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Reconciling the pediatric requirements with the EHR model May 2006 Consent In cases where consent forms are managed by the system, allow adolescent patients.

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Presentation on theme: "Reconciling the pediatric requirements with the EHR model May 2006 Consent In cases where consent forms are managed by the system, allow adolescent patients."— Presentation transcript:

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

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

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

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

5 Reconciling the pediatric requirements with the EHR model May 2006 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 (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

6 Reconciling the pediatric requirements with the EHR model May 2006 E-Prescribing & Ordering 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

7 Reconciling the pediatric requirements with the EHR model May 2006 E-Prescribing & Ordering 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

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

9 Reconciling the pediatric requirements with the EHR model May 2006 E-Prescribing & Ordering 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

10 Reconciling the pediatric requirements with the EHR model May 2006 E-Prescribing & Ordering 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

11 Reconciling the pediatric requirements with the EHR model May 2006 E-Prescribing & Ordering 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

12 Reconciling the pediatric requirements with the EHR model May 2006 E-Prescribing & Ordering 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

13 Reconciling the pediatric requirements with the EHR model May 2006 Epidemiology 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

14 Reconciling the pediatric requirements with the EHR model May 2006 Epidemiology 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

15 Reconciling the pediatric requirements with the EHR model May 2006 Epidemiology 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

16 Reconciling the pediatric requirements with the EHR model May 2006 Growth 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

17 Reconciling the pediatric requirements with the EHR model May 2006 Immunizations 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

18 Reconciling the pediatric requirements with the EHR model May 2006 Medical Home 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

19 Reconciling the pediatric requirements with the EHR model May 2006 Medical Home 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

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

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

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

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

24 Reconciling the pediatric requirements with the EHR model May 2006 Parental Data Entry 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

25 Reconciling the pediatric requirements with the EHR model May 2006 Parental Data Entry 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

26 Reconciling the pediatric requirements with the EHR model May 2006 Patient Identification 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

27 Reconciling the pediatric requirements with the EHR model May 2006 Patient Identification 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

28 Reconciling the pediatric requirements with the EHR model May 2006 Patient Identification 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

29 Reconciling the pediatric requirements with the EHR model May 2006 Patient Identification 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

30 Reconciling the pediatric requirements with the EHR model May 2006 Patient Identification 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

31 Reconciling the pediatric requirements with the EHR model May 2006 Privacy 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

32 Reconciling the pediatric requirements with the EHR model May 2006 Privacy 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


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