1. Pediatric Data Standards SIG Meeting Atlanta, GA September 21, 2007

2. Meeting Objectives Q1: SIG Business, QRDA Project Overview  Agree upon agenda and meeting objectives  Approve May 2007 WGM minutes  Get to know each other a little better  Celebrate a few recent successes  Explain “QRDA project” and review status

3. Meeting Objectives Q2: QRDA Project Working Session  Confirm approach  Improve upon work based on group input  Review next steps and gather feedback Q3: Terminology Work  Identify overall group interests  Discuss immediate opportunity  Determine possible next steps

4. Meeting Objectives Q4: SIG Business, Plans for 2008  Co-Chair opportunity  Select dates/times for standing monthly calls  New: Vote on balloting Child Health-FP  Draft plans for 2008 (and beyond)  Determine plan for addressing parking lot items  Determine priorities and assignments for next steps  Draft agenda for January 2008 meeting

5. Meeting Objectives Q1: SIG Business, QRDA Project Overview  Agree upon agenda and meeting objectives  Approve May 2007 WGM minutes  Agree upon ground rules  Get to know each other a little better  Celebrate a few recent successes  Explain “QRDA project” and review status

6. 1. Stay on schedule 2. Stay on topic; Use parking lot 3. Silence mobiles and pagers 4. Get out of your comfort zone 5. Expect to contribute 6. Silence is agreement 7. Be constructive Ground Rules

7. 30-second Introductions  Name, Organization, Role  At dinner yesterday: What is one thing you learned about someone?  Not at dinner yesterday: What is one thing you would have shared about yourself?

8. Congratulations!

9. 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 President’s Goal to Make EHR Systems Accessible by 2014

10. 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

11. 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

12. 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.

13. 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

14. 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 patient’s 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

15. HL7 Pediatric Data Standards SIG Tactical Plan 2007 ObjectiveTactics  Ensure EHR Technical Committee Functional Model addresses critical functions for child health care  Determine strategy for addressing functions not included in EHR-FM; Child Health Profile  Recruit one-to-two vendors at a minimum to commit to adopt Child Health Profile Prioritize functions not in the EHR-FM Support liaison to EHR-TC Continue to work with EHR TC to include critical functions in the model Publish profile document to the model Invite vendors to participate in meetings/SIG activities  Develop marketing plan for a released child health profile (vendors, conformance organizations other stakeholders); Mailing and personal calls/meetings with vendors  Provide value to HL7 and other initiatives Match functions with functions outlined in AAP EHR white paper; Prepare letter stating to what extent the functionality outlined in the AAP paper is addressed in the EHR FM Match functions with CCHIT ambulatory and inpatient certification criteria for 2007  Participate in HL7 immunization project Explore opportunities to collaborate on international level Present at relevant industry meetings to build credibility Publish articles/updates in HL7 newsletters  Broad representation and participation in HL7 and other national initiatives Support National Child Health Data Standards Work Group Support AAP Council on Clinical Information Technology Support Council on Certification of Health Information Technology Communicate with Child Health Corporation of America CIO Forum Participate in joint HL7 work group sessions Present at relevant industry meetings to recruit participants Continue to recruit participation from pediatric community  Secure support and leadership (financial and otherwise) from pediatric organizations Receive endorsement from CHCA, NACHRI, AAP and ABP Develop budget and secure financial support for PeDSSIG activities Influence adoption of pediatric requirements Establish PeDSSIG credibility Build pediatric consensus Earn commitment from pediatric stakeholders Goal

16. Congratulations!  EHR-S FM includes 90% of requests  Child Health-FP registered with HL7  CCHIT to use Child Health-FP  Led QRDA exploration project  Public comments addressed  Marketing success  Recruitment success

17. QRDA Overview

18. Planning 2008

19. Meeting Objectives Q4: SIG Business, Plans for 2008  Co-Chair opportunity  Select dates/times for standing monthly calls  Vote on balloting Child Health-FP  Draft plans for 2008 (and beyond)

20. Co Chair Opportunities Co ChairTerm Andy Spooner, MDJan 2006 - Jan 2008 David Classen, MDJan 2007 – Jan 2009 Joy Kuhl (Admin)May 2006 – May 2008 Open Chair (New)Jan 2008 – Jan 2010 Status Will seek re-election Not seeking re-election Will seek re-election Vote at Jan 2008 mtg

21. Proposed Monthly Calls 2008 Second Week of Each Month: Rotating Tues/Thurs  Thursday, January 10, 1-2 PM Central  Tuesday, February 12, 9-10 AM Central  Thursday, March 13, 1-2 PM Central  Tuesday, April 8, 9-10 AM Central  Thursday, May 8, 1-2 PM Central  Tuesday, June 10, 9-10 AM Central  Thursday, July 10, 1-2 PM Central  Tuesday, August 12, 9-10 AM Central  Thursday, September 11, 1-2 PM Central  Tuesday, October 14, 9-10 AM Central  Thursday, November 13, 1-2 PM Central  Tuesday, December 9, 9-10 AM Central

22. Balloting the Child Health-FP Decisions to Make Today 1.Do we want the profile to become a standard? 2.If so, what kind? 1.Informative a.Requires 60% approval b.EHR TC and PeDSSIG votes 2.Normative a.Requires 90% approval b.Open to HL7 membership for voting c.Approval makes it ANSI standard d.Requires two ballot cycles

23. Balloting the Child Health-FP Next Steps  Complete intent to ballot form by October 15  Inform EHR TC (and Patient Care) of intention and seek approval  Submit documentation to EHR TC and publications workgroup to create ballot documents  Publicize ballot opportunity  Ballot – November/December  Recruit reconciliation volunteers  January Work Group reconciliation session  EHR TC accepts reconciliation document  Second ballot period likely March 2008  Opportunity to become HL7 ANSI standard May 2008

24. 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

25. ObjectiveTactics  Build pediatric consensus on new data standards  Maintain broad representation and participation in HL7 initiatives on behalf of child health care  Strong participation in relevant national HIT data standards public comment periods on behalf of child health care  Bring Child Health Functional Profile for EHR systems through normative HL7 ballot  Continue to work with EHR TC to include critical functions in the EHR-S FM model; Participate in opportunities for public comment  Provide input into EHR TC quality functions work  Explore and encourage development of derived profiles to the Child Health-FP (e.g. neonatology) with educational toolkit  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  Explore relationships between AAP guidelines and data standards  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, including a checklist of the SHALL criteria  Vote on most essential functions in child health profile to share with Child Health Expert Panel  Work through AAP to invite specialty sections to work with us on derived profiles?  Explore opportunities for industry conference presentations  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

26. Pediatric Terminology

27. Meeting Objectives Q3: Terminology Work  Identify overall group interests  Discuss immediate opportunity  Determine possible next steps

28. Next Steps Jan 2008 Agenda

29. Next Meeting: January 13-18, 2008 San Antonio, TX Which days are preferred? Monday, January 14? Tuesday, January 15?