1. Model Children’s EHR Format AHRQ 2011 Annual Conference September 19, 2011 3:30PM-5:00PM Scott Finley, MD, MPH, Principal Investigator, Westat History and Process

2. Project Team Subcontractors : Prime Contractor: Subcontractors: 2

3. What is a “Format?” Called for in the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Further defined as requirements for: A minimum set of data elements A minimum set of data elements Applicable data standards Applicable data standards Usability Usability Functionality Functionality Interoperability Interoperability 3

4. What is a requirement? “The system SHALL present patient age using units appropriate to the actual age of the patient, using appropriate thresholds for unit selection” “The system SHALL present patient age using units appropriate to the actual age of the patient, using appropriate thresholds for unit selection” SHALL / SHOULD / MAY SHALL / SHOULD / MAY 4

5. Project Purpose Existing EHR systems often do not optimally support the provision of health care to children Project components ■ Identify gaps between existing systems and an optimal EHR for children ■ Design, develop, test, and disseminate a Format based on those gaps ■ Assess existing products for conformance with the Format ■ Demonstrate use of the Format in prototype development 5

6. Scope of Work Focus Focus – Requirements for the unique incremental needs of Children – Build on existing foundational work – Suitable for existing and potential systems – Primary care and general inpatient needs Constraints Constraints – Schedule for Format development – Not a standards-setting process 6

7. Prior Work HL7 EHR-S Functional Model HL7 EHR-S Functional Model – Hierarchy – Not child-specific HL7 Child Health Functional Profile HL7 Child Health Functional Profile – 125-150 child-specific changes from Functional Model Numerous publications Numerous publications Selected home-grown systems Selected home-grown systems 7

8. Technical Expert Panel (TEP) Provide guidance to project Provide guidance to project Review key documents and deliverables Review key documents and deliverables Provide expertise on issues with EHRs used for children Provide expertise on issues with EHRs used for children Serve as a resource on specific clinical, technical, and child welfare issues Serve as a resource on specific clinical, technical, and child welfare issues 8

9. TEP Representation Physician Informaticians Physician Informaticians – Children’s health focus – More general health focus Non-Physician clinicians Non-Physician clinicians Children’s advocacy organizations Children’s advocacy organizations State Medicaid agencies State Medicaid agencies Vendors and product developers Vendors and product developers Office of the National Coordinator for Health IT Office of the National Coordinator for Health IT Indian Health Service Indian Health Service 9

10. Other Input CHIPRA Category D Grantees CHIPRA Category D Grantees – Pennsylvania – North Carolina Federal Workgroup Federal Workgroup 10

11. Gap Analysis Conducted by Intermountain Healthcare Conducted by Intermountain Healthcare Identified key topic areas Identified key topic areas Drafted initial requirements Drafted initial requirements 11

12. Topic Areas in Format Activity Clearance Activity Clearance Birth History Birth History Child Abuse Reporting Child Abuse Reporting Child Welfare Child Welfare Children with Special Health Care Needs Children with Special Health Care Needs Growth Data Growth Data Immunizations Immunizations Medication Management Medication Management Newborn Screening Newborn Screening Parents, Guardians, and Family Relationship Data Parents, Guardians, and Family Relationship Data Patient Identifiers Patient Identifiers Patient Portals/Personal Health Record Information Access Patient Portals/Personal Health Record Information Access Prenatal Screening Prenatal Screening Primary Care Primary Care Quality Measures Quality Measures Registry Linkages Registry Linkages School-based Linkages School-based Linkages Security and Confidentiality Security and Confidentiality Special Terminology and Information Special Terminology and Information Specialized Scales and Scoring Specialized Scales and Scoring Well Child and Preventive Care Well Child and Preventive Care 12

13. Requirements Development Process For each topic area: Review findings from gap analysis Review findings from gap analysis Initial requirements drafted by subject matter expert (SME) Initial requirements drafted by subject matter expert (SME) Project team review Project team review Outside SME and TEP review(s) Outside SME and TEP review(s) 13

14. Concept Evolution #1 From the HL7 Child Health Functional Profile: “The system MAY provide the ability to compute post conceptional age (corrected age) for the purposes of decision support.” “The system MAY provide the ability to compute post conceptional age (corrected age) for the purposes of decision support.” 14

15. Concept Evolution #2 From the Model Format: “The system SHOULD be able to display head circumference adjusted for the degree of prematurity by subtracting the number of weeks premature the individual was born from each plot point during the first two years of life. The growth chart should reflect that this plot was corrected for prematurity.” “The system SHOULD be able to display head circumference adjusted for the degree of prematurity by subtracting the number of weeks premature the individual was born from each plot point during the first two years of life. The growth chart should reflect that this plot was corrected for prematurity.” 15

16. Format Characteristics Specialized requirements database (Accompa) Specialized requirements database (Accompa) Chiefly functional requirements, including interoperability Chiefly functional requirements, including interoperability Usability challenges Usability challenges Few existing standards to support taxonomy or data elements Few existing standards to support taxonomy or data elements >700 detailed requirements >700 detailed requirements Suitable for system development and system selection Suitable for system development and system selection 16

17. Requirements Tool 17

18. Requirement Details 18

19. Summary >700 incremental EHR requirements for children >700 incremental EHR requirements for children No new standards set No new standards set Compatible with existing & potential systems Compatible with existing & potential systems Primary care and general inpatient care Primary care and general inpatient care Best accessed through Accompa guest account (exports will also exist) Best accessed through Accompa guest account (exports will also exist) 19

20. Contact Information Scott Finley, MD, MPH Principal Investigator, Westat scottfinley@westat.com Scott Finley, MD, MPH Principal Investigator, Westat scottfinley@westat.com scottfinley@westat.com Lois Olinger, MA Lois Olinger, MA Project Manager, Westat loisolinger@westat.com loisolinger@westat.comloisolinger@westat.com Erin Grace, MHA AHRQ Project Officer Erin.grace@AHRQ.hhs.gov Erin Grace, MHA AHRQ Project Officer Erin.grace@AHRQ.hhs.gov Erin.grace@AHRQ.hhs.gov Jessica Kahn, MPH CMS Project Lead Jessica.Kahn@CMS.hhs.gov Jessica Kahn, MPH CMS Project Lead Jessica.Kahn@CMS.hhs.gov Jessica.Kahn@CMS.hhs.gov 20

21. Questions? 21