1. Pediatric Data Standards SIG Overview Atlanta, GA September 20, 2007

2. Why 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 Support Presidents Goal to Make EHR Systems Accessible by 2014

3. Alliance for Pediatric Quality 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 Pediatric Consortia Health Level Seven (HL7) Pediatric Data Standards SIG 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 PeDSSIG is Part of National Pediatric HIT Community Support workgroups, build consensus and adoption HL7

4. Example: HIT Workflow AAPPeDSSIGHL7CCHIT EMR Position Papers Pediatric EHR Functions EHR-FM Standard EHR Vendor Certification Criteria Alliance Support and Endorsement Vendor Compliance & Certification; Provider Adoption

5. 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.

6. 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

7. 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 patients 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

8. DRAFT HL7 Pediatric Data Standards SIG Tactical Plan 2008 ObjectiveTactics Build pediatric consensus on new data standards Maintain broad representation and participation in HL7 initiatives on behalf of child health care Participate in relevant national HIT data standards public comment periods on behalf of child health care Bring Child Health Functional Profile for EHR systems through HL7 ballot Continue to work with EHR TC to include critical functions in the EHR-S FM model; Participate in opportunities for public comment Explore and encourage development of derived profiles to the Child Health-FP (e.g. neonatology) Participate in PHR FM project by providing pediatric input 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 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 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

9. Questions? David Classen, MD dclassen@fcg.com Andrew Spooner, MD andrew.spooner@cchmc.org Joy Kuhl joy.kuhl@chca.com