TBD HL7 Child Health David Classen, MD Joy Kuhl (Alliance) Andy Spooner, MD Feliciano Yu, MD AAP COCIT Eugenia Marcus, MD Beki Marshall (AAP) Joseph Schneider, MD Adopt Standards Health Information Technology vendors Child health practitioners, clinicians and 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 Representation Connecting the Community Develop and Pilot HL7 ( see left column) NHIN Projects IHE NQF HIT Expert Panel Paul Fu, MD, David Stumpf, MD, Brian Jacobs, MD Vendor Consortia Certify Products CCHIT TBD Harmonize HIT Standards Panel NACHRI HIT Advisory Council TBD CHCA CIO FORUM Jennifer Gedney (CHCA) CIOs: Pam Arora, Allana Cummings, Dan Nigrin, Albert Oriol, Denise Zabawski IOM EHR Collaborative: Data Sharing Network Christopher Forrest (CHOP) Core Team TBD

Link with HL7 Child Health WG Provide administrative co chair Support and endorse work

HL7 Child Health Work Group Andy Spooner, MD

Overview HL7 Child Health Work Group Founded: 2003 Leadership: David Classen, MD, Andy Spooner, MD and Feliciano Yu, MD Participation: Primarily CMIOs, physicians, medical informatics experts and vendor representatives Distribution: 100+ previously on ; 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 Update Jan 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: Update Jan 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 Update 5 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

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

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

Childrens 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 PHIT Leadership Liaison Membership and Communications Education and Projects Pele Yu, MD Dexter DCosta Darlene Carr Allan CastroJennifer Gedney Paul Zlotnik, MD Leadership

Alliance for Pediatric Quality Identify Requirements Influence Adoption Set National Agenda HIMSS Pediatric Health Informatics & Technology SIG eHealth Collaborative Health Level Seven (HL7) Child Health Work Group AAP Council on Clinical Information Technology Adopt Standards Health Information Technology vendors Child health practitioners, clinicians and 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 and Collaboratives 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 members – CIOs and CMIOs of childrens 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 Information Technology 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

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

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

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 growth tracking and age specific vital signs First testing and certified products late vendors applied for 2008 child health certification; anticipate completion by June 30, 2009 (41% of ambulatory certification) Certified vendors: 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, ments/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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