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HL7 Child Health Update CHCA Evidence-Based Order Set Project

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Presentation on theme: "HL7 Child Health Update CHCA Evidence-Based Order Set Project"— Presentation transcript:

1 HL7 Child Health Update CHCA Evidence-Based Order Set Project
Pediatric Rheumatology Network: CARRANet American College of Rheumatology (ACR) Concept Mapping Robert W. Warren, MD, PhD, MPH Chief Medical Information Officer Texas Childrens Hospital January 18, 2010

2 CHCA Evidence-Based Order Set Project

3 Order Sets Project Executive Team
Robert Warren, Houston Charles Macias, Houston Patrick Barrera, Houston Mark Del Beccaro, Seattle Michael Leu, Seattle Andrew Spooner, Cincinnati Sherrie Graham, CHCA Gary Anthony, CSC

4 Order Sets Project Goals
By sharing evidence-based order sets (EBOS) among member hospitals Improve child health care by decreasing unfounded variability of practice Increase speed and decrease cost of implementation of evidence-based orders sets in EHRs

5 Milestones and Activities
Establish Project governance to define, implement, and evaluate project goals. Establish an evidence-based order set (EBOS) Library, with basic rules for submission, from pilot hospitals. Define basic rules for EBOS submissions, including statement of order set development at the submitting institution. EBOS should include (1) set descriptors; (2) inclusion/exclusion criteria; (3) care process with associated evidence; (4) outcome measures Create a standard format for EBOS in the Library. Populate and evaluate initial candidate EBOS, using the standard format. Validate effort with CHCA Governance and member hospitals Expand effort as appropriate Don’t know if this is helpful and we don’t want to read to them. We need to solicit agreement on what will occur during each timeframe as to who does what and what is to be done for each step. Perhaps use more of a bulleted or grid approach to help them see and reach agreement might be more helpful. Run by Gary as he spoke to Gretchen. ***I am not sold on these next three slides. This information is mostly contained on slide #11. I tried condensing information and bulleting it, but I am open to another approach.

6 Order Sets Library Examples
Asthma Acute Gastroenteritis Bronchiolitis Diabetes Acute Chest in Sickle Cell Patient Status Epilepticus Femur Fracture Fever-Neonate Pneumonia UTI CAP Fever & Neutropenia in Oncology Patient DVT Acute Chest in the Sickle Cell pt; Fever & Neutropenia in the Oncology pt; Acute Gastroenteritis; Status Epilepticus; and DVT

7 Pediatric Rheumatology Network

8 CARRANet $8+M GO grant ; PIs: Sandborg, Schanberg, Ilowite, Wallace
Sustainable, informatics infrastructure for pediatric rheumatology To enroll 60 sites To enroll 20,000 children with rheumatic disease Registry with common and disease-specific data elements

9 Informatics Infrastructure CARRANet
Centralized, web-based data capture Data management, visualization, and cleaning tools to facilitate site-based and pooled data validation Centralized, ontology-based, centralized,database environment (i2b2/SHRINE) with site-specific PHI encryption and data ownership, designed for secure, selective sharing and federated query of research data Means to correlate data from samples housed in the CARRA biorepository with subject-level phenotypic data stored in the distributed database.


11 From draft CARRANet Clinical Registry Form

12 Concepts and Definitions …
Be Careful What You Ask. You May Get Another Answer. Medication Inclusion: Pulse steroids? GA BA-directed? Opioids? Use for rheumatologic disease, or any purpose ? Prescribed only ? Current – actually taken today; prescribed for today; if oral, taken today without emesis; taken anytime in last x days; majority or all of doses taken in last x days ? Is a PRN medication (e.g. ibuprofen for fever) a “current” medication ? Unknown – to whom? Not in record ?

13 Ambiguity Threatens Value CHIPRA and Meaningful Use Quality Measure: Immunizations
Is the question: educate, recommend and/or give an immunization ? Are all immunization data available at the time of care to make the appropriate decision ? Transient populations ? Vaccine guidelines change. Is quality determined by action based on guidelines applicable at the time of the encounter ? Is appropriateness dependent on circumstance ? If a child is admitted to hospital, and rapidly transferred elsewhere for intensive care, should vaccination have been done ? What if provider practices in a religious community refusing vaccinations? What if patient is “immunosuppressed” by condition or medication ?

14 What’s the Source of Truth ?
Each provider and patient ? Then nobody else is really sure what the truth is … Existing and evolving standard terminologies: e.g. LOINC, RxNorm, ICD, SNOMED … (but they only describe “elements,” not relationships) Institutional ontologies Collaborative ontologies Internal EHR ontologies – Centricity, Epic … “Meta”-EHR ontology – openEHR ?

15 American College of Rheumatology (ACR) Concept Mapping

16 Goals (my take) Build a Rheumatology functional profile, with rigorously defined data elements: begin with identification of data elements, within constructs such as “musculoskeletal exam” and “drug monitoring” Utilize UML (Unified Modeling Language) based mind mapping software and openEHR, so that specifics can be “rapidly” translated to multiple commercial systems Provide the basis for a “universal translator” (a multifaceted rosetta stone) of critical rheumatology data from multiple different systems and sites, into common terminology for collaborative QI and research efforts

17 OpenEHR (ISO 18308) Archetype:
Re-usable, versioned, formal model of a clinical domain Standardized format Maximal dataset Consider using archetypes as basis for CDA entries, with SNOMED identifiers for each archetype Template: Structured compilation of archetypes for specific purpose – e.g. basis of documents, forms, reports, messages

18 OpenEHR Ontological Separation
Ontologies of information: Domain content models – formal definitions of clinical concepts (archetypes) Information representation model – basis for domain content model, designed to be stable Ontologies of reality: “Classifications” like WHO’s ICPC (International Classification of Primary Care) “Process descriptions” such as clinical guidelines “Descriptive” terminologies” like SNOMED-CT, RxNorm, ICD

19 openEHR Semantic architecture
Screen Forms 1:N Messages 1:N Reports Templates 1:N Terminology interface Data conversion schemas Terminologies Archetypes Snomed CT ICDx ICPC 1:N Querying What openEHR provides Reference Model





24 Back to the Future National pediatric data lexicon and concepts
Shared evidence-based guidelines and order sets with defined eligibility criteria and outcomes, e.g. CHCA and Epic National, broad scope, pediatric clinical (research) data network(s) that really work, are sustainable Goals: Support clinical research and care, dynamically refining care parameters cross institutions Identify “new” pediatric diseases: a human phenome project

25 October 1 and 6, 2009 WSM Percent of Patients Delayed: ED to Inpatient Unit Training Webcasts Questions? sherrie CHCA Contact: Hema Bisarya

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