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Reconciling the pediatric requirements with the EHR model May 2006 Pediatric Data Standards SIG Functional Requirements Review.

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Presentation on theme: "Reconciling the pediatric requirements with the EHR model May 2006 Pediatric Data Standards SIG Functional Requirements Review."— Presentation transcript:

1 Reconciling the pediatric requirements with the EHR model May 2006 Pediatric Data Standards SIG Functional Requirements Review

2 Reconciling the pediatric requirements with the EHR model May 2006 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 Reconciling the pediatric requirements with the EHR model May 2006 Four Sets of Conformance Criteria INCLUDED (74 CCs): Our CC are easily found in the DSTU: INCLUDED.pptINCLUDED.ppt NOT INCLUDED (47 CCs): Cant find anything like our CC in the DSTU: NOT INCLUDED.pptNOT INCLUDED.ppt ALMOST INCLUDED (32 CCs): Something close to our CC is in the DSTU: ALMOST INCLUDED.pptALMOST INCLUDED.ppt GRAY AREA (19 CCs): The SIG needs to decide what it means, exactly: GRAY AREA.pptGRAY AREA.ppt

4 Reconciling the pediatric requirements with the EHR model May Categories to Assign 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)

5 Reconciling the pediatric requirements with the EHR model May 2006 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 Reconciling the pediatric requirements with the EHR model May 2006 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 Age Representation

7 Reconciling the pediatric requirements with the EHR model May 2006 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 Age Representation

8 Reconciling the pediatric requirements with the EHR model May 2006 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 Age Representation

9 Reconciling the pediatric requirements with the EHR model May 2006 [Allergies] could include items such as foods or environmental agents. Closest conformance criterion: DC #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 Allergies

10 Reconciling the pediatric requirements with the EHR model May 2006 Allow the classification of reactions into allergic reactions, side effects, and intolerances Closest conformance criterion: DC #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 Allergies

11 Reconciling the pediatric requirements with the EHR model May 2006 List food allergies and medication allergies separately Closest conformance criterion: DC #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 Allergies

12 Reconciling the pediatric requirements with the EHR model May 2006 The user determines what defines an allergy or adverse reaction Closest conformance criterion: DC #4 (The system SHOULD provide the ability to capture the reaction type). INCLUDED, noncontroversial Reference number: 8 Allergies

13 Reconciling the pediatric requirements with the EHR model May 2006 Store data until the statutorily designated time Closest conformance criterion: I #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 Archiving

14 Reconciling the pediatric requirements with the EHR model May 2006 The user may indicate who they are sending results to and the system will track this Closest conformance criterion: DC #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 Communications

15 Reconciling the pediatric requirements with the EHR model May 2006 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 (The system MAY be able to indicate that the patients personal representative (guardian/surrogate) has completed advanced directive(s) on their behalf. ). INCLUDED, noncontroversial Reference number: 12 Consent

16 Reconciling the pediatric requirements with the EHR model May 2006 Allow recording of both consent and assent to treatment Closest conformance criterion: DC #7 (EHR systems SHOULD allow documentation of an assent as appropriate for patients legally unable to consent. ). INCLUDED, noncontroversial Reference number: 11 Consent

17 Reconciling the pediatric requirements with the EHR model May 2006 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 : Manage consents and authorizations ((Does not explicitly mention this function)). NEEDS NEW CC IN THIS FUNCTION Reference number: 13 Consent

18 Reconciling the pediatric requirements with the EHR model May 2006 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 Custody

19 Reconciling the pediatric requirements with the EHR model May 2006 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 Custody

20 Reconciling the pediatric requirements with the EHR model May 2006 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 Custody

21 Reconciling the pediatric requirements with the EHR model May 2006 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 Custody

22 Reconciling the pediatric requirements with the EHR model May 2006 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 Custody

23 Reconciling the pediatric requirements with the EHR model May 2006 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 Custody

24 Reconciling the pediatric requirements with the EHR model May 2006 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 Custody

25 Reconciling the pediatric requirements with the EHR model May 2006 Incorporate age, weight, and disease criteria into alerts related to laboratory results Closest conformance criterion: DC #11 (The system MAY trigger decision support algorithms from [test] results. ). INCLUDED, noncontroversial Reference number: 31 Decision Support

26 Reconciling the pediatric requirements with the EHR model May 2006 Integrate patient and family preferences into clinical decision support Closest conformance criterion: DC #3 (The system SHOULD integrate patient and family preferedecision support systems). INCLUDED, noncontroversial Reference number: 34 Decision Support

27 Reconciling the pediatric requirements with the EHR model May 2006 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 Decision Support

28 Reconciling the pediatric requirements with the EHR model May 2006 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 Decision Support

29 Reconciling the pediatric requirements with the EHR model May 2006 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 Decision Support

30 Reconciling the pediatric requirements with the EHR model May 2006 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 Decision Support

31 Reconciling the pediatric requirements with the EHR model May 2006 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 Decision Support

32 Reconciling the pediatric requirements with the EHR model May 2006 Provide decision support for special immunizations such as palivizumab Closest conformance criterion: DC #1 (The system SHALL support presentation of guidelines and protocols to clinicians). INCLUDED, noncontroversial Reference number: 42 Decision Support

33 Reconciling the pediatric requirements with the EHR model May 2006 Indicate in the case of decision support function whether the function applies to the pediatric population Closest conformance criterion: DC #1, 3, 4, 5 (assuming decision support = guidelines) ((Comes close)). NEEDS NEW CC IN THIS FUNCTION Reference number: 32 Decision Support

34 Reconciling the pediatric requirements with the EHR model May 2006 Link disease specific guidelines to the problem list Closest conformance criterion: DC #4 (The system SHALL present guidelines and protocols appropriate for the patients problem list. ). INCLUDED, noncontroversial Reference number: 36 Decision Support

35 Reconciling the pediatric requirements with the EHR model May 2006 Apply patient age to all decision support functions Closest conformance criterion: DC #5 (The system SHALL support context-sensitive care plans, guidelines and protocols (function DC ) ). INCLUDED if we make minor mods in a CC Reference number: 25 Decision Support

36 Reconciling the pediatric requirements with the EHR model May 2006 Facilitate selection of guidelines based on patient age Closest conformance criterion: DC #5 (The system SHALL support context-sensitive care plans, guidelines and protocols (function DC ) (provided "context" = "age")). INCLUDED if we make minor mods in a CC Reference number: 28 Decision Support

37 Reconciling the pediatric requirements with the EHR model May 2006 Indicate the source of any applicable guidelines or decision support rules Closest conformance criterion: DC #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 Decision Support

38 Reconciling the pediatric requirements with the EHR model May 2006 Allow for disease specific health maintenance schedules with accompanying decision support Closest conformance criterion: DC #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 Decision Support

39 Reconciling the pediatric requirements with the EHR model May 2006 In cases where forms vary with age, select forms to be presented based on age. Closest conformance criterion: DC #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 Decision Support

40 Reconciling the pediatric requirements with the EHR model May 2006 Modify displays based on age Closest conformance criterion: DC #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 Decision Support

41 Reconciling the pediatric requirements with the EHR model May 2006 Modify displays based on gestational age at birth Closest conformance criterion: DC #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 Decision Support

42 Reconciling the pediatric requirements with the EHR model May 2006 Remind users of anticipatory guidance topics based on age Closest conformance criterion: DC #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 Decision Support

43 Reconciling the pediatric requirements with the EHR model May 2006 Remind users of anticipatory guidance topics based on risk factors Closest conformance criterion: DC #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 Decision Support

44 Reconciling the pediatric requirements with the EHR model May 2006 Remind users of anticipatory guidance topics based on topics previously discussed Closest conformance criterion: DC (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 Decision Support

45 Reconciling the pediatric requirements with the EHR model May 2006 Alert clinicians to the need for developmental screening based on guidelines Closest conformance criterion: DC #1 (The system SHOULD identify services for preventive care and wellness from patient demographics (eg. age, sex, region) ). INCLUDED, noncontroversial Reference number: 21 Decision Support

46 Reconciling the pediatric requirements with the EHR model May 2006 Alert clinicians to the need for hearing and vision screening per guidelines Closest conformance criterion: DC #1 (The system SHOULD identify services for preventive care and wellness from patient demographics (eg. age, sex, region) ). INCLUDED, noncontroversial Reference number: 22 Decision Support

47 Reconciling the pediatric requirements with the EHR model May 2006 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 (as long as failure to participate in well-care is considered a health risk, which pediatricians generally do) AND DC (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 Decision Support

48 Reconciling the pediatric requirements with the EHR model May 2006 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 Decision Support

49 Reconciling the pediatric requirements with the EHR model May 2006 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 Decision Support

50 Reconciling the pediatric requirements with the EHR model May 2006 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 Decision Support

51 Reconciling the pediatric requirements with the EHR model May 2006 Include body weight (or any other data used to decide dose, like gestational age or diagnosis) in the data sent with a prescription Closest conformance criterion: (These data elements would be dictated by e-prescribing standards). NOT INCLUDED, noncontroversial Reference number: 58 E-Prescribing & Ordering

52 Reconciling the pediatric requirements with the EHR model May 2006 Allow export of data to national drug databases designed to detect adverse drug events Closest conformance criterion: COVERED IN "REGISTRIES PACKAGE" ((DC Manage immunizations; S.1.1 Registry notification; S Encounter-specific functionality; S Health service reports at the conclusion of an episode of care; I Unique identity, registry, and directory services; I.3.2 Distributed registry access; I.5.4 Interchange agreements; I.6 Business rules management)). INCLUDED, noncontroversial Reference number: 49 E-Prescribing & Ordering

53 Reconciling the pediatric requirements with the EHR model May 2006 Handle immunization separately from other medications Closest conformance criterion: DC ([Manage immunizations]). INCLUDED, noncontroversial Reference number: 56 E-Prescribing & Ordering

54 Reconciling the pediatric requirements with the EHR model May 2006 Allow drug dose and based on compounded oral solutions, in the case where no oral solution is available in standard formularies Closest conformance criterion: DC ([Order Medication]). NOT INCLUDED, noncontroversial Reference number: 47 E-Prescribing & Ordering

55 Reconciling the pediatric requirements with the EHR model May 2006 Allow drug dosing based on ideal body weight for a given medication Closest conformance criterion: DC ([Order Medication]). NEEDS NEW CC IN THIS FUNCTION Reference number: 48 E-Prescribing & Ordering

56 Reconciling the pediatric requirements with the EHR model May 2006 In weight-based dosage functions, reflect maximum dose per day in the resulting prescription Closest conformance criterion: DC ([Order Medication]). NEEDS NEW CC IN THIS FUNCTION Reference number: 57 E-Prescribing & Ordering

57 Reconciling the pediatric requirements with the EHR model May 2006 Link to FDA drug alerts Closest conformance criterion: DC ([Order Medication]). NEEDS NEW CC IN THIS FUNCTION Reference number: 61 E-Prescribing & Ordering

58 Reconciling the pediatric requirements with the EHR model May 2006 Offer drug dosing decision support for those drugs with a recommended starting dose range (e.g., methylphenidate) and graduated dosage increments Closest conformance criterion: DC ([Order Medication]). NEEDS NEW CC IN THIS FUNCTION Reference number: 63 E-Prescribing & Ordering

59 Reconciling the pediatric requirements with the EHR model May 2006 Support calculations for the preparation of intravenous infusions Closest conformance criterion: DC (Now that standard concetrations are the law of the land, we may need to give up on this one.). DELETE? Reference number: 64 E-Prescribing & Ordering

60 Reconciling the pediatric requirements with the EHR model May 2006 Support standard concentrations for infusions Closest conformance criterion: DC (Hard to imagine an IV prescribing system that did not include data on the concentration of infusions… is this a peditric issue?). DELETE? Reference number: 65 E-Prescribing & Ordering

61 Reconciling the pediatric requirements with the EHR model May 2006 Allow recording of dose per meter squared of body surface area, so that the prescription can be replicated later at the same dose per meter-square Closest conformance criterion: DC #14 (The system MAY support medication re-prescribing by allowing a prior prescription to be reordered without re-entering previous data (e.g. administration schedule, quantity). --> Probably should be promoted to SHOULD and the dosage per kg should be available so one can replicate the prescription at the same dosage (i.e., at the new body surface area)). INCLUDED if we make minor mods in a CC Reference number: 50 E-Prescribing & Ordering

62 Reconciling the pediatric requirements with the EHR model May 2006 Allow recording of the dose per kilogram in the record of a prescribed medication, so that the prescription can be replicated later at the same dose per kilogram Closest conformance criterion: DC #14 (The system MAY support medication re-prescribing by allowing a prior prescription to be reordered without re-entering previous data (e.g. administration schedule, quantity). --> Probably should be promoted to SHOULD and the dosage per kg should be available so one can replicate the prescription at the same dosage (i.e., at the new body weight)). INCLUDED if we make minor mods in a CC Reference number: 53 E-Prescribing & Ordering

63 Reconciling the pediatric requirements with the EHR model May 2006 Link adverse drug reactions, including allergies, to the activity of ordering or modifying a prescription Closest conformance criterion: DC #15 (The system SHOULD check and report allergies, drug- drug interactions, and other potential adverse reactions, when new medications are ordered. ). INCLUDED, noncontroversial Reference number: 60 E-Prescribing & Ordering

64 Reconciling the pediatric requirements with the EHR model May 2006 Allow recording of exceptions to medication administration, such as refusal of medication, vomiting of the dose, or intravenous access not available Closest conformance criterion: DC ([Manage medication administration]). NEEDS NEW CC IN THIS FUNCTION Reference number: 51 E-Prescribing & Ordering

65 Reconciling the pediatric requirements with the EHR model May 2006 Allow recording of over-the-counter medications, herbal remedies, and vitamin preparations in the medication list Closest conformance criterion: DC (The system SHALL provide a user interface to enter non-prescription medications including over the counter and complementary medications such as vitamins, herbs and supplements. ). INCLUDED, noncontroversial Reference number: 52 E-Prescribing & Ordering

66 Reconciling the pediatric requirements with the EHR model May 2006 When allow ordering of blood products in units appropriate to pediatric care Closest conformance criterion: DC ([Order blood products and other biologics]). NOT INCLUDED, noncontroversial Reference number: 68 E-Prescribing & Ordering

67 Reconciling the pediatric requirements with the EHR model May 2006 When a medication is discontinued, the user would have the ability to indicate if a medication was ineffective. Closest conformance criterion: DC #8 (The system SHOULD allow checking of medications against a list of drugs noted to be ineffective for the patient in the past. ). INCLUDED, noncontroversial Reference number: 67 E-Prescribing & Ordering

68 Reconciling the pediatric requirements with the EHR model May 2006 Allow the use of other data in dosing decision support, such as a lab value (e.g., urine specific gravity) of clinical characteristic (e.g., gestational age) Closest conformance criterion: DC #2 (The system SHALL identify specific and appropriate drug dosages for each patient condition at the time of medication ordering. ). Possibly included, controversial Reference number: 54 E-Prescribing & Ordering

69 Reconciling the pediatric requirements with the EHR model May 2006 Indicate when dosing decision support is based on evidence Closest conformance criterion: DC #1 (Upon request, the system SHALL provide appropriate evidence-based documentation for clinical care recommendations. ). INCLUDED, noncontroversial Reference number: 59 E-Prescribing & Ordering

70 Reconciling the pediatric requirements with the EHR model May 2006 Communicate with pediatric providers on medication use: Weight/height/BSDA, conditions and any disease management information from pharmacy. Closest conformance criterion: Makes no sense (These data elements would be dictated by e- prescribing standards). NOT INCLUDED, noncontroversial Reference number: 55 E-Prescribing & Ordering

71 Reconciling the pediatric requirements with the EHR model May 2006 Make the patients age, weight, body surface area, and gestational age visible when viewing orders at every stage of the ordering process Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 62 E-Prescribing & Ordering

72 Reconciling the pediatric requirements with the EHR model May 2006 Transmit relevant body measurements (usually weight) with prescriptions Closest conformance criterion: N/A ([EHRs are going to do what the eRx messaging standards say to do… if weight is a field, then they'll send it. If not, they won't.]). NOT INCLUDED, noncontroversial Reference number: 66 E-Prescribing & Ordering

73 Reconciling the pediatric requirements with the EHR model May 2006 Provide patient education materials that are appropriate for patients in varying age ranges Closest conformance criterion: DC #9 (The system MAY enable age-appropriate and/or reading-ability appropriate educational materials for the patient and/or patient representative ). INCLUDED, noncontroversial Reference number: 69 Education

74 Reconciling the pediatric requirements with the EHR model May 2006 identify patients by parent's employer in cases of epidemiologic surveillance involving an occupational exposure Closest conformance criterion: D #1 (The system MAY support the identification of patients related by employer and work location for purposes of epidemiological exposure and public health analysis and reporting --> Needs to include PARENT'S employer as well). INCLUDED if we make minor mods in a CC Reference number: 73 Epidemiology

75 Reconciling the pediatric requirements with the EHR model May 2006 Allow recording of the location of day care center, institutional food source, camps, schools, and so forth for the purposes of environmental monitoring Closest conformance criterion: DC #1 (The system SHALL provide identification of the individual care providers or care managers within a cared for population --> Only if schools, camps, and day care centers are classified as "providers or care managers"). INCLUDED if we make minor mods in a CC Reference number: 70 Epidemiology

76 Reconciling the pediatric requirements with the EHR model May 2006 Facilitate notification of schools, camps, day care settings, and so forth of health risks that apply to populations of children within those institutions Closest conformance criterion: DC #4 (The system MAY have the ability to disseminate a notification of a health risk to the identified individual care providers or care-managers through one or more alternative means --> Only if schools, camps, and day care centers are classified as "providers or care managers"). INCLUDED if we make minor mods in a CC Reference number: 72 Epidemiology

77 Reconciling the pediatric requirements with the EHR model May 2006 Facilitate epidemiologic studies by recording living situation Closest conformance criterion: S #1 & #2 (The system SHOULD provide a mechanism to identify the patients primary residence. The system MAY provide a mechanism to identify the patients secondary or alternate residence. ). INCLUDED, noncontroversial Reference number: 71 Epidemiology

78 Reconciling the pediatric requirements with the EHR model May 2006 Allow the recording of a relationship by living situation Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 77 Family Linkage

79 Reconciling the pediatric requirements with the EHR model May 2006 Facilitate the scheduling of siblings to be seen as a group or in contiguous time slots Closest conformance criterion: N/A (S.1.6: Scheduling) (N/A). NOT INCLUDED, noncontroversial Reference number: 78 Family Linkage

80 Reconciling the pediatric requirements with the EHR model May 2006 Allow linkages between siblings charts Closest conformance criterion: S #1 (The system MAY support the identification of persons related by genealogy.). INCLUDED, noncontroversial Reference number: 74 Family Linkage

81 Reconciling the pediatric requirements with the EHR model May 2006 Allow linkages between the charts of parents and children Closest conformance criterion: S #1 (The system MAY support the identification of persons related by genealogy.). INCLUDED, noncontroversial Reference number: 75 Family Linkage

82 Reconciling the pediatric requirements with the EHR model May 2006 Allow the creation of family groups of records within the system, for the purpose of moving between records within a family, subject to patient preferences, family preferences, and privacy regulations Closest conformance criterion: S #1 (The system MAY support the identification of persons related by genealogy.). INCLUDED, noncontroversial Reference number: 76 Family Linkage

83 Reconciling the pediatric requirements with the EHR model May 2006 Link records in cases where there is a medical reason to do so, such as in cases of familial disease Closest conformance criterion: S #1 (The system MAY support the identification of persons related by genealogy.). INCLUDED, noncontroversial Reference number: 79 Family Linkage

84 Reconciling the pediatric requirements with the EHR model May 2006 Allow the assignment of an unknown gender Closest conformance criterion: N/A (This may simply be a matter of allowing the value of "unknown" in the a gender field). VOCABULARY ISSUE: … Reference number: 80 Gender

85 Reconciling the pediatric requirements with the EHR model May 2006 Allow recording of gestational age at the time of delivery as a permanent feature of the patient that can be accessed at all times during the care of the patient, in much the same way as a "problem" Closest conformance criterion: N/A (This may simply be a matter of allowing gestational age to be an item on the problem list). VOCABULARY ISSUE: … Reference number: 81 Gestational Age

86 Reconciling the pediatric requirements with the EHR model May 2006 Allow the recording of head circumference Closest conformance criterion: DC #2 comes close (The system MAY capture other clinical measures as discrete elements such as peak expiratory flow rate, size of lesions, oxygen saturation, body mass index and severity of pain.). INCLUDED if we make minor mods in a CC Reference number: 83 Growth

87 Reconciling the pediatric requirements with the EHR model May 2006 Allow graphic display of growth data against a user-selectable set of normative curves Closest conformance criterion: DC.1.4? (Growth charting is briefly mentioned in the text of DC.1.4 "Manage Assessments," but there are no specifics). NOT INCLUDED, noncontroversial Reference number: 82 Growth

88 Reconciling the pediatric requirements with the EHR model May 2006 Plot body mass index against normative curves Closest conformance criterion: DC.1.4? (Growth charting is briefly mentioned in the text of DC.1.4 "Manage Assessments," but there are no specifics). NOT INCLUDED, noncontroversial Reference number: 85 Growth

89 Reconciling the pediatric requirements with the EHR model May 2006 Provide graphical growth chart and norms for children with varying conditions (e.g., Down syndrome and Turner syndrome) Closest conformance criterion: DC.1.4? (Growth charting is briefly mentioned in the text of DC.1.4 "Manage Assessments," but there are no specifics). NOT INCLUDED, noncontroversial Reference number: 87 Growth

90 Reconciling the pediatric requirements with the EHR model May 2006 include the appropriate templates for growth data fields, which would be presented to the caregiver using CDC standards based on demographic data (i.e., length, weight, head circumference for < 36 months; height; weight, BMI for over 36 months). Closest conformance criterion: Makes no sense (Either the EHR allows the entering of head circumference or it does not. Either it calculates BMI or it does not. Whether these "fields" come up depend on the age-dependent templates the system implements (see Decision Support).). DELETE? Reference number: 84 Growth

91 Reconciling the pediatric requirements with the EHR model May 2006 Provide alerts about variances in the growth chart Closest conformance criterion: Needs more detail… hard to put this one into a conformance criterion (Growth charting is briefly mentioned in the text of DC.1.4 "Manage Assessments," but there are no specifics). NOT INCLUDED, noncontroversial Reference number: 86 Growth

92 Reconciling the pediatric requirements with the EHR model May 2006 Provide mechanism for monitoring of growth over time Closest conformance criterion: Needs more detail… hard to put this one into a conformance criterion (Growth charting is briefly mentioned in the text of DC.1.4 "Manage Assessments," but there are no specifics). NOT INCLUDED, noncontroversial Reference number: 88 Growth

93 Reconciling the pediatric requirements with the EHR model May 2006 Support the recording of multiple guardians and residences for given child whose parents are divorced or who have joint custody Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 90 Guardianship

94 Reconciling the pediatric requirements with the EHR model May 2006 Allow reference to subsets of the demographic data of the patients guardian to serve for parts of the patients demographic data, to avoid re-entry of data and avoid data anomalies Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 91 Guardianship

95 Reconciling the pediatric requirements with the EHR model May 2006 Allow recording of a guarantor, who may be different from the parent or guardian Closest conformance criterion: S #1 (The system MAY support the identification of persons related by insurance plan. ). INCLUDED, noncontroversial Reference number: 89 Guardianship

96 Reconciling the pediatric requirements with the EHR model May 2006 Allow recording of immunizations including lot numbers and vaccine information statements Closest conformance criterion: DC #1 & #2 (The system SHALL record as discrete data elements data associated with any immunization given including date, type, lot number and manufacturer. The system SHOULD allow the association of standard codes with discrete data elements associated with an immunization.). INCLUDED, noncontroversial Reference number: 93 Immunizations

97 Reconciling the pediatric requirements with the EHR model May 2006 Allow reporting of immunization status of populations of children within the practice Closest conformance criterion: DC #3 ([This is not directly mentioned in the conformance criteria, but it would be a derivative of the process used to compute immunizations for individuals]). NOT INCLUDED, noncontroversial Reference number: 95 Immunizations

98 Reconciling the pediatric requirements with the EHR model May 2006 Based on known immunization data, calculate immunization status (current versus delayed) and display in summary lists Closest conformance criterion: DC #3 (The system SHALL determine any required immunizations during an encounter based on a current accepted schedule such as that from the Centers for Disease Control and Prevention. ). INCLUDED, noncontroversial Reference number: 97 Immunizations

99 Reconciling the pediatric requirements with the EHR model May 2006 Provide alerting and reminders for missedimmunizations Closest conformance criterion: DC #3 (The system SHALL determine any required immunizations during an encounter based on a current accepted schedule such as that from the Centers for Disease Control and Prevention.). INCLUDED, noncontroversial Reference number: 101 Immunizations

100 Reconciling the pediatric requirements with the EHR model May 2006 Allow user level updating of immunization guidelines Closest conformance criterion: DC #5 (The system SHALL allow for the updating of the immunization schedule --> Does not include "user level… is this important?). INCLUDED if we make minor mods in a CC Reference number: 96 Immunizations

101 Reconciling the pediatric requirements with the EHR model May 2006 Include mechanisms for immunization decision support that includes easy updating as recommendation change is included. Closest conformance criterion: DC #5 (The system SHALL allow for the updating of the immunization schedule). INCLUDED, noncontroversial Reference number: 100 Immunizations

102 Reconciling the pediatric requirements with the EHR model May 2006 Allow flexible reporting of immunizations in a given practice to support required vaccine program reporting Closest conformance criterion: DC #8 (The system SHOULD prepare a report of a patient's immunization history upon request for appropriate authorities such as schools or day-care centers. ). INCLUDED, noncontroversial Reference number: 92 Immunizations

103 Reconciling the pediatric requirements with the EHR model May 2006 Allow recording of parental consent to immunizations, according to applicable state law, as part of the point of care interface Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 94 Immunizations

104 Reconciling the pediatric requirements with the EHR model May 2006 Compute immunization recommendations for a time other than the time of the current encounter (for example if a parent wants to know what immunizations are due at the next visit, the system would facilitate this analysis) Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 98 Immunizations

105 Reconciling the pediatric requirements with the EHR model May 2006 Display immunizations by antigen Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 99 Immunizations

106 Reconciling the pediatric requirements with the EHR model May 2006 Include age and DOB on every display, both printed and on the screen Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 102 Interface

107 Reconciling the pediatric requirements with the EHR model May 2006 In the case of laboratories, allow recording of verification and communication to family members Closest conformance criterion: DC #1, 3, 4 (The system SHALL facilitate documentation of communications between providers and patients or their representatives. The system SHALL capture details of provider communications with patients or family (e.g. date, provider id, details of communication, result of communication requests). The system SHALL document communication originating with the patient or patient representative (e.g. date, entity, details of communication)). INCLUDED, noncontroversial Reference number: 103 Lab Results

108 Reconciling the pediatric requirements with the EHR model May 2006 Allow the designation of Advocate for the patient, who can append information to the chart Closest conformance criterion: DC ((Mentions surrogate for patient in the description, but lists no conformance criteria)). NEEDS NEW CC IN THIS FUNCTION Reference number: 104 Medical Home

109 Reconciling the pediatric requirements with the EHR model May 2006 Allow the recording of a primary care physician for each patient Closest conformance criterion: N/A (N/A - this has GOT to be an oversight). NOT INCLUDED, noncontroversial Reference number: 105 Medical Home

110 Reconciling the pediatric requirements with the EHR model May 2006 have the capability to identify multiple primary providers as well as multiple sub-specialists Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 106 Medical Home

111 Reconciling the pediatric requirements with the EHR model May 2006 Indicate multiple primary care providers, in the case were a pediatrician and a family practitioner are assuming that role Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 108 Medical Home

112 Reconciling the pediatric requirements with the EHR model May 2006 If the system provides a directory of providers, indicate which of those providers see pediatric patients, or who are pediatric specialists Closest conformance criterion: S #5 (The system MAY provide a directory of clinical personnel external to the organization that are not users of the system to facilitate documentation communication and information exchange --> Needs addition of data on peds specificity). INCLUDED if we make minor mods in a CC Reference number: 107 Medical Home

113 Reconciling the pediatric requirements with the EHR model May 2006 Links to a source where living wills are stored Closest conformance criterion: DC #2 (The system SHOULD be able to indicate the type of advanced directives such as living will, durable power of attorney, or a "Do Not Resuscitate order".). INCLUDED, noncontroversial Reference number: 110 Miscellaneous

114 Reconciling the pediatric requirements with the EHR model May 2006 Coordinate bed identification between facilities, for transport from general hospital to children's hospital or to NICU. Closest conformance criterion: S #1 (The system SHOULD identify and display/view the patients assigned location, unambiguously. ). INCLUDED, noncontroversial Reference number: 109 Miscellaneous

115 Reconciling the pediatric requirements with the EHR model May 2006 Provide age based norms for data when such norms exist Closest conformance criterion: DC (). NEEDS NEW CC IN THIS FUNCTION Reference number: 114 Norms

116 Reconciling the pediatric requirements with the EHR model May 2006 The system should accept normal ranges supplied by the external reference laboratory. Ideally, lab values are linked to ""disease-specific state"" values. Closest conformance criterion: DC (Receiving normal ranges and critical ranges from external sources is the default behavior for systems that accept lab values from external sources; this is not explicitly mentioned in the functional model). NEEDS NEW CC IN THIS FUNCTION Reference number: 116 Norms

117 Reconciling the pediatric requirements with the EHR model May 2006 Indicate normal ranges for values for which there are mutliple normal ranges within each age range (example: blood pressure, for whuch there are different normal values for each height range within each age range) Closest conformance criterion: DC (). NEEDS NEW CC IN THIS FUNCTION Reference number: 113 Norms

118 Reconciling the pediatric requirements with the EHR model May 2006 Provide an indicator of abnormal vital signs in cases where the vital signs fall outside the range of normal for age Closest conformance criterion: DC (). NEEDS NEW CC IN THIS FUNCTION Reference number: 115 Norms

119 Reconciling the pediatric requirements with the EHR model May 2006 Calculate and immeditely display, along with the original data, percentile values for any piece of data entered into the system for which a percentile distribution is known (height, weight, head circumference, body mass index, blood pressure) Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 111 Norms

120 Reconciling the pediatric requirements with the EHR model May 2006 Indicate normal range for items (lab values and physical exam data) based on stage of sexual maturity Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 112 Norms

121 Reconciling the pediatric requirements with the EHR model May 2006 Incorporate documentation from external sources Closest conformance criterion: DC #1, and DC #4 (The system SHALL allow external documents to be stored in the system, and The system SHALL document communication originating with the patient or patient representative (e.g. date, entity, details of communication) ). INCLUDED, noncontroversial Reference number: 119 Parental Data Entry

122 Reconciling the pediatric requirements with the EHR model May 2006 provide a Web-based interface for entering data by parents, patients, school nurses, pharmacy labs/medical devices technicians. Closest conformance criterion: DC #3 (specifying "web-based" is beyond the scope of this document; this CC should handle the EHR end of this requirement) (The system SHALL capture, explicitly label the source of clinical data provided on behalf of the patient.). NOT INCLUDED, noncontroversial Reference number: 121 Parental Data Entry

123 Reconciling the pediatric requirements with the EHR model May 2006 Distinguish data provided by the clinician from data provided by the parent, guardian, teacher, translator, or family Closest conformance criterion: DC #3 & #4 (The system SHALL capture, explicitly label the source of clinical data provided on behalf of the patient. The system SHALL present patient- originated data for use by care providers.). INCLUDED, noncontroversial Reference number: 118 Parental Data Entry

124 Reconciling the pediatric requirements with the EHR model May 2006 Provide patients with a web-based tool to access their medical record information. Closest conformance criterion: DC #5 (The system SHALL enable a secure web connection to support communications between providers and patients or their representatives ). INCLUDED if we make minor mods in a CC Reference number: 122 Parental Data Entry

125 Reconciling the pediatric requirements with the EHR model May 2006 Support entry of information by parents, patients, school nurses via the Web Closest conformance criterion: DC #5 (The system SHALL enable a secure web connection to support communications between providers and patients or their representatives ). INCLUDED if we make minor mods in a CC Reference number: 123 Parental Data Entry

126 Reconciling the pediatric requirements with the EHR model May 2006 Allow designation of a given patient as competent to enter his or her own information at a point selected by the clinician Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 117 Parental Data Entry

127 Reconciling the pediatric requirements with the EHR model May 2006 Permit oversight by parents of the patient entered information Closest conformance criterion: N/A (May be to ill- defined in this form). NOT INCLUDED, noncontroversial Reference number: 120 Parental Data Entry

128 Reconciling the pediatric requirements with the EHR model May 2006 Allow the assignment of temporary identifiers in cases where a government issued identifier is not available. Closest conformance criterion: DC #2 (The system SHALL provide the ability to uniquely identify a patient and tie the record to a single patient. ). INCLUDED, noncontroversial Reference number: 129 Patient Identification

129 Reconciling the pediatric requirements with the EHR model May 2006 Support administrative transactions before an official, government issued identifier is available Closest conformance criterion: DC #2 (The system SHALL provide the ability to uniquely identify a patient and tie the record to a single patient. ). INCLUDED, noncontroversial Reference number: 132 Patient Identification

130 Reconciling the pediatric requirements with the EHR model May 2006 Allow cross-referencing of multiple identifiers that may identify the same patient Closest conformance criterion: DC #6 (The system SHALL provide the ability to query and retrieve appropriate parts of a patient record using a primary identifier, secondary identifiers, or other information which are not identifiers, but could be used to help identify the patient. ). Possibly included, controversial Reference number: 125 Patient Identification

131 Reconciling the pediatric requirements with the EHR model May 2006 Allow changes in identifying data at the time of family changes due to adoption Closest conformance criterion: DC #6 almost works (The system SHALL provide the ability to query and retrieve appropriate parts of a patient record using a primary identifier, secondary identifiers, or other information which are not identifiers, but could be used to help identify the patient. ). NEEDS NEW CC IN THIS FUNCTION Reference number: 124 Patient Identification

132 Reconciling the pediatric requirements with the EHR model May 2006 Allow entry of mothers identifying data as part of the patients identifying data Closest conformance criterion: DC #6 almost works (Closest CC doesn't quite do it: The system SHALL provide the ability to query and retrieve appropriate parts of a patient record using a primary identifier, secondary identifiers, or other information which are not identifiers, but could be used to help identify the patient. ). NEEDS NEW CC IN THIS FUNCTION Reference number: 126 Patient Identification

133 Reconciling the pediatric requirements with the EHR model May 2006 Allow name changes, and retain old names for the purpose of searching for patient records Closest conformance criterion: DC #6 almost works (The system SHALL provide the ability to query and retrieve appropriate parts of a patient record using a primary identifier, secondary identifiers, or other information which are not identifiers, but could be used to help identify the patient. ). NEEDS NEW CC IN THIS FUNCTION Reference number: 128 Patient Identification

134 Reconciling the pediatric requirements with the EHR model May 2006 Allow entry of temporary ID numbers, which can be replaced with more formal identification number systems Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 127 Patient Identification

135 Reconciling the pediatric requirements with the EHR model May 2006 To the extent afforded by existing national patient identifier systems, allow replacement of an identifier assigned in the pediatric period to a new, adult identifier at the age of majority Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 133 Patient Identification

136 Reconciling the pediatric requirements with the EHR model May 2006 Allow the retention (and use as search criteria) the multiple names applied to a patient Closest conformance criterion: S ((Mentions changing names in the description, but there are no conf criteria mentioning how name changes would affect subsequent system operation)). NEEDS NEW CC IN THIS FUNCTION Reference number: 130 Patient Identification

137 Reconciling the pediatric requirements with the EHR model May 2006 Allow users to be able to find a patient in the system based on multiple search criteria Closest conformance criterion: S ((Mentions changing names in the description, but there are no conformance criteria mentioning how name changes would affect subsequent system operation)). NEEDS NEW CC IN THIS FUNCTION Reference number: 131 Patient Identification

138 Reconciling the pediatric requirements with the EHR model May 2006 Allow construction of graphical patient pedigrees Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 134 Pedigree

139 Reconciling the pediatric requirements with the EHR model May 2006 Alert users to preferences based on religion, such as transfusions in Jehovah's Witness patients Closest conformance criterion: DC #1 (The system SHALL capture, present, and store patient preferences such as language, religion and culture.). INCLUDED, noncontroversial Reference number: 135 Preferences

140 Reconciling the pediatric requirements with the EHR model May 2006 Allow parents to append information to the chart, per HIPAA guidelines Closest conformance criterion: Redundant, since all products must comply with HIPAA (N/A). INCLUDED, noncontroversial Reference number: 136 Preferences

141 Reconciling the pediatric requirements with the EHR model May 2006 Allow creation of a record of a patient before the patients birth Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 137 Prenatal

142 Reconciling the pediatric requirements with the EHR model May 2006 Allow the retention of data related to prenatal procedures within the record of the patient postnatally Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 138 Prenatal

143 Reconciling the pediatric requirements with the EHR model May 2006 Label clinical information as requiring special privacy consideration, based on patient's age and applicable laws (this applies to so-called adolescent privacy) Closest conformance criterion: DC #2 (The system SHALL restrict access to summarized information based on applicable rules for confidentiality of patient health information --> assuming the rules can respond to age and sensitive diagnoses). INCLUDED if we make minor mods in a CC Reference number: 144 Privacy

144 Reconciling the pediatric requirements with the EHR model May 2006 In cases of care given to patients during adolescence, provide the ability to flag certain encounters, problems, diagnoses, and results as requiring special privacy handling Closest conformance criterion: DC #2 and I.1.9 #8 (The system SHALL restrict access to summarized information based on applicable rules for confidentiality of patient health information AND System MAY allow varying levels of confidentiality based on patient class and/or diagnosis). Possibly included, controversial Reference number: 142 Privacy

145 Reconciling the pediatric requirements with the EHR model May 2006 Allow user to mark sections or patients as confidential. This allows the practice to not print demographics, certain confidential sections, or other items Closest conformance criterion: I #8 (if "age" is added to it) (System MAY allow varying levels of confidentiality based on patient class and/or diagnosis. --> System SHOULD allow varying levels of confidentiality based on patient class, age, and/or diagnosis.). INCLUDED if we make minor mods in a CC Reference number: 140 Privacy

146 Reconciling the pediatric requirements with the EHR model May 2006 Protect the genetic identity of the child, when desired, when assisted reproductive technology is used Closest conformance criterion: I.1.9 #1 (The system SHOULD enforce the applicable jurisdictional and organizational patient privacy rules). Possibly included, controversial Reference number: 145 Privacy

147 Reconciling the pediatric requirements with the EHR model May 2006 Allow labeling of data for special privacy considerations Closest conformance criterion: I.1.9 #8 (System MAY allow varying levels of confidentiality based on patient class and/or diagnosis. ). INCLUDED, noncontroversial Reference number: 139 Privacy

148 Reconciling the pediatric requirements with the EHR model May 2006 In cases of care given to patients during adolescence, offer reminders based on diagnoses of the need for special privacy handling Closest conformance criterion: N/A (N/A). NOT INCLUDED, noncontroversial Reference number: 141 Privacy

149 Reconciling the pediatric requirements with the EHR model May 2006 Include donor management support: Functions in an EMR related to organ and tissue donation may need to accommodate information about the gamete or zygote donated that resulted in pregnancy that gave rise to the patient, within applicable privacy laws. Closest conformance criterion: S.1.2: Donor Management Support… but does not include ART (). NOT INCLUDED, noncontroversial Reference number: 143 Privacy

150 Reconciling the pediatric requirements with the EHR model May 2006 Allow linkage to registries maintained in the public sector Closest conformance criterion: COVERED IN "REGISTRIES PACKAGE" ((DC Manage immunizations; S.1.1 Registry notification; S Encounter-specific functionality; S Health service reports at the conclusion of an episode of care; I Unique identity, registry, and directory services; I.3.2 Distributed registry access; I.5.4 Interchange agreements; I.6 Business rules management)). INCLUDED, noncontroversial Reference number: 146 Registries

151 Reconciling the pediatric requirements with the EHR model May 2006 Exchange data with newborn metabolic screening registries Closest conformance criterion: COVERED IN "REGISTRIES PACKAGE" ((DC Manage immunizations; S.1.1 Registry notification; S Encounter-specific functionality; S Health service reports at the conclusion of an episode of care; I Unique identity, registry, and directory services; I.3.2 Distributed registry access; I.5.4 Interchange agreements; I.6 Business rules management)). INCLUDED, noncontroversial Reference number: 147 Registries

152 Reconciling the pediatric requirements with the EHR model May 2006 Exchange data with other public health registries of relevance to children Closest conformance criterion: COVERED IN "REGISTRIES PACKAGE" ((DC Manage immunizations; S.1.1 Registry notification; S Encounter-specific functionality; S Health service reports at the conclusion of an episode of care; I Unique identity, registry, and directory services; I.3.2 Distributed registry access; I.5.4 Interchange agreements; I.6 Business rules management)). INCLUDED, noncontroversial Reference number: 148 Registries

153 Reconciling the pediatric requirements with the EHR model May 2006 Exchange immunization data with immunization registries Closest conformance criterion: COVERED IN "REGISTRIES PACKAGE" ((DC Manage immunizations; S.1.1 Registry notification; S Encounter-specific functionality; S Health service reports at the conclusion of an episode of care; I Unique identity, registry, and directory services; I.3.2 Distributed registry access; I.5.4 Interchange agreements; I.6 Business rules management)). INCLUDED, noncontroversial Reference number: 149 Registries

154 Reconciling the pediatric requirements with the EHR model May 2006 Link to registries such as the newborn screening systems at the hospital, state, and national level to ensure optimal communication including timely notification and follow-up. Closest conformance criterion: COVERED IN "REGISTRIES PACKAGE" ((DC Manage immunizations; S.1.1 Registry notification; S Encounter-specific functionality; S Health service reports at the conclusion of an episode of care; I Unique identity, registry, and directory services; I.3.2 Distributed registry access; I.5.4 Interchange agreements; I.6 Business rules management)). INCLUDED, noncontroversial Reference number: 151 Registries

155 Reconciling the pediatric requirements with the EHR model May 2006 Provide a linkage of adverse drug reactions in children to feed national databases involving the Safe Pharmaceutical Act for Children Closest conformance criterion: COVERED IN "REGISTRIES PACKAGE" ((DC Manage immunizations; S.1.1 Registry notification; S Encounter-specific functionality; S Health service reports at the conclusion of an episode of care; I Unique identity, registry, and directory services; I.3.2 Distributed registry access; I.5.4 Interchange agreements; I.6 Business rules management)). INCLUDED, noncontroversial Reference number: 152 Registries

156 Reconciling the pediatric requirements with the EHR model May 2006 provide data fields that allow information (potentially coded) that is then passed to another data based to link epidemiologic database Closest conformance criterion: COVERED IN "REGISTRIES PACKAGE" ((DC Manage immunizations; S.1.1 Registry notification; S Encounter-specific functionality; S Health service reports at the conclusion of an episode of care; I Unique identity, registry, and directory services; I.3.2 Distributed registry access; I.5.4 Interchange agreements; I.6 Business rules management)). INCLUDED, noncontroversial Reference number: 153 Registries

157 Reconciling the pediatric requirements with the EHR model May 2006 Report adverse drug reactions Closest conformance criterion: COVERED IN "REGISTRIES PACKAGE" ((DC Manage immunizations; S.1.1 Registry notification; S Encounter-specific functionality; S Health service reports at the conclusion of an episode of care; I Unique identity, registry, and directory services; I.3.2 Distributed registry access; I.5.4 Interchange agreements; I.6 Business rules management)). INCLUDED, noncontroversial Reference number: 154 Registries

158 Reconciling the pediatric requirements with the EHR model May 2006 Include gestational age on data reported to registries Closest conformance criterion: N/A (Wouldnt this be up to the registry? Would not the registry be the one to specify whether it wanted gestational age?). DELETE? Reference number: 150 Registries

159 Reconciling the pediatric requirements with the EHR model May 2006 Produce treatment plan reports for schools, day care, camp, and so forth Closest conformance criterion: DC #1 (The system SHOULD allow authorized users to create customized views of summarized information based on sort and filter controls for date or date range, problem, or other clinical parameters. ). INCLUDED, noncontroversial Reference number: 157 Reports

160 Reconciling the pediatric requirements with the EHR model May 2006 Provide communications to pediatric providers, including physicians, nurse practitioners, school nurses, developmental and behavioral health providers. Closest conformance criterion: DC #1 (The system SHOULD allow authorized users to create customized views of summarized information based on sort and filter controls for date or date range, problem, or other clinical parameters. ). INCLUDED, noncontroversial Reference number: 158 Reports

161 Reconciling the pediatric requirements with the EHR model May 2006 Provide discharge summary documents for parents and guardians Closest conformance criterion: DC #1 (The system SHOULD allow authorized users to create customized views of summarized information based on sort and filter controls for date or date range, problem, or other clinical parameters. ). INCLUDED, noncontroversial Reference number: 159 Reports

162 Reconciling the pediatric requirements with the EHR model May 2006 Provide treatment plans to parents and guardians Closest conformance criterion: DC #1 (The system SHOULD allow authorized users to create customized views of summarized information based on sort and filter controls for date or date range, problem, or other clinical parameters. ). INCLUDED, noncontroversial Reference number: 162 Reports

163 Reconciling the pediatric requirements with the EHR model May 2006 Support generation and maintenance of summary reports for parents Closest conformance criterion: DC #1 (The system SHOULD allow authorized users to create customized views of summarized information based on sort and filter controls for date or date range, problem, or other clinical parameters. ). INCLUDED, noncontroversial Reference number: 163 Reports

164 Reconciling the pediatric requirements with the EHR model May 2006 include nationally approved/endorsed pediatric measures, such as JCAHO, AHRQ, Health Plan Employer Data and Information Set (HEDIS); Title V Maternal and Child Health program indicators; National Quality Forum (NQF) initial hospital indicator set (pediatric-specific measures); Child and Adolescent Health Measurement Initiative (CAHMI). Closest conformance criterion: S (Outcome measures and analysis) (This sort of thing is less a function of the end- user system as it is a function of the data repository report- writing application.). INCLUDED, noncontroversial Reference number: 155 Reports

165 Reconciling the pediatric requirements with the EHR model May 2006 Provide flexibility to change the reports per changing requirements Closest conformance criterion: S (Outcome measures and analysis) (This sort of thing is less a function of the end-user system as it is a function of the data repository report-writing application.). INCLUDED, noncontroversial Reference number: 160 Reports

166 Reconciling the pediatric requirements with the EHR model May 2006 Provide reports based on pediatric quality measures to quality monitoring organizations Closest conformance criterion: S (Outcome measures and analysis) (This sort of thing is less a function of the end-user system as it is a function of the data repository report-writing application.). INCLUDED, noncontroversial Reference number: 161 Reports

167 Reconciling the pediatric requirements with the EHR model May 2006 Prepare age appropriate forms for external distribution, including camp physicals, athletic forms, and so forth Closest conformance criterion: S #all (The system SHOULD be capable of generating reports of structured clinical and administrative data through either internal or external reporting tools. The system MAY be capable of including information extracted from unstructured clinical and administrative data in the report generation process, using internal or external tools. The system SHALL be capable of generating reports, using either internal or external reporting tools. Reports generated SHALL be capable of being exported. The system SHOULD allow the user to specify report parameters, based on patient demographic and/or clinical data, which would allow sorting and/or filtering of the data. The system (or an external application, using data from the system) MAY allow users to save report parameters for generating subsequent reports. The system (or an external application, using data from the system) MAY allow users to modify one or more parameters of a saved report specification when generating a report using that specification.). INCLUDED, noncontroversial Reference number: 156 Reports

168 Reconciling the pediatric requirements with the EHR model May 2006 provide support for the management of patients enrolled in research protocols and management of patients enrolled in research protocols. Closest conformance criterion: DC #4 (The system SHOULD support the management and tracking of patients participating in research studies. ). INCLUDED, noncontroversial Reference number: 164 Research

169 Reconciling the pediatric requirements with the EHR model May 2006 Capture, track referrals between healthcare providers or health care organizations. (DC.1.4.4) Closest conformance criterion: DC.1.9.5: Manage Referrals, e.g., #1 (The system SHALL support the capture of referral(s) to other care provider (s), whether internal or external to the organization). INCLUDED, noncontroversial Reference number: 165 Telehealth

170 Reconciling the pediatric requirements with the EHR model May 2006 Capture, track teleconsultations between healthcare providers or health care organizations. (DC.1.4.4) Closest conformance criterion: DC.1.9.5: Manage Referrals, e.g., #1 (The system SHALL support the capture of referral(s) to other care provider (s), whether internal or external to the organization). INCLUDED, noncontroversial Reference number: 166 Telehealth

171 Reconciling the pediatric requirements with the EHR model May 2006 Provide access to the electronic medical record to sites where telehealth is being implemented Closest conformance criterion: N/A (Whether an application is available through a network is an implementation issue). NOT INCLUDED, noncontroversial Reference number: 167 Telehealth

172 Reconciling the pediatric requirements with the EHR model May 2006 include special terminology used in pediatric care: Example: EMR systems include common pediatric terms (pediatric lexicon) used to describe pediatric preventive health care (e.g., developmental milestones, educational progress, and anticipatory guidance) and physical findings (e.g., weak cry, bulging anterior fontanels, and umbilical granuloma). Closest conformance criterion: Nonsensical; making terminology systems adequate for pediatric care is beyond the present scope (We need an entirely separate document detailing what we mean by pediatric terminology.). NOT INCLUDED, noncontroversial Reference number: 168 Terminology

173 Reconciling the pediatric requirements with the EHR model May 2006 Support terminology systems specifically designed for use in pediatrics Closest conformance criterion: Nonsensical; no such terminoligy systems exist (). NOT INCLUDED, noncontroversial Reference number: 169 Terminology

174 Reconciling the pediatric requirements with the EHR model May 2006 Allow recording of immunization status (current versus delayed) in summary lists Closest conformance criterion: N/A (N/A). VOCABULARY ISSUE: … Reference number: 170 Vocabulary

175 Reconciling the pediatric requirements with the EHR model May 2006 Allow recording of educational status in summary lists Closest conformance criterion: N/A (N/A). VOCABULARY ISSUE: … Reference number: 171 Vocabulary

176 Reconciling the pediatric requirements with the EHR model May 2006 Allow the recording of developmental assessments in summary lists Closest conformance criterion: N/A (N/A). VOCABULARY ISSUE: … Reference number: 172 Vocabulary

177 Reconciling the pediatric requirements with the EHR model May 2006 Allow the recording of health maintenance status as part of summary lists Closest conformance criterion: N/A (N/A). VOCABULARY ISSUE: … Reference number: 173 Vocabulary


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