Welcome! HL 7 Child Health Work Group Webcast June 10, 2009 Dial In: (770) 657 -9270 passcode: 324598
Overview of Sessions Child Health Work Group Meeting June 10, 2009 § 9: 00 -10: 30 central General Business and National Updates § 11: 00 -12: 30 central Leap. Frog Flight Simulator Project Update § 1: 00 -2: 30 central Understanding CDA, CCD and CCR
Agenda General Business and Project Updates 9: 00 -10: 30 AM Central § Agenda § Introductions § Ground Rules § Objectives § Approval of Jan 2009 Minutes and DMG § National HIT Activities and the CHWG
Agenda General Business and Project Updates 9: 00 -10: 30 AM Central § Agenda § Introductions § Ground Rules § Objectives § Approval of Jan 2009 Minutes and DMG § National HIT Activities and the CHWG
Ground Rules 1. 2. 3. 4. Use mute feature on phone Avoid “hold”; Hang up if necessary Introduce self when speaking Stay on schedule • Stay on topic • Collect electronic questions • Use parking lot
Meeting Objectives § Approve Jan 2009 minutes § Decision making guide approval § Participants are able to talk comfortably at a high level about national pediatric HIT activities § Draw interest from potential volunteers
January 2009 Minutes Approval Please see meeting minutes http: //www. hl 7. org/Library/Committees/pedsdata/minutes/Child. Health_Minutes_HL 7 WGM_Jan 09. doc
DMG Approval Please see decision making guide http: //www. hl 7. org/Library/Committees/pedsdata/Child%20 Health%20 HL 7%20 WG%20 DMP%20 v 2. 0. doc
Agenda General Business and Project Updates 9: 00 -10: 30 AM Central § Agenda § Introductions § Ground Rules § Objectives § Approval of Jan 2009 Minutes and DMG § National HIT Activities and the CHWG
National HIT Activities § § § Alliance for Pediatric Quality – Joy HL 7 Child Health Work Group – Andy HL 7 and Professional Societies – Andy AAP Council on Clinical Info Tech – Beki HIMSS Pediatric SIG – Jennifer NACHRI HIT Advisory Group – Allan HIT Standards Panel – Rob Certification Commission for HIT – Aileen NQF Health Info Tech Expert Panel – Paul Immunization Messaging IG – Rob Other
Alliance for Pediatric Quality (AAP, ABP, CHCA & NACHRI) Joy Kuhl
Overview Alliance for Pediatric Quality Founded: Leadership: Mission: 2005 American Board of Pediatrics American Academy of Pediatrics Child Health Corporation of America National Association of Children’s Hospitals and Related Institutions To establish a unified voice for improving the quality of pediatric health care
Alliance HIT Strategy for Influence Identify Requirements Health Level Seven (HL 7) Child Health Work Group AAP Council on Clinical Information Technology HIMSS Pediatric Health Informatics & Technology SIG NACHRI Pediatric Advisory Council CHCA CIO and CMIO Forums Alliance for Pediatric Quality Support work, convene, build consensus, endorse and advocate Set National Agenda HHS: Coordinator e. Health Collaborative Develop and Pilot Standards Adopt Standards HL 7, SNOMED… Influence Adoption Health Information Technology vendors Integrating the Healthcare Enterprise NHINS and Collaboratives NQF HIT Expert Panel Vendor Consortia Harmonize Standards HIT Standards Panel Certify Products CCHIT Desired Outcomes Support safe care for children Child health practitioners, clinicians and hospitals Enable pediatric performance measurement by improving interchange of standardized information Reduce system implementation costs due to duplication and customization
Leadership Representation Connecting the Community Identify Requirements Influence Adoption HL 7 Child Health AAP COCIT HIMSS PHIT SIG Allan Castro (NACHRI) Jennifer Gedney (CHCA) Feliciano Yu, MD NACHRI HIT Advisory Council TBD CHCA CIO FORUM Jennifer Gedney (CHCA) CIOs: Pam Arora, Allana Cummings, Dan Nigrin, Albert Oriol, Denise Zabawski Lisa Simpson, MD, Policy: Marc Probst, MD, Standards TBD Develop and Pilot HL 7 (see left column) David Classen, MD Joy Kuhl (Alliance) Andy Spooner, MD Feliciano Yu, MD Eugenia Marcus, MD Beki Marshall (AAP) Joseph Schneider, MD Set National Agenda e. Health Collaborative Alliance for Pediatric Quality IOM EHR Collaborative: Data Sharing Network Christopher Forrest (CHOP) IHE Core Team TBD Adopt Standards Support safe care for children Health Information Technology vendors NQF HIT Expert Panel Support work, convene, build consensus, endorse and advocate Joy Kuhl (Alliance) Beki Marshall (AAP) Jennifer Gedney (CHCA) Allan Castro and Michael Ellwood (NACHRI) Paul Fu, MD, David Stumpf, MD, Brian NHIN Projects Jacobs, MD Vendor Consortia Harmonize HIT Standards Panel Certify Products CCHIT 09 -10 TBD Desired Outcomes Child health practitioners, clinicians and hospitals Enable pediatric performance measurement by improving interchange of standardized information Reduce system implementation costs due to duplication and customization
Link with HL 7 Child Health WG § Provide administrative co chair § Support and endorse work
HL 7 Child Health Work Group Andy Spooner, MD
Overview HL 7 Child Health Work Group Founded: Leadership: 2003 David Classen, MD, Andy Spooner, MD and Feliciano Yu, MD Participation: Primarily CMIOs, physicians, medical informatics experts and vendor representatives Distribution: 100+ previously on email; listserv unknown Operations: One in person meeting and two webcast meetings in conjunction with HL 7 work group meetings; Other calls and webcasts as needed
Emphasis To-Date § Functional Data Standards § § Standards for EHR systems include critical child health functions Published EHR system standards for general pediatrics Work is baseline for CCHIT child health certification criteria Started identifying functionality important for pediatric specialties (e. g. pediatric critical care) § Terminology Data Standards § Explored opportunity to improve terminology systems for pediatrics using AAP policy statements (e. g. SNOMED) § Seeking funding to move work forward § Messaging Data Standards § Created immunization activity diagrams and story boards – now part of HL 7 messaging standards § Provided incubation and leadership in HL 7 to develop standard for reporting quality measure data – Quality Reporting Document Architecture
Strategic Plan Update Jan Mtg Action Items ü SWOT analysis updated; will revisit in future meeting ü Strategic plan updated per January suggestions ü Recruited pediatric representation in HL 7 ED work; future update ü Participating in Leap. Frog project as advisors; update and input today ü Pediatrics HIT supplement made accessible ü Co chairs reviewed framework for actionable plan and put priority work in motion ü Expressed interest to COCIT in development of policy statement on HIT needs for medical home
Strategic Plan: Update Jan Mtg Action Items § Andy exploring IHE link § Exploring HITSP and HITEP links § Recruited pediatric participation in HITSP immunization work; discussing HL 7 today; Possible future education session on gaps in standards, etc. § Participating in public comment opportunities § Andy providing update on HL 7 clinical meeting § Not started: collect findings on ambulatory EMR failures through AAP
Strategic Plan Update 5 Focus Areas § § § Identify pediatric HIT priorities HIT standards crash course Ensure involvement in immunizations efforts Support one new HL 7 standards development effort EHR FM Child Health Profile and CCHIT gap analysis and call for action
HL 7 and Intentions with Professional Societies Andy Spooner, MD
Bridging the Chasm Meeting § HL 7 CIC § Healthcare professional societies: no organized voice in national data standards activities § Desired output: proposal to organize that involvement § “Bridging the Chasm” meeting on data standards and professional societies, April 19 -21, Washington, DC § Over 100 societies represented. ACP, ABIM, AAFP, ABFP, ACOG, ABP; large number of specialists in areas like refractive ophthalmic surgery, rheumatology, radiology, and neurosurgery; a few non-physician groups § Attendee list & meeting materials posted at http: //www. hl 7. org/btc. htm
BTC: Meeting Conclusion § Form a group focused on data standards § § Engage in political advocacy missions that would help the data standards effort § § How to fund/organize? Jim Dove, MD, of Springfield Illinois, former president of the American College of Cardiology, agreed to be leader Plans are to reconvene in a few months Government mandate to employ existing standards Unique patient identifier National Heath Information Network. Work on clinical content projects § § Terminologies? CCD?
AAP Council on Clinical Information Technology Beki Marshall
AAP Council on Clinical Information Technology (COCIT) § Serves as the “home” for health information technology initiatives within the AAP § About 600 members with special interest or training in applying information technology to pediatric practice § An 11 -member volunteer Executive Committee oversees COCIT activities
COCIT Strategic Plan § Developed June 2007 -April 2008 § Will guide COCIT activities in 20082010
COCIT Mission The mission of COCIT is to provide strategic direction and leadership to promote affordable, child-friendly health information technology (HIT) and health information exchange (HIE) solutions that support quality care; and to drive the creation and successful deployment of systems which have these characteristics.
COCIT Vision Every infant, child and adolescent would be cared for in every venue with the necessary health information technology that is both cost effective and improves the quality of health care, regardless of socio-economic status.
Goal #1: Ensure Health IT solutions are child-friendly, affordable, cost effective, and support quality care. § § Advising the Certification Commission on Health Information Technology on Requirements for Child Health Develop an implementation strategy based on the results of the AAP Periodic Survey of Fellows addressing pediatrician adoption of electronic health records
Goal #2: Support the usage of pediatric HIT and HIE in actual practice, with a particular focus on addressing the Child Health Priorities identified in the AAP Strategic Plan. § Develop two electronic health passport test cases for children and youth in foster care § Establish a work plan to address the intersection between electronic health records and immunization information systems § Develop a plan for continuously improving the following COCIT offerings: § Pediatric Office of the Future (Exhibit at AAP National Conference & Exhibition) § Pediatric Documentation Challenge (At NCE and TEPR) § Council Program for Council Members (At NCE, includes scientific abstract program) § Technology Learning Center (At NCE) § EMR Review Web Site (including Buddy List)
Goal #3: Increase the visibility and effectiveness of the efforts of COCIT and the AAP in providing HIT and HIE direction and leadership. § Establish a schedule of topics and authors to write a monthly article on health information technology for a non -COCIT AAP publication § Develop a policy statement on the role of HIT and HIE in pediatrics § Create a 1 -2 page concept paper on COCIT’s activities to inform the work of the AAP Chief Quality Officer § Develop a concept and/or grant proposal to develop an institute for HIT within the AAP whose mission would be to provide strategic direction and leadership in promoting affordable, child-friendly health IT and HIE solutions that support quality care and drive the creation and successful deployment of these solutions
Goal #4: Provide high value for COCIT members. § Establish a COCIT mentoring program to assist the general membership in getting involved with COCIT initiatives and HIT/HIE projects § Develop a welcome kit for new members § Develop a two-page checklist for COCIT members that summarizes recommendations from the “Special Requirements for Electronic Health Records Systems in Pediatrics” clinical report, the Implementing an Electronic Health Record toolkit, and other resources for pediatricians to use in the vendor selection process
Next Steps § Recruit volunteers from COCIT membership to form teams to address objectives § To establish a work plan and concrete tasks to address objectives § To recruit additional volunteers from COCIT membership to complete specific tasks within the work plan § To review the Strategic Plan annually and update as objectives are completed
Children’s Health Insurance Program Reauthorization Act (CHIPRA) § $5 million/year for 5 years to develop a model electronic health record format for children in Medicaid and CHIP § Funding to be distributed through Agency for Healthcare Research and Quality
American Recovery and Reinvestment Act of 2009 (ARRA) § $19 Billion in incentives through Medicare and Medicaid for “meaningful use” of HIT § Established Health IT Policy and Standards Committees § Office of the National Coordinator for Health IT
AAP Vision § “The American Academy of Pediatrics (AAP) views the implementation of the Medical Home (MH), the deployment of health information technology (HIT), and the reform of healthcare as parallel and intertwined processes. § To achieve this potential, HIT must be designed, deployed, implemented, and managed effectively, not only as a simple documentation tool for payment, but as the ongoing, organized source of information for future evidence-based medicine. ”
Meaningful Use § Potential for each state Medicaid agency to develop its own definition § Legislation requires e-prescribing, quality reporting, and health information exchange § Meaningful use in pediatrics may be different than for adults § Fewer meaningful quality measures § ADHD meds cannot be e-prescribed § Various state laws/policies on adolescent privacy limit health information exchange opportunities
HL 7 Child Health Linkages § Potential opportunities to explore § Standards for electronic health passports for children in foster care § Standards for model electronic health record format for children § Supporting state and regional immunization information systems in adopting HL 7 immunization transactional standards § Others?
HIMSS Pediatric Healthcare and Informatics Technology (PHIT) SIG Jennifer Gedney
HIMSS PHIT SIG Overview Leadership § Membership Jennifer Gedney Pele Yu, MD Allan Castro Co-Chair Membership and Communications PHIT Leadership Liaison Education and Projects § 103 members § Mission Statement Dexter D’Costa Darlene Carr Paul Zlotnik, MD § To serve as the “information hub” for addressing the special interests of pediatric health informatics and technology (PHIT) professionals within HIMSS. § Goal § To unify pediatric health informatics and technology (PHIT) professionals within HIMSS and provide *pediatric-specific* input on the major challenges facing the HIT industry, as well as information on recent advances that benefit the pediatric HIT community.
HIMSS PHIT SIG Link with Alliance Identify Requirements Health Level Seven (HL 7) Child Health Work Group AAP Council on Clinical Information Technology HIMSS Pediatric Health Informatics & Technology SIG NACHRI Pediatric Advisory Council CHCA CIO and CMIO Forums Alliance for Pediatric Quality Support work, convene, build consensus, endorse and advocate Set National Agenda HHS: Coordinator e. Health Collaborative Develop and Pilot Standards Adopt Standards HL 7, SNOMED… Influence Adoption Health Information Technology vendors Integrating the Healthcare Enterprise NHINS and Collaboratives NQF HIT Expert Panel Vendor Consortia Harmonize Standards HIT Standards Panel Certify Products CCHIT Desired Outcomes Support safe care for children Child health practitioners, clinicians and hospitals Enable pediatric performance measurement by improving interchange of standardized information Reduce system implementation costs due to duplication and customization
Priorities and Challenges § Strengthen pediatric voice in HIMSS § Increase membership and committee members § PHIT SIG contribution to Regional and National Health IT efforts § Promote pediatric educational sessions § PHIT SIG Webcasts § Pediatric sessions at annual HIMSS Conference § PHIT e. NEWS
Current/Possible Linkages to HL 7 Group § Use HIMSS PHIT SIG to solicit input for standards § Promote HL 7 priorities through education webinars or articles in PHIT e. News
NACHRI HIT Advisory Group Allan Castro
Overview § The NACHRI/N. A. C. H. HIT Advisory Group provides guidance to NACHRI/N. A. C. H. in their public policy efforts in the area of pediatric health information technology § Formed May 2009 § 18 members – CIO’s and CMIO’s of children’s hospitals
Link with Alliance § Partner with Alliance for input to appropriate agencies § Recent examples of collaboration - meaningful use comments to NCVHS, comments on regional extension centers to ONC § We seek to enhance collaboration with the Alliance
Priorities § Bring awareness of pediatric health IT issues at the federal level § ARRA Medicaid Incentives § Meaningful use § Collaborate with other similar organizations
Healthcare Information Technology Standards Panel Rob Savage
Healthcare Information Technology Standards Panel Overview § HITSP is an effort to identify existing standards that promote interoperability between health information systems The Players § American Health Information Community (AHIC) is now National e. Health Collaborative (Ne. HC) § Nationwide Health Information Network(NHIN) § Certification Commission for Healthcare IT (CCHIT)
HITSP Previous Process § AHIC and its workgroups release “Use Cases” with priorities for interoperability § HITSP and its Technical Committees develop Interoperability Specifications (IS) § IS draw upon existing standards from HL 7, IHE, others § Efforts like NHIN and CCHIT rely on these IS § ONC provides staff support
HITSP New Process § ARRA defined a Policy and Standards Committee which have recently formed with WGs § HITSP continues under contract to ONC § NIST now has testing role § Not clear where HITSP priorities come from § Status of Ne. HC (AHIC Successor) uncertain
Link with Alliance § Previous § Alliance helped recruit volunteer participation in work groups § Alliance participated in public comments on behalf of pediatric community § Future § TBD
HL 7 Child Health Linkages § Previous § Minimal formal connection: some participants heavily involved in HITSP work § Future § TBD
CCHIT Child Health Work Group Certification Criteria Aileen Sedman, MD
CCHIT Overview § CCHIT is an independent, nonprofit organization that has been recognized by the federal government as an official certification body for electronic health record products § Its mission is to accelerate the adoption of health information technology by creating a credible, sustainable product certification program § More information on CCHIT and CCHIT Certified products is available at www. cchit. org
CCHIT and Child Health § Child Health Expert Panel formed 2007 § Asked to create criteria that could be added to ambulatory, inpatient, ED (i. e. a company could ask for this special designation along with foundational requirements) § First criteria created 2007 for testing in 2008 - growth tracking and age specific vital signs § First testing and certified products late 2008 § 26 vendors applied for 2008 child health certification; anticipate completion by June 30, 2009 (41% of ambulatory certification) § Certified vendors: http: //www. cchit. org/choose/ambulatory/08/ § Panel completed gap analysis with HL 7 Child Health functional profile – gaps as foundation for future criteria development
Alliance Link § Alliance lobbied CCHIT to form Child Health Work Group § Submits letters of endorsement for pediatric work group volunteers § Coordinates pediatric community input into public comment periods
HL 7 Child Health Linkages § Previous § A number of participants are volunteers on CCHIT work groups § Joy, Aileen and Pele performed gap analysis to ensure consideration of HL 7 child health functional profile § Participants invited to submit comments to Alliance § Future § More of the same § Other?
National Quality Forum and Health Information Technology Expert Panel Paul Fu, Jr. , MD, MPH
HITEP - I Overview § In 2007, AHRQ commissioned NQF HITEP - I to address the ability of EHRs to create and aggregate data for quality measurement § Recommended a high-priority set of quality measures (84) § Identified a set of required data categories (11) and data types (39) to be incorporated into HITSP IS 06 Quality § Identified gaps § AHIC Quality Workgroup recommended further development of these data types into a quality data set (QDS) and an environmental scan of workflows needed to generate data for measures
HITEP – II Overview § Focus of HITEP - II is on identifying workflows and data sources and making recommendations for a standardized quality data set (QDS) § Expert Panel and two workgroups § Workflow workgroup (Paul Fu, Jr. , MD, MPH; Brian Jacobs, MD) – describe efficient capture of standard data elements from appropriate authoritative sources § QDS workgroup (David Stumpf, MD, Ph. D) – expands on the data categories, types, and elements from HITEP – I and HITSP by adding data concepts, identifying code sets, and describing common value thresholds
Current Status § HITEP – I final report § “Recommended Common Data Types and Prioritized Performance Measures for Electronic Healthcare Information Systems” § HITEP – II draft report § “Health IT Enablement of Quality Measurement – the Quality Data Set (QDS) and Dataflow” § Open for public comments until June 30, 2009 § http: //www. qualityforum. org/projects/ongoing/HITEP 2/com ments/index. asp § Alliance submitting joint pediatric HIT comments (send comments to Joy by June 24)
Health Quality Measure Format § NQF issued a subcontract to: § Create a Health Quality Measure Format (HQMF) for the electronic representation of measure specifications, and § Write an HL 7 Structured Document to facilitate implementation of the new format, resulting in successful balloting and approval by a standards development organization § Awarded to Alschuler Associates in May 2009 § Same vendor who worked with HL 7 Child Health on HL 7 Quality Reporting Document Architecture (QRDA) § Alliance lobbying for inclusion of pediatric measure/s
HITEP Recommendations for Future Work § § Ongoing maintenance of the QDS Maintenance of reusable code lists Development of a measure authoring tool Enhanced coordination with SDOs and EHR certification bodies to encourage incorporation of quality data types into EHR data sets
HL 7 Immunization Messaging Implementation Guide Rob Savage
American Immunization Registry Association Information systems are important tools supporting full immunization
Overview IIS is population based data source IIS source of complete immunization record IIS support for assessing coverage IIS support for VFC usage and soon ordering of vaccine § IIS using HL 7 to share data with EHR-S § § § Millions of HL 7 transactions in 2008
Priorities § Improving interoperability through new HL 7 Implementation Guide § Goals include § Accurate, tightly constrained IG § Support for better query § Support for use of profiles § Assuring that functionality provided by IIS is included in any future evolution
Challenges § Existing implementations are successful but not consistent across vendors § Upgrading and aligning will cost money/ effort § Landscape is changing (less silos) § Version 2. x is where we are. Some want to move to version 3 (messages vs documents)
HL 7 Child Health Linkages § Support in ballot process § Work with your EHR-S to interact with IIS § Work with your IIS to support upgrading
Other Updates, Q&A and Discussion
Thank You!
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