Alliance for Pediatric Quality An Overview

1. Alliance for Pediatric Quality An Overview August 28, 2006

2. HospitalCommunity PhysicianCommunity Joining to Improve Pediatric Quality What is the Alliance? A collaboration of four major national pediatric organizations formed to measurably improve the quality of health care for America’s children.

3. Vision Every child will have the opportunity to grow up healthy, supported by a health care system where care is safe, effective, patient-centered, timely, efficient, equitable and based on the best possible science and technology.

4. Goals 1. Promote the use of meaningful pediatric measures industry wide. The Alliance will accelerate the identification and use of measures by the pediatric community that will best drive change and improvement in the quality of health care for children. It will also define those measures that should emerge as measures of accountability for pediatrics. 2. Make sure health information technology works for kids. The Alliance will bring together multiple technology organizations and individuals to create one pathway for ensuring the adoption of pediatric data standards that work across all care settings.

5. Strategies • Work for consensus – speak with one voice on behalf of children • Endorse and promote projects that advance pediatric quality and health information technology in children’s health care • Convene stakeholders • Advocate in media and legislature

6. Strong Foundation 1990s 2002 2006 2000 2003 2004 2005 2001 Special Interest Group for pediatric data Standards approved by HL-7 AAP starts COCIT Convened to discuss data standards AAP EMR specs updated w/ HL7 Sig. input HL7 Sig. releases pediatric specs for EMR First electronic medical records requirements for pediatrics AAP releases evidence-based clinicalguidelines(eQUIPP) CHCA, NACHRI, MMP work w/JCAHO on pediatricmeasures • NQF endorses • asthma measure • set Developed first set of core measures Pedi-QS asthma core measure setto JCAHO • Alliance forPediatricQuality • Formed AMA (CQI) Consortium releases acutegastroenteritis, asthma measures 2002 2006 2000 2003 2004 2005 1990s 2001

7. Accomplishments to Date Pedi-QS Workgroup Drives Inpatient Measures • Asthma measure set endorsed by NQF • Current work includes: • Additional asthma measures • Neonatal care • Nursing sensitive measures • Pediatric intensive care • Surgical infection prevention identification and use • Analyze national priorities for future measure development • Develop new performance measure sets using Pedi-QS Pedi-QS methodology recognized by industry

8. Accomplishments to Date Physician Community Drives Ambulatory Measures • AAP evidence-based clinical guidelines – ripe for measure development • AMA Consortium for Physician Performance Improvement (pediatric gastroenteritis and asthma measures) • Active pediatric representation at AQA, NQF, NCQAand private payor panels • Ambulatory Pediatric CAHPS survey • Miller et al study (2005) – Build upon findings of existing/needed quality measures

9. Accomplishments to Date HL7 Special Interest Group Drives Pediatric Data Standards HL7 Pediatric Data StandardsSpecial Interest Group(HL7 PeDSSIG) • Developed pediatric requirements for EHR specifications • Developed information flow charts for pediatric immunization; vendor adoption in process • Submitted to CCHIT inpatient EHR functionality requirements on behalf of Alliance • HL7 Pediatric Profile creation underway • Role of Special Interest Group • 58 organizations, including AAP, CHCA and NACHRI and vendors • Identify critical pediatric-specific data standards for quality and outcomes measurement reporting • Create nomenclature lexicon and required terminology • Seek approval of HL7 for pediatric recommendations

10. Accomplishments to Date Council on Clinical Information Technology (COCIT) • Sample Ongoing AAP HIT Efforts • Develops and publishes policy documents on pediatric health IT • National advocacy/involvement • Health IT education • Physicians Electronic Health Record Commission (PEHRC) • Evaluation of pediatric electronic medical record vendors at TEPR • Representatives at CCHIT, ANSI HITSP, ASTM Committee E31 (CCR) • EHR policy statement published • Inpatient HIT systems policy underway • Strong vendor participation in Pediatric Documentation ChallengeTM • Active EMR review web site

11. How We Work Together Standards panel harmonizingstandards forhealth IT vendors Certification commission uses HL7 standards as baseline for health IT vendor certification HITSP CCHIT American Health Information Community COCIT HL7 COCIT HL7 Federally chartered commission makes recommendations to HHS Conducts pilots with hospitals to build interoperability NHIN HISPC Addresses business policy and state law affecting privacy and security Pay for Performance CHOB Indiana

12. How We Could Work Together AAP Council on Clinical Information Technology (COCIT) HL7 Pediatric Data Standards Special Interest Group (PeDSSIG) • National advocacy/involvement with national health IT organizations on behalf of pediatrics • Develop and publish policy documents on pediatric health information IT issues • Educate stakeholders, disseminate, andimplement communication approaches for pediatric IT standards • Educate public about vendor pediatric capabilities (e.g. through Documentation Challenge™ and EMR review web site) • Identify critical pediatric-specific data standards for quality and outcomesmeasurement reporting • Develop, propose, and get approval for standards in HL7 • Coordinate with other groups interested inusing pediatric data standards, including vendors • Identify required terminology; Create nomenclature lexicon Provide input into areas of focus; Support through education, advocacy, policy creation Provide pediatric HL7 standards; Identifycurrent standards that apply to focus areas APQ Technology Workgroup National Policy Makers Health Information Technology Vendors Pediatric Care Providers

13. A Proactive, Unified Approach APQ Information Technology Workgroup A group of technical experts in the pediatric community who identifies and coordinates opportunities for unified action through the Alliance - providing strength to current pediatric healthcare IT activities through consensus building, advocacy and endorsement Immediate APQ Activities • Host regular workgroup calls to review activities underway and to identify opportunities for unified action • Coordinate response to HITSP interoperability specifications • Support representative to HL7 EHR TC • Support other representatives to national initiatives • Upon completion, endorse HL7 PeDSSIG pediatric profile and assistance with market communication and education • Joint response to CCHIT re. inclusion of growth charts

14. Organizational Structure Informal coalition Shared decision-making In-kind resources Founders/CEOs Executive Committee/VPs • Day-to-day activity • Ex Officio Executive Committee • Manage work groups, consultants • Front-line liaison to stakeholders Admin support Executive Director Consultants Pedi-QS Workgroup Information Technology Workgroup Workgroup Workgroup Workgroup

15. Year One Focus • Evaluate and prioritize measures and move them very quickly to the public domain for use in improvement and accountability • Endorse a common set of measures • Evaluate and accelerate pay for performance strategies for pediatrics • Determine opportunities for sharing data • Concurrently our four organizations are exploring a data sharing initiative; work is independent of the Alliance at this time • Seek industry-wide adoption of data standards for pediatrics • CCHIT integration of HL7 standards • Endorse pediatric data standards (as supplied by the Special Interest Group) • Support Special Interest Group efforts in embedding pediatric-specific EHR requirements in vendor systems

16. Initial Measures of Success • The Alliance will conduct an annual evaluation of our accomplishments and develop success metrics • Some of our success factors follow: • JCAHO and industry will widely use pediatric measures recommended by the Alliance • CCHIT adopts standards recommended by HL7 Special Interest Group • The Alliance will be recognized by national quality organizations as the “go-to” organizations for pediatric quality

17. Support the Alliance • When you see opportunities to advance quality or health information technology standards at the national level, please contact: AAP : Ed Zimmerman (847) 434-1917 ABP: Paul Miles (919) 929-0461 CHCA: Donna Payne (913) 262-1436 NACHRI: Mary Gorman (703) 684-1355