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Model Children’s EHR Format

Model Children’s EHR Format. History and Process. AHRQ 2011 Annual Conference September 19, 2011 3:30PM-5:00PM Scott Finley, MD, MPH, Principal Investigator, Westat. Project Team. Subcontractors:. Prime Contractor:. Subcontractors:. 2. What is a “Format?”.

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Model Children’s EHR Format

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  1. Model Children’s EHR Format History and Process AHRQ 2011 Annual Conference September 19, 2011 3:30PM-5:00PM Scott Finley, MD, MPH, Principal Investigator, Westat

  2. Project Team Subcontractors: Prime Contractor: Subcontractors: 2

  3. What is a “Format?” Called for in the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Further defined as requirementsfor: A minimum set of data elements Applicable data standards Usability Functionality Interoperability 3

  4. What is a requirement? • “The system SHALL present patient age using units appropriate to the actual age of the patient, using appropriate thresholds for unit selection” • SHALL / SHOULD / MAY 4

  5. 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 5

  6. Scope of Work • 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 • Schedule for Format development • Not a standards-setting process 6

  7. Prior Work • HL7 EHR-S Functional Model • Hierarchy • Not child-specific • HL7 Child Health Functional Profile • 125-150 child-specific changes from Functional Model • Numerous publications • Selected home-grown systems 7

  8. Technical Expert Panel (TEP) Provide guidance to project Review key documents and deliverables Provide expertise on issues with EHRs used for children Serve as a resource on specific clinical, technical, and child welfare issues 8

  9. TEP Representation Physician Informaticians Children’s health focus More general health focus Non-Physician clinicians Children’s advocacy organizations State Medicaid agencies Vendors and product developers Office of the National Coordinator for Health IT Indian Health Service 9

  10. Other Input • CHIPRA Category D Grantees • Pennsylvania • North Carolina • Federal Workgroup 10

  11. Gap Analysis • Conducted by Intermountain Healthcare • Identified key topic areas • Drafted initial requirements 11

  12. Topic Areas in Format • Activity Clearance • Birth History • Child Abuse Reporting • Child Welfare • Children with Special Health Care Needs • Growth Data • Immunizations • Medication Management • Newborn Screening • Parents, Guardians, and Family Relationship Data • Patient Identifiers • Patient Portals/Personal Health Record Information Access • Prenatal Screening • Primary Care • Quality Measures • Registry Linkages • School-based Linkages • Security and Confidentiality • Special Terminology and Information • Specialized Scales and Scoring • Well Child and Preventive Care

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

  14. Concept Evolution #1 From the HL7 Child Health Functional Profile: • “The system MAY provide the ability to compute post conceptional age (corrected age) for the purposes of decision support.” 14

  15. Concept Evolution #2 From the Model Format: • “The system SHOULD be able to display head circumference adjusted for the degree of prematurity by subtracting the number of weeks premature the individual was born from each plot point during the first two years of life. The growth chart should reflect that this plot was corrected for prematurity.” 15

  16. Format Characteristics • Specialized requirements database (Accompa) • Chiefly functional requirements, including interoperability • Usability challenges • Few existing standards to support taxonomy or data elements • >700 detailed requirements • Suitable for system development and system selection 16

  17. Requirements Tool 17

  18. Requirement Details 18

  19. Summary • >700 incremental EHR requirements for children • No new standards set • Compatible with existing & potential systems • Primary care and general inpatient care • Best accessed through Accompa guest account (exports will also exist) 19

  20. Contact Information Scott Finley, MD, MPHPrincipal Investigator, Westatscottfinley@westat.com Lois Olinger, MA Project Manager, Westat loisolinger@westat.com Erin Grace, MHA AHRQ Project Officer Erin.grace@AHRQ.hhs.gov Jessica Kahn, MPH CMS Project Lead Jessica.Kahn@CMS.hhs.gov 20

  21. Questions? 21

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