welcome! hl7 child health work group webcast june 10, 2009 dial in: (770) 657-9270 passcode: 324598
TRANSCRIPT
Welcome!
HL7 Child Health Work Group
WebcastJune 10, 2009
Dial In: (770) 657-9270 passcode: 324598
Child Health Work Group Meeting June 10, 2009 9:00-10:30 central
General Business and National Updates
11:00-12:30 centralLeapFrog Flight Simulator Project Update
1:00-2:30 centralUnderstanding CDA, CCD and CCR
Overview of Sessions
General Business and Project
Updates9:00-10:30 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
Updates9:00-10:30 AM Central Agenda Introductions Ground Rules Objectives Approval of Jan 2009 Minutes and
DMG National HIT Activities and the
CHWG
Agenda
1. Use mute feature on phone2. Avoid “hold”; Hang up if
necessary3. Introduce self when speaking4. Stay on schedule
• Stay on topic• Collect electronic questions• Use parking lot
Ground Rules
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 minuteshttp://www.hl7.org/Library/Committees/pedsdata/minutes/ChildHealth_Minutes_HL7WGM_Jan09.doc
DMG Approval
Please see decision making guidehttp://www.hl7.org/Library/Committees/pedsdata/Child%20Health%20HL7%20WG%20DMP%20v2.0.doc
General Business and Project
Updates9:00-10:30 AM Central Agenda Introductions Ground Rules Objectives Approval of Jan 2009 Minutes and
DMG National HIT Activities and the
CHWG
Agenda
Alliance for Pediatric Quality – Joy HL7 Child Health Work Group – Andy HL7 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
National HIT Activities
Alliance for Pediatric Quality(AAP, ABP, CHCA &
NACHRI)
Joy Kuhl
Overview
Alliance for Pediatric Quality
Founded: 2005Leadership: American Board of Pediatrics
American Academy of PediatricsChild Health Corporation of AmericaNational Association of Children’s Hospitals
and Related Institutions Mission: To establish a unified voice for improving the
quality of pediatric health care
Alliance forPediatricQuality
Identify Requirements
Influence Adoption
Set National Agenda
HIMSS Pediatric Health Informatics & Technology SIG
eHealth CollaborativeHealth Level Seven (HL7) Child HealthWork Group
AAPCouncil on
Clinical Information
Technology
Adopt Standards
Health InformationTechnology
vendors
Child health practitioners,
cliniciansand hospitals
Desired Outcomes
Reduce system implementation
costs due to duplication and customization
Enable pediatric performance
measurement by improving
interchange of standardized information
Support safe care for children
Support work, convene, build
consensus, endorse and
advocate
HHS: Coordinator
Alliance HIT Strategy for Influence
Develop and Pilot Standards
HL7, SNOMED…
NHINS andCollaboratives
Integrating the Healthcare Enterprise
NQF HIT Expert Panel
Vendor Consortia
Certify Products
CCHIT
Harmonize Standards
HIT Standards Panel
NACHRI Pediatric Advisory Council
CHCA CIO and CMIO Forums
Alliance forPediatricQuality
Identify Requirements
Influence Adoption
Set National Agenda
HIMSS PHIT SIGAllan Castro (NACHRI)
Jennifer Gedney (CHCA)Feliciano Yu, MD
eHealth CollaborativeLisa Simpson, MD, Policy: Marc
Probst, MD, Standards TBDHL7 Child HealthDavid Classen, MDJoy Kuhl (Alliance)Andy Spooner, MDFeliciano Yu, MD
AAP COCITEugenia Marcus, MDBeki Marshall (AAP)
Joseph Schneider, MD
Adopt Standards
Health InformationTechnology
vendors
Child health practitioners,
cliniciansand hospitals
Desired Outcomes
Reduce system implementation
costs due to duplication and customization
Enable pediatric performance
measurement by improving
interchange of standardized information
Support safe care for children
Support work, convene, build
consensus, endorse and advocate
Joy Kuhl (Alliance)Beki Marshall (AAP)
Jennifer Gedney (CHCA)Allan Castro and Michael
Ellwood (NACHRI)
Leadership RepresentationConnecting the Community
Develop and Pilot
HL7 (see left column)
NHIN Projects
IHE
NQF HIT Expert PanelPaul Fu, MD, David Stumpf,
MD, Brian Jacobs, MD
Vendor Consortia
Certify Products
CCHIT 09-10 TBD
Harmonize
HIT Standards Panel
NACHRI HIT Advisory Council
TBD
CHCA CIO FORUMJennifer Gedney (CHCA)CIOs: Pam Arora, Allana Cummings, Dan Nigrin,
Albert Oriol, Denise Zabawski
IOM EHR Collaborative: Data Sharing NetworkChristopher Forrest (CHOP)
Core Team TBD
Link with HL7 Child Health WG
Provide administrative co chair Support and endorse work
HL7 Child HealthWork Group
Andy Spooner, MD
Overview
HL7 Child Health Work Group
Founded: 2003Leadership: David Classen, MD, Andy Spooner, MD
and Feliciano Yu, MDParticipation: 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 HL7 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
HL7 messaging standards Provided incubation and leadership in HL7 to develop standard for
reporting quality measure data – Quality Reporting Document Architecture
Strategic Plan UpdateJan Mtg Action Items
SWOT analysis updated; will revisit in future meeting Strategic plan updated per January suggestions Recruited pediatric representation in HL7 ED work;
future update Participating in LeapFrog project as advisors; update
and input today Pediatrics HIT supplement made accessible Co chairs reviewed framework for actionable plan
and put priority work in motion Expressed interest to COCIT in development of
policy statement on HIT needs for medical home
Strategic Plan: UpdateJan Mtg Action Items
Andy exploring IHE link Exploring HITSP and HITEP links Recruited pediatric participation in HITSP
immunization work; discussing HL7 today; Possible future education session on gaps in standards, etc.
Participating in public comment opportunities Andy providing update on HL7 clinical meeting Not started: collect findings on ambulatory
EMR failures through AAP
Strategic Plan Update5 Focus Areas
Identify pediatric HIT priorities HIT standards crash course Ensure involvement in immunizations efforts Support one new HL7 standards development
effort EHR FM Child Health Profile and CCHIT gap
analysis and call for action
HL7 and Intentions with Professional Societies
Andy Spooner, MD
Bridging the Chasm Meeting
HL7 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.hl7.org/btc.htm
BTC: Meeting Conclusion
Form a group focused on data standards 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
Engage in political advocacy missions that would help the data standards effort 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 2008-2010
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
HL7 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 HL7 immunization transactional standards
Others?
HIMSS Pediatric Healthcare and
Informatics Technology (PHIT) SIG
Jennifer Gedney
HIMSS PHIT SIG Overview
Leadership Membership
103 members
Mission Statement 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.
ChairCo-Chair Co-Chair
PHIT Leadership Liaison
Membership and
Communications
Education and Projects
Pele Yu, MD
Dexter D’CostaDarlene Carr
Allan CastroJennifer Gedney
Paul Zlotnik, MD
Leadership
Alliance forPediatricQuality
Identify Requirements
Influence Adoption
Set National Agenda
HIMSS Pediatric Health Informatics & Technology SIG
eHealth CollaborativeHealth Level Seven (HL7) Child HealthWork Group
AAPCouncil on
Clinical Information
Technology
Adopt Standards
Health InformationTechnology
vendors
Child health practitioners,
cliniciansand hospitals
Desired Outcomes
Reduce system implementation
costs due to duplication and customization
Enable pediatric performance
measurement by improving
interchange of standardized information
Support safe care for children
Support work, convene, build
consensus, endorse and
advocate
HHS: Coordinator
HIMSS PHIT SIG Link with Alliance
Develop and Pilot Standards
HL7, SNOMED…
NHINS andCollaboratives
Integrating the Healthcare Enterprise
NQF HIT Expert Panel
Vendor Consortia
Certify Products
CCHIT
Harmonize Standards
HIT Standards Panel
NACHRI Pediatric Advisory Council
CHCA CIO and CMIO Forums
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 eNEWS
Current/Possible Linkages to HL7 Group
Use HIMSS PHIT SIG to solicit input for standards
Promote HL7 priorities through education webinars or articles in PHIT eNews
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 InformationTechnology 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 eHealth Collaborative (NeHC) 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 HL7, IHE, others
Efforts like NHIN and CCHIT rely on these IS
ONC provides staff support
HHS Secretary
AHIC
ONC
HITSP
HL7 IHE CHIMITA PHIN
CCHIT
NHIN
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 NeHC (AHIC
Successor) uncertain
HHS Secretary
ARRA PolicyCommittee
ONC
HL7 IHE CHIMITA PHIN
CCHIT
NHIN
ARRAStandardsCommittee
HITSP
NeHC?
???
NIS
T
Link with Alliance
Previous Alliance helped recruit volunteer participation in
work groups Alliance participated in public comments on behalf of
pediatric community
Future TBD
HL7 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 HL7 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
HL7 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 HL7 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 IS06 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, PhD) – 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/
HITEP2/comments/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 HL7 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 HL7 Child Health on HL7
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
HL7 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 HL7 to share data with EHR-S
Millions of HL7 transactions in 2008
Priorities
Improving interoperability through new HL7 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)
HL7 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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