1. HL7 Child Health Work Group Update HL7 EHR-Public Health Task Force Andy Spooner, MD CMIO, Cincinnati Children’s Hospital & Medical Center Co Chair, HL7 Child Health Work Group October 27, 2010

2. www.hl7.org | HL7 Child Health Work Group | October 27, 2010 Introductions & Purpose Andy Spooner, MD, FAAP CMIO, Cincinnati Children’s Hospital & Medical Center Founding Co Chair, HL7 Child Health Work Group Co Chair, CCHIT Inpatient Work Group Purpose 1.Provide insight into related work products 2.Explore next steps in potential collaboration

3. www.hl7.org | HL7 Child Health Work Group | October 27, 2010 Data Standards and Certification Criteria: EHR System Functionality for Child Health Care 1. Child Health Work Group Overview 2. HL7 EHR-S Functional Model, Release 2 3. HL7 Child Health Functional Profile, Release 2 4. CCHIT Child Health Certification Criteria 5. Gap Analysis Work 6. What’s Next 7. Q&A Session Overview

4. 1. CHILD HEALTH WORK GROUP OVERVIEW

5. www.hl7.org | HL7 Child Health Work Group | October 27, 2010 Overview HL7 Child Health Work Group Founded: 2003 Leadership: David Classen, MD, Gay Giannone, RN, Andy Spooner, MD and Feliciano Yu, MD Participation: Primarily CMIOs, physicians, medical informatics experts and vendor representatives Distribution: 100+ previously on email Operations: One in person meeting and two webcast meetings in conjunction with HL7 work group meetings; Other calls and webcasts as needed

6. www.hl7.org | HL7 Child Health Work Group | October 27, 2010 Emphasis To-Date  Functional Data Standards  Standards for EHR systems include critical child health functions  Published EHR system standards for general pediatrics  Work was baseline for CCHIT child health certification criteria, other  Terminology Data Standards  Explored improving terminology systems for pediatrics using AAP policy statements (e.g. SNOMED)  Funding not available to support further work  Messaging Data Standards  Created immunization activity diagrams and story boards – now part of HL7 messaging standards  Provided incubation and leadership in HL7 to develop standard for reporting quality measure data – Quality Reporting Document Architecture using HL7 CDA  Provided support to create standards-based neonatal care report using HL7 CDA

7. 2. HL7 EHR-SYSTEM FUNCTIONAL MODEL

8. www.hl7.org | HL7 Child Health Work Group | October 27, 2010 Functional Standards: Relationships of Artifacts

9. 3. HL7 CHILD HEALTH FUNCTIONAL PROFILE FOR EHR SYSTEMS

10. www.hl7.org | HL7 Child Health Work Group | October 27, 2010 Child Health Functional Profile History Content drawn from AAP articles on important EHR functionality for child health care Volunteers drafted functional requirements Requirements not included in the functional model became material for the profile 25 volunteers contributed; Core team of 7 did the heavy lifting Submitted intent to ballot form October 2007 Available for adoption as accepted HL7 and ANSI standard – January 2009

11. www.hl7.org | HL7 Child Health Work Group | October 27, 2010 Manage Immunization Administration Statement: Capture and maintain discrete data concerning immunizations given to a patient including date administered, type, manufacturer, lot number, and any allergic or adverse reactions. Facilitate the interaction with an immunization registry to allow maintenance of a patient’s immunization history. Description: During an encounter, recommendations based on accepted immunization schedules are presented to the provider. Allergen and adverse reaction histories are checked prior to giving the immunization. If an immunization is administered, discrete data elements associated with the immunization including date, type, manufacturer and lot number are recorded. Any new adverse or allergic reactions are noted. If required, a report is made to the public health immunization registry. 1. The system SHALL provide the ability to recommend required immunizations, and when they are due, during an encounter based on widely accepted immunization schedules. 2. The system SHALL provide the ability to recommend required immunizations based on patient risk factors. 3. The system SHALL perform checking for potential adverse or allergic reactions for all immunizations when they are about to be given. 4. The system SHALL provide the ability to capture immunization administration details, including date, type, lot number and manufacturer. 5. The system SHALL provide the ability to capture other clinical data pertinent to the immunization administration (e.g. vital signs, adverse reactions). 6. The system SHALL record as discrete data elements data associated with any immunization. 7. The system SHOULD provide the ability to associate standard codes with discrete data elements associated with an immunization. 8. The system SHALL provide the ability to update the immunization schedule. Function: “Manage Immunization Administration” “Capture and maintain discrete data concerning immunizations…” Edits in RED for CH Profile Criteria requested by Child Health for original model now standard Example Edits and Additions to EHR FM

12. www.hl7.org | HL7 Child Health Work Group | October 27, 2010 Results  Useful to CCHIT Child Health Work Group  Will be useful for Model EMR Format for Children Project  Specific adoption/influence unknown other than tie to CCHIT certified vendors for child health

13. 4. CCHIT CHILD HEALTH WORK GROUP

14. www.hl7.org | HL7 Child Health Work Group | October 27, 2010 AAP HL7 Child Health HL7CCHIT Published EMR Position Papers Developed Pediatric EMR Functions Published Pediatric EMR Functional Model Standard Influenced EMR Vendor Certification Criteria Vendor Compliance & Certification; Provider Adoption An Example

15. 5. GAP ANALYSIS WORK

16. www.hl7.org | HL7 Child Health Work Group | October 27, 2010 Gap Analysis Project Compared:  HL7 Child Health Functional Profile for EHR Systems  CCHIT inpatient certification criteria, 2007  CCHIT ambulatory certification criteria, 2007  CCHIT child health certification criteria, 2007 Then:  Submitted recommendations to CCHIT Child Health WG, Feb. 2009; Letters and discussions with Inpatient and Ambulatory  WG completed review, May 2009; Will incorporate results into work on release 2 of the HL7 profile

17. 6. WHAT’S NEXT

18. www.hl7.org | HL7 Child Health Work Group | October 27, 2010 What’s Next 1.Input into EHR FM R2 2.Child Health Profile R2 3.Derived Profile for Neonatology

19. 7. Q&A

20. www.hl7.org | HL7 Child Health Work Group | October 27, 2010 Contact Information Andy Spooner, MD, FAAP Chief Medical Information Officer Cincinnati Children’s Hospital and Medical Center andrew.spooner@cchmc.org (513) 803-0121