Pediatric Data Standards SIG

1. Pediatric Data Standards SIG Functional Requirements Review

2. V10 Document Statements • Each slide's title is the general area of functionality • Bullets represent: • the current wording of the function statement • the closest matching conformance criterion from the November 2005 EHR TC document • whether the above two represent a "match," and • an arbitrary ID number to reference an internal database • Next steps: • Work groups/individuals review categories based on assignments and suggest edits; Review suggested edits together through a series of webcasts to be scheduled soon

3. Four Sets of Conformance Criteria • INCLUDED (74 CCs): Our CC are easily found in the DSTU: INCLUDED.ppt • NOT INCLUDED (47 CCs): Can’t find anything like our CC in the DSTU: NOT INCLUDED.ppt • ALMOST INCLUDED (32 CCs): Something close to our CC is in the DSTU: ALMOST INCLUDED.ppt • GRAY AREA (19 CCs): The SIG needs to decide what it means, exactly: GRAY AREA.ppt

4. Age Representation Allergies (Miller, Omlor, Yu) Archiving Communications Consent Custody (Weigle) Decision Support (Akhtar, Del Beccaro, Warren) E-prescribing and Ordering (Yu, Del Beccaro) Epidemiology Family Linkage (Murray) Gender (Murray) Gestational Age (Murray) Growth (Sedman, Weigle) Guardianship Immunizations (Yu, Akhtar) Interface Lab Results (Rocca) Medical Home (Schneider, Sedman, Warren) Miscellaneous Norms Parental Data Entry (Schneider) Patient Identification (Miller, Underwood) Pedigree (Schneider) Preferences Prenatal Privacy Registries Reports Research (Miller) Telehealth (Akhtar, Rocca) Terminology (Underwood, Rocca) Vocabulary (Underwood, Rocca) Suggested New Category: RHIO (Schneider) 32 Categories to Assign

5. V10 Document Statements • Each slide's title is the general area of functionality • Bullets represent: • the current wording of the function statement • the closest matching conformance criterion from the November 2005 EHR TC document • whether the above two represent a "match," and • an arbitrary ID number to reference an internal database • Possible next steps: • Work groups/individuals review and suggest edits; Review suggested edits together through a series of webcasts

6. Age Representation • Allow recording of post conceptional age and distinguish it from post-natal age • Closest conformance criterion: N/A… DC.1.2 (Manage patient demographics) comes closest ([no CC contains this specific concept]). • NOT INCLUDED, noncontroversial • Reference number: 2

7. Age Representation • Allow recording of the exact time of birth down to the minute • Closest conformance criterion: N/A… DC.1.2 (Manage patient demographics) comes closest ([no CC contains this specific concept]). • NOT INCLUDED, noncontroversial • Reference number: 3

8. Age Representation • Display age with the appropriate units, based on the child's age (for example, infants who are four days old should have their age displayed in days, as opposed two weeks or months) • Closest conformance criterion: N/A… DC.1.2 (Manage patient demographics) comes closest (N/A). • NOT INCLUDED, noncontroversial • Reference number: 4

9. Allergies • [Allergies] could include items such as foods or environmental agents. • Closest conformance criterion: DC.1.3.2 #1 (The system SHALL capture true allergy, intolerance, and adverse reaction to drug, dietary or environmental triggers as unique, discrete entries.). • INCLUDED, noncontroversial • Reference number: 5

10. Allergies • Allow the classification of reactions into allergic reactions, side effects, and intolerances • Closest conformance criterion: DC.1.3.2 #1 (The system SHALL capture true allergy, intolerance, and adverse reaction to drug, dietary or environmental triggers as unique, discrete entries.). • INCLUDED, noncontroversial • Reference number: 6

11. Allergies • List food allergies and medication allergies separately • Closest conformance criterion: DC.1.3.2 #1 (The system SHALL capture true allergy, intolerance, and adverse reaction to drug, dietary or environmental triggers as unique, discrete entries. Do we really want to ask for this? What do we really mean by separate?). • Possibly included, controversial • Reference number: 7

12. Allergies • The user determines what defines an allergy or adverse reaction • Closest conformance criterion: DC.1.3.2 #4 (The system SHOULD provide the ability to capture the reaction type). • INCLUDED, noncontroversial • Reference number: 8

13. Archiving • Store data until the statutorily designated time • Closest conformance criterion: I.1.2.1 #1 (The system SHALL provide for the storage and retrieval of health record data and clinical documents for legally proscribed (sic) time. ). • INCLUDED, noncontroversial • Reference number: 9

14. Communications • The user may indicate who they are sending results to and the system will track this • Closest conformance criterion: DC.1.10.1 #8 (The system MAY route results to patients by methods such as phone, fax, electronically or in the form of a letter). • INCLUDED, noncontroversial • Reference number: 10

15. Consent • In cases where advanced directives are managed by the system, provide forms appropriate to both patients and guardians where the patient is below the legal age of consent • Closest conformance criterion: DC.1.11.2 (The system MAY be able to indicate that the patient’s personal representative (guardian/surrogate) has completed advanced directive(s) on their behalf. ). • INCLUDED, noncontroversial • Reference number: 12

16. Consent • Allow recording of both consent and assent to treatment • Closest conformance criterion: DC.1.11.3 #7 (EHR systems SHOULD allow documentation of an assent as appropriate for patients legally unable to consent. ). • INCLUDED, noncontroversial • Reference number: 11

17. Consent • In cases where consent forms are managed by the system, allow adolescent patients to participate as if they were adults under appropriate conditions • Closest conformance criterion: DC.1.11.3: Manage consents and authorizations ((Does not explicitly mention this function)). • NEEDS NEW CC IN THIS FUNCTION • Reference number: 13

18. Custody • Identify a child who has been removed from a home • Closest conformance criterion: N/A ((This would simply be an item in the child's history, e.g. Social Hx)). • VOCABULARY ISSUE: … • Reference number: 14

19. Custody • Indicate when a child is in foster care • Closest conformance criterion: N/A ((This would simply be an item in the child's history, e.g. Social Hx)). • VOCABULARY ISSUE: … • Reference number: 15

20. Custody • Indicate when a child is under ongoing investigation for abuse or neglect • Closest conformance criterion: N/A ((This would simply be an item in the child's history, e.g. Social Hx)). • VOCABULARY ISSUE: … • Reference number: 16

21. Custody • Indicate when the child has been adopted • Closest conformance criterion: N/A ((This would simply be an item in the child's history, e.g. Social Hx)). • VOCABULARY ISSUE: … • Reference number: 17

22. Custody • Provide patient identification mechanisms that can withstand changes in family structure, such as loss of a child from the family in a custody decision • Closest conformance criterion: N/A ((I am pretty sure this needs some significant clarification)). • NOT INCLUDED, noncontroversial • Reference number: 19

23. Custody • Provide patient identification mechanisms that can withstand changes in family structure, such as removal of the child from the home • Closest conformance criterion: N/A ((I am pretty sure this needs some significant clarification)). • NOT INCLUDED, noncontroversial • Reference number: 20

24. Custody • Provide authentication procedures for adults who claim to be parents or guardians of a child, in cases where the child is under investigation four abuse and neglect • Closest conformance criterion: Needs more detail… hard to put this one into a conformance criterion (Perhaps this one could be achieved merely by supporting some kind of alerting mechanism for kids whose custody is not straightforward). • NOT INCLUDED, noncontroversial • Reference number: 18

25. Decision Support • Incorporate age, weight, and disease criteria into alerts related to laboratory results • Closest conformance criterion: DC.1.10.1 #11 (The system MAY trigger decision support algorithms from [test] results. ). • INCLUDED, noncontroversial • Reference number: 31

26. Decision Support • Integrate patient and family preferences into clinical decision support • Closest conformance criterion: DC.1.11.1 #3 (The system SHOULD integrate patient and family preferedecision support systems). • INCLUDED, noncontroversial • Reference number: 34

27. Decision Support • Link care processes to the problem list • Closest conformance criterion: DC.1.5 #9 (The system MAY associate encounters, orders, medications, notes with one or more problems.). • INCLUDED, noncontroversial • Reference number: 35

28. Decision Support • Link lab values to problem list • Closest conformance criterion: DC.1.5 #9 (The system MAY associate encounters, orders, medications, notes with one or more problems.). • INCLUDED, noncontroversial • Reference number: 37

29. Decision Support • Link medical imaging to items all on the problem list • Closest conformance criterion: DC.1.5 #9 (The system MAY associate encounters, orders, medications, notes with one or more problems.). • INCLUDED, noncontroversial • Reference number: 38

30. Decision Support • Link orders to problems [in problem lists] • Closest conformance criterion: DC.1.5 #9 (The system MAY associate encounters, orders, medications, notes with one or more problems.). • INCLUDED, noncontroversial • Reference number: 39

31. Decision Support • Provide problem lists link to medical orders, lab, medical imaging, disease specific guidelines, or care processes including rationale for care. • Closest conformance criterion: DC.1.5 #9 (The system MAY associate encounters, orders, medications, notes with one or more problems.). • INCLUDED, noncontroversial • Reference number: 43

32. Decision Support • Provide decision support for special immunizations such as palivizumab • Closest conformance criterion: DC.1.6.1 #1 (The system SHALL support presentation of guidelines and protocols to clinicians). • INCLUDED, noncontroversial • Reference number: 42

33. Decision Support • Indicate in the case of decision support function whether the function applies to the pediatric population • Closest conformance criterion: DC.1.6.1 #1, 3, 4, 5 (assuming decision support = guidelines) ((Comes close)). • NEEDS NEW CC IN THIS FUNCTION • Reference number: 32

34. Decision Support • Link disease specific guidelines to the problem list • Closest conformance criterion: DC.1.6.1 #4 (The system SHALL present guidelines and protocols appropriate for the patient’s problem list. ). • INCLUDED, noncontroversial • Reference number: 36

35. Decision Support • Apply patient age to all decision support functions • Closest conformance criterion: DC.1.6.1 #5 (The system SHALL support context-sensitive care plans, guidelines and protocols (function DC.2.2.1.2) ). • INCLUDED if we make minor mods in a CC • Reference number: 25

36. Decision Support • Facilitate selection of guidelines based on patient age • Closest conformance criterion: DC.1.6.1 #5 (The system SHALL support context-sensitive care plans, guidelines and protocols (function DC.2.2.1.2) (provided "context" = "age")). • INCLUDED if we make minor mods in a CC • Reference number: 28

37. Decision Support • Indicate the source of any applicable guidelines or decision support rules • Closest conformance criterion: DC.1.6.2 #4 (The system SHOULD allow tracking of updates to care plans by: authors, creation date, version history, references, local sources, non-local sources). • INCLUDED, noncontroversial • Reference number: 33

38. Decision Support • Allow for disease specific health maintenance schedules with accompanying decision support • Closest conformance criterion: DC.2.1.1 #2 (The system SHALL enable access to standards and practices related to age, gender, normal growth and development and medical conditions [this assumes that "assessments" refers to forms for data collection]). • INCLUDED, noncontroversial • Reference number: 23

39. Decision Support • In cases where forms vary with age, select forms to be presented based on age. • Closest conformance criterion: DC.2.1.1 #2 (The system SHALL enable access to standards and practices related to age, gender, normal growth and development and medical conditions [this assumes that "assessments" refers to forms for data collection]). • INCLUDED, noncontroversial • Reference number: 29

40. Decision Support • Modify displays based on age • Closest conformance criterion: DC.2.1.1 #2 (The system SHALL enable access to standards and practices related to age, gender, normal growth and development and medical conditions [this assumes that "assessments" refers to forms for data collection]). • INCLUDED, noncontroversial • Reference number: 40

41. Decision Support • Modify displays based on gestational age at birth • Closest conformance criterion: DC.2.1.1 #2 (The system SHALL enable access to standards and practices related to age, gender, normal growth and development and medical conditions [this assumes that "assessments" refers to forms for data collection] [assumes gestational age could be treated as a "medical condition," which is reasonable]). • INCLUDED, noncontroversial • Reference number: 41

42. Decision Support • Remind users of anticipatory guidance topics based on age • Closest conformance criterion: DC.2.2.1.2 #1 (assuming that "anticipatory guidance topics" can be considered a "care plan") (The system SHALL support access to resources for care plans that are context sensitive to patient specific data and assessment, and are appropriate to the age, gender, developmental stage and medical condition of the patient (DC 1.3.1, DC 1.4, DC 1.5, DC 1.6)). • INCLUDED, noncontroversial • Reference number: 44

43. Decision Support • Remind users of anticipatory guidance topics based on risk factors • Closest conformance criterion: DC.2.2.1.2 #1 (assuming that "anticipatory guidance topics" can be considered a "care plan") (The system SHALL support access to resources for care plans that are context sensitive to patient specific data and assessment, and are appropriate to the age, gender, developmental stage and medical condition of the patient (DC 1.3.1, DC 1.4, DC 1.5, DC 1.6)). • INCLUDED, noncontroversial • Reference number: 45

44. Decision Support • Remind users of anticipatory guidance topics based on topics previously discussed • Closest conformance criterion: DC.2.5.1 (sort of) (The system SHOULD present alerts for all patient specific preventive services to the provider (is anticipatory guidance a preventive service?)). • INCLUDED, noncontroversial • Reference number: 46

45. Decision Support • Alert clinicians to the need for developmental screening based on guidelines • Closest conformance criterion: DC.2.5.1 #1 (The system SHOULD identify services for preventive care and wellness from patient demographics (eg. age, sex, region) ). • INCLUDED, noncontroversial • Reference number: 21

46. Decision Support • Alert clinicians to the need for hearing and vision screening per guidelines • Closest conformance criterion: DC.2.5.1 #1 (The system SHOULD identify services for preventive care and wellness from patient demographics (eg. age, sex, region) ). • INCLUDED, noncontroversial • Reference number: 22

47. Decision Support • Based on the record of encounters, the patient's current age, and existing guidelines, calculate whether the patient is current on the health maintenance schedule • Closest conformance criterion: DC.2.6.3 (as long as failure to participate in well-care is considered a health risk, which pediatricians generally do) AND DC.2.5.1 (The system SHALL provide a means to identify those patients who have not received appropriate action in response to a health risk alert. (Care Plan Function Links) --> How to modify this to deal with health maintenance? AND The system SHOULD present alerts for all patient specific preventive services to the provider. ). • INCLUDED if we make minor mods in a CC • Reference number: 26

48. Decision Support • Allow the deferral of alerts and reminders to a subsequent episode of care • Closest conformance criterion: N/A ((If a system decided that service X was needed today, and the user decided not to do it, then the system generally would decide that is needed tomorrow, too, right?)). • NOT INCLUDED, noncontroversial • Reference number: 24

49. Decision Support • Display deferred actions • Closest conformance criterion: N/A ((If a system decided that service X was needed today, and the user decided not to do it, then the system generally would decide that is needed tomorrow, too, right?)). • NOT INCLUDED, noncontroversial • Reference number: 27

50. Decision Support • In cases where gender is unknown, and in the case where certain decision support is gender specific, provide both male and female versions in cases where the gender is unknown • Closest conformance criterion: N/A (N/A). • NOT INCLUDED, noncontroversial • Reference number: 30