1. Model Children’s EHR Format Erin Grace, MHA Senior Manager, Health IT AHRQ 2012 Annual Conference Session #97: Improving Quality of Care for Children Bethesda, MD September 11, 2012

2. Overview CHIPRA Legislation CHIPRA Legislation Project Team Project Team Scope of the Project Scope of the Project Progress Progress Next Steps Next Steps

3. Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Section 401 (f) Development of a Model EHR Format for Children Enrolled in Medicaid or CHIP Section 401 (f) Development of a Model EHR Format for Children Enrolled in Medicaid or CHIP By 1/1/2010 the Secretary shall establish a program to encourage the development & dissemination of a model EHR Format for children By 1/1/2010 the Secretary shall establish a program to encourage the development & dissemination of a model EHR Format for children 3

4. By law, the model EHR Format for children must be: Compatible with other EHR standards Usable by Caregivers to assure care appropriateness and quality Designed to allow interoperable exchanges Accessible to Caregivers for school and leisure compliance (e.g. immunizations) AccessibleInteroperable CompatibleViewable 4

5. Sponsoring Agencies AHRQ: 5

6. Project Team Subcontractors : 6 Prime Contractor: Subcontractors:

7. What is a “Format?” Requirements for: A minimum set of data elements A minimum set of data elements Applicable data standards Applicable data standards Usability Usability Functionality Functionality Interoperability Interoperability 7

8. Project Purpose Existing EHR systems often do not optimally support the provision of health care to children Project components ■ Identify gaps between existing systems and an optimal EHR for children ■ Design, develop, test, and disseminate a Format based on those gaps ■ Assess existing products for conformance with the Format ■ Demonstrate use of the Format in prototype development 8

9. Model Children’s EHR Format and Meaningful Use The goal is that the model format will be integrated into the EHR certification requirements for a future stage of Meaningful Use. The goal is that the model format will be integrated into the EHR certification requirements for a future stage of Meaningful Use. – MU definition in future stages to include additional pediatric-relevant objectives and clinical quality measures – ONC EHR certification criteria to follow suit 9

10. Scope of Work Focus Focus – Requirements for the unique incremental needs of children – Build on existing foundational work – Suitable for existing and potential systems – Primary care and general inpatient needs Constraints Constraints – Schedule for Format development – Not a standards-setting process 10

11. Technical Expert Panel (TEP) Provide guidance to project Provide guidance to project Review key documents and deliverables Review key documents and deliverables Provide expertise on issues with EHRs used for children Provide expertise on issues with EHRs used for children Serve as a resource on specific clinical, technical, and child welfare issues Serve as a resource on specific clinical, technical, and child welfare issues 11

12. TEP Representation Physician Informaticians Physician Informaticians – Children’s health focus – More general health focus Non-Physician clinicians Non-Physician clinicians Children’s advocacy organizations Children’s advocacy organizations Medicaid Medicaid Vendor Vendor Federal Agencies (ONC, IHS) Federal Agencies (ONC, IHS) 12

13. Gap Analysis Conducted by Intermountain Healthcare Conducted by Intermountain Healthcare Identified key topic areas Identified key topic areas Drafted initial requirements Drafted initial requirements 13

14. Topics Activity Clearance Activity Clearance Birth Information Birth Information Child Abuse Reporting Form Child Abuse Reporting Form Child Welfare Child Welfare Children with Special Health Care Needs Children with Special Health Care Needs Growth data Growth data Immunizations Immunizations Medication Management Medication Management Newborn Screening Newborn Screening Parents, Guardians, and Family Relationship Data Parents, Guardians, and Family Relationship Data Patient (Child) Identifier Patient (Child) Identifier Patient Portals – Personal Health Record (PHR) Patient Portals – Personal Health Record (PHR) Prenatal Screening Prenatal Screening Primary Care Primary Care Quality Measures Quality Measures Registry Linkages Registry Linkages School-based Linkages School-based Linkages Security and Confidentiality Security and Confidentiality Special Terminology and Information Special Terminology and Information Specialized Scales and Scoring Specialized Scales and Scoring Well Child and Preventive Care Well Child and Preventive Care 14

15. Requirements Development Process For each topic area: Review findings from gap analysis Review findings from gap analysis Initial requirements for some topics drafted by TEP Initial requirements for some topics drafted by TEP Additional requirements drafted by subject matter expert (SME) Additional requirements drafted by subject matter expert (SME) Project team review Project team review Outside SME and TEP review(s) Outside SME and TEP review(s) 15

16. Current Work Completing conformance testing of select number of existing EHR systems Completing conformance testing of select number of existing EHR systems Adding more robust EPSDT requirements language Adding more robust EPSDT requirements language Cleaning up database before broad public release Cleaning up database before broad public release Developing a feedback methodology Developing a feedback methodology Targeted Release Fall 2012 Targeted Release Fall 2012

17. Target Audiences for Format CHIPRA Demonstration grantees CHIPRA Demonstration grantees Developers of existing EHR products Developers of existing EHR products New developers New developers System purchasers System purchasers Certifying bodies Certifying bodies Standards groups Standards groups Regulators Regulators Users/developers of “Meaningful Use” criteria Users/developers of “Meaningful Use” criteria 17

18. Contact Information Scott Finley, MD, MPH Principal Investigator, Westat ScottFinley@Westat.com Scott Finley, MD, MPH Principal Investigator, Westat ScottFinley@Westat.com ScottFinley@Westat.com Lois Olinger, MA Lois Olinger, MA Project Manager, Westat LoisOlinger@Westat.com LoisOlinger@Westat.comLoisOlinger@Westat.com Erin Grace, MHA AHRQ Project Officer Erin.Grace@AHRQ.hhs.gov Erin Grace, MHA AHRQ Project Officer Erin.Grace@AHRQ.hhs.gov Erin.Grace@AHRQ.hhs.gov Tom Novak Tom Novak CMS Project Lead Thomas.Novak@CMS.hhs.gov Thomas.Novak@CMS.hhs.gov 18