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IHE QRPH – Maternal and Child Health

IHE QRPH – Maternal and Child Health. Detailed Profile Proposal for 2008/09 presented to the QRPH Infrastructure Planning Committee for November 18 to November 19 at the face to face meeting Charles Rica, Ana Estelrich November 19, 2008. Proposed Editors. Principal Editors:

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IHE QRPH – Maternal and Child Health

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  1. IHE QRPH – Maternal and Child Health Detailed Profile Proposal for 2008/09 presented to the QRPH Infrastructure Planning Committee for November 18 to November 19 at the face to face meeting Charles Rica, Ana Estelrich November 19, 2008

  2. Proposed Editors Principal Editors: Charles RICA, MD, PhD (GIP-DMP) – Ana ESTELRICH (GIP-DMP) Co-editors: Pr. Didier LEMERY, MD, PhD (Dept of pediatrics, Clermont) Pr Paul LANDAIS, MD, PhD (Dept of biostatistics, and Public Health, AP-HP) Dr. Bernard GIUSANO, MD (Dept of pediatrics, Dept of Public Health, CHU Nice) Dr. Catherine CRENN-HEBERT, MD (Dept. of pediatrics, AP-HP) Brigitte LEFEUVRE (Ministry of Health - Direction Genérale de la santé) Christophe BROYER (Ministry of Health - Direction Genérale de la santé)

  3. Summary Existing Problem • Medical information related to mother’s and child health is dispersed between the different healthcare providers involved in the pregnancy/delivery/child growth periods • Existing standards (US, UE initiatives) need to be harmonized • Documents that binds this information have to be defined (standard used, contents) • Public Health & Clinical Research need to have coherent and exhaustive .databases to work on general statistical survey, epidemiological studies, and to make evaluations on the medical (child growth, immunization, epidemic illness,…) state of the country

  4. Summary Relevant standards • XDS.Folder • XDS Document Registry • SVS profile • PCC Medical Summary Implementation Profiles, especially • Antepartum record • Immunization Content • HL7 CDA-R2 • DICOM • PERISTAT Summarize how the problem could be solved • EU works on perinatality health indicators (PERISTAT) or can be use as a basis to establish a common vocabulary and data sets, • French CDA-R2 document on health certificate can be used as a basis to establish the format of the document which could bind such information • Documents can be put into an XDS folder, shared within the affinity domain

  5. Use Case - Public Health - Current • Physicians have to manually fill these three health certificates at the age of 8 days, 9 months, and 24 months old, and then send them to the social services (PMI). • Information sent to PMI can trigger intervention from its services • The information must be pseudonimized by thePMI, then recopied into on statistics institutions servers, in order to process it. Also, if the child changes physician and the certificates are lost, the data is lost as well. Erroneous conclusions are drawn at a national level. • Information is lost and cannot be retrieved for the Child EHR/PHR • Information is often incomplete and only the first certificate is sent to PMI in most cases. .

  6. Use Case - Public Health - Desired Creating an health certificate • Health certificates should be electronic documents, created from data contained into the physician database. Missing data could be completed by the physician when creating them. • In the case of a child who has consulted several physicians, a health certificate should be created from the aggregation of data coming from disparate systems. This could prevent data loss. Using a health certificate by the PMI and by Public Health • As an aggregation of data of the same patient, the health certificate used by the PMI should automatically provide other functionalities such as following links with other cases of illness in the same location. • Interventions from Social seServices can be tiggered by the health certificate contents • Pseudonymization, then integration to national databases to provide national institute of statistics (DRASS, INSERM, InVS) should be automated for the public health officials.

  7. Use Case (I) pregnancy period • After having confirmed she is pregnant by means of a biological test, Mrs X comes to see her gynecologist, for her first consultation for her pregnancy. • The gynecologist, who works with a peri-natality network, creates a folder named “Maternal and Child Health” (MCH) within the mother’s EHR.   • He will send to it biological results he has ordered like determination of Human Chorionic Gonadotrophine (HCG) level, complete blood group, serology tests such as, HIV, syphilis or hepatitis (B/C), or biological tests like urine albumin, and blood red, white, platelet cell counts, etc. • The Gynecologist will send a pregnancy diagnosis certificate, to this folder, as well as a notification of document availability to the authority in charge of pregnancy public health statistics.  • Also, consultations reports, and transabdominal ultrasound exams that are produced during the several consultations Mrs. X will have within her pregnancy, will be also sent to this folder.

  8. Use-case (2) Labor and Delivery • During the labor and the delivery, healthcare providers could retrieve medical information related of her pregnancy by means of this MCH folder. • At birth, the obstetrician or the midwife in charge of the delivery fills a report of delivery. This report includes mother and child(ren) name(s), date and hour of birth, sex, weight, number of gestational days, etc. • Anotification of document availability will be sent to the authority in charge of pregnancy public health statistics. • The physician also fills a health report and sends it to Mrs. X MCH folder • A notification of document availability will be sent to the authority in charge of maternal and child protection (PMI)..   • Information concerning Mrs. X social situation are also a part of this report, as well as the physician recommendations, about mobilizing social services for intervention, treatment or education.

  9. Use-case (3) Child growth • After leaving the hospital, Mrs. X comes to see her general practitioner, for the child medical consultations. • The GP retrieve information about her pregnancy by requesting her MCH folder (gynecologist, midwife, obstetrician reports, biological test results, first health record filled up by the pediatrics specialist of the hospital). •  After the consultation, the GP fills up a second health report, then send it to Mrs. X MCH folder while a notification of document availability is sent to the PMI. • Clinical examination, and immunization tests are reported in this report.  • A third health report will be filled and send on the same way by the GP after the next consultation. • PMI can retrieve the three certificates by requesting them on the MCH folder, and after the data being pseudonymized, sends it to the Public Health Agencies and Organizations, or Research Entities. This data is used to derive nation-wide statistical and epidemiologic reports, relating to the sanitary state of the country, on a pediatric level.

  10. Proposed Standards & Systems • IHE Medical Summary Implementation Profiles • HL7 CDA-R2 • W3C XForms • IHE-ITI XDS • IHE-ITI SVS • DICOM • PERISTAT peri-natal health indicators for European Community • HITSP standards (selection)

  11. Technical Approach • Sharing documents by means of an XDS folder would imply that a common rule of interoperability is adopted between those actors like format standards, value sets, terminologies as well as they all agree with a common healthcare policy that could insure that every actors are belonging to a same affinity domain.  • Technical approach then should be summarized on sharing specialized documents by means of XDS transactions and actors. • These documents have to be defined in order to address the needs of both US and French Public Health systems.

  12. Impact on IHE New actors • MCH document provider • MCH document consumer  Existing actors • Value Set consumer • XDS actors (registry, repository, folders)  New transactions (standards used) • The same actors are used as in the XDS transactions. Please see the transaction diagram. Impact on existing integration profiles • This is a stand-alone profile that might use the Publish and Subscribe profile and Sharing Value Sets profile.  New integration profiles needed • None Breakdown of tasks that need to be accomplished • Evaluate the content of the necessary forms. • Decide on the important data. • Transform the data in CDA format (there is already a French team dedicated to this task). :

  13. Impact on IHE Risks • If this profile is not taken by the committee this year it will lead to separate efforts in both continents for an identical subject, leading to discrepancies and a non-harmonized approach. Open Issues • Must find a common reference of indicators for the content indicated. The European Commission has already done some on this level (Peristat) • Transform the data in CDA format (there is already a French team dedicated to this task). :

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