1. Copyright 2009, Children’s Hospitals Neonatal Database – All Rights Reserved In affiliation with Child Health Corporation of America Neonatal Care Report Clinical Document Architecture (CDA) Release 2 ∙ Version 3

2. Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America Children’s Hospitals Neonatal Consortium (CHNC) 2 Background & Rationale  collaborative of 24 children’s hospital Neonatal ICUs  multidisciplinary initiative, started in 2006  limited knowledge about best practices & outcomes for the unique population of infants in tertiary NICUs: Neonatal Care Report  complex & uncommon neonatal diseases  preterm infants with co-morbidities/complications  ill term infants requiring emergent intervention  e.g., ECMO, surgery, dialysis  congenital anomalies  genetic & metabolic syndromes  typically referred for surgical and other subspecialty care

3. Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America 3 Aims of the Initiative:  To evaluate & optimize the tertiary neonatal intensive care provided at children’s hospitals  determine variations in care  evaluate efficacy of current practices  promote safety & facilitate research efforts  spearhead benchmarking & quality improvement initiatives CHNC Mission Neonatal Care Report  ultimately improve clinical outcomes

4. Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America CHNC Partnership with Child Health Corporation of America (CHCA)  In 2008, CHNC partnered with CHCA, a business alliance of 43 leading children’s hospitals  Developed a comprehensive clinical database: Children’s Hospitals Neonatal Database (CHND) 4 Neonatal Care Report Development of Database - CHND Establishment of a Core Data Set  In 2009, CHNC/CHCA completes specifications for a core data set of about 700 defined data fields  Data collection primarily manual abstraction from current systems of clinical documentation (costly)

5. Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America Children’s Hospitals Neonatal Database Participants 5 Atlanta Birmingham Boston Chicago Columbus Cincinnati Dallas Detroit Denver Fort Worth Houston Kansas City Little Rock Los Angeles Memphis (Le Bonheur) Oakland Philadelphia Pittsburgh St. Louis San Diego Salt Lake City St. Petersburg Washington, DC Wilmington, DE *13 additional CHCA hospitals and 8 non CHCA sites considering future participation. Neonatal Care Report

6. Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America Messaging a Subset of Data Employing HL7 standards to facilitate electronic extraction  HL7 Clinical Document Architecture (CDA) Release 2 Selection of Subset of Data Elements for the NCR  unambiguous data fields, well established standards  present in majority of centers (varied stages of EHR development ) 6 Neonatal Care Report (NCR) Demographic data Name, MRN, Maternal Zip Birth Data Birth weight Gestational Age Apgar scores (1, 5, prolonged ) Admission/Discharge Information Dates Measurements (weights, head circ.) Acuity Scoring severity of illness assessment derived from existing mortality models: Pediatric Risk of Mortality: PRISM-III Pediatric Index of Mortality: PIM-II Clinical Risk Index for Babies: CRIB-II Score for Neonatal Acute Physiology: SNAPPE II Predominantly laboratory and physiologic data Scored at several intervals 1 st 12 hours, Day 3, Day 7 of admission

7. Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America Working Group Contributors Co-Chair/Co-Editor:Robert H. Dolin, MD Semantically Yours, LLC bobdolin@gmail.com bobdolin@gmail.com Co-Chair/Co-Editor:Liora Alschuler Alschuler Associates, LLC liora@alschulerassociates.com liora@alschulerassociates.com Co-Chair:Calvin Beebe Mayo Clinic cbeebe@mayo.edu cbeebe@mayo.edu Co-Chair:Keith W. Boone GE Healthcare keith.boone@ge.com keith.boone@ge.com Primary Editor:Gay Giannone, MSN RN Alschuler Associates, LLC gay@alschulerassociates.com gay@alschulerassociates.com Co-Editor:Joy Kuhl, MBA, CPF Principal | Optimal Accords, LLC joy@optimalaccords.com joy@optimalaccords.com Co-Editor:Michael A. Padula, MD Neonatologist, Clinical Informaticist The Children's Hospital of Philadelphia padula@email.chop.edu padula@email.chop.edu Co-Editor:Feliciano Yu, M.D. Information Technology Division Pediatrics Professor University of Alabama at Birmingham School of Medicine fyu@peds.uab.edu fyu@peds.uab.edu Co-Editor:David J. Durand, MD Director, Division of Neonatology Children's Hospital and Research Center Oakland ddurand@mail.cho.org ddurand@mail.cho.org Co-Editor:Karna Murthy, MD Neonatologist, Children's Memorial Hospital Assistant Professor of Pediatrics Northwestern University k-murthy@northwestern.edu k-murthy@northwestern.edu Co-Editor:Jacqueline Kueser Vice President, Strategy/R&D Children’s Hospitals Corporation of America jacqueline.kueser@chca.com jacqueline.kueser@chca.com Co-Editor: Kirk Elrod CHCA IT Liaison/Business Analyst Children’s Hospitals Corporation of America kirk.elrod@chca.com kirk.elrod@chca.com Current Working Group also includes: Kate Conrad,Bobby George, Andy SpoonerDavid Muraco, Diane WardCeleste Milton, Jean Millar Ann Watt Shaun ShakibSandy Stuart Brett MarquardJingdong (JD) Li Anneke GoossenWilliam Goossen Teresa Finitzo 7 Neonatal Care Report