Track B: Update on CHIPRA Model Children's EHR Format (Text Version)

On September 28, 2010, Erin Grace, Jessica Kahn, and Scott Finley made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (1.8 MB).

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Slide 1

Track B: Update on CHIPRA Model Children's EHR Format

AHRQ 2010 Annual Conference
September 28, 2010
3PM-4:30PM

Erin Grace, MPH, AHRQ Project Officer
Jessica Kahn, MPH, CMS Project Lead
Scott Finley, MD, MPH, Principal Investigator, Westat

Slide 2

Sponsoring Agencies

AHRQ, Agency for Healthcare Research and Quality:

• Erin Grace, MHA, Project Officer
• Heather Johnson, MS, Junior Service Fellow

CMS, Centers for Medicare & Medicaid Services:

• Jessica Kahn, MPH, CMS Project Lead
• Leslie Flaherty, HITECH Specialist

Images: The AHRQ logo and CMS logo are shown.

Slide 3

Project Team

Prime Contractor:

• Westat | Excellence in Research (Image: Westat's logo is shown)

Subcontractors:

• American Academy of Pediatrics
• American Academy of Family Physicians
• University of Maryland, Robert H. Smith School of Business
• Intermountain Healthcare
• Duke Medicine
• Fox Systems

Images: Each contractors' logo is shown.

Slide 4

Project Overview

Existing EHR systems often do not optimally support the provision of health care to children. The goal is to develop a model EHR Format for children, demonstrate that it can be readily used, and package it in a way that facilitates broad incorporation into EHR systems. The project will:

• Develop a framework for the optimal EHR for children.
• Identify gaps between existing systems and this framework.
• Design, develop, test, and disseminate the model Format.
• Assess existing products for conformance with the Format.
• Demonstrate consumption of the Format.

Slide 5

Technical Expert Panel (TEP)

• Provide input and feedback to project overall.
• Review key documents and deliverables.
• Provide guidance on functionalities and requirements.
• Serve as a resource on specific clinical, technical, and child welfare issues.

Slide 6

TEP Representation

• Physician Informaticians:
  • Children's health focus
  • More general health focus
• Non-Physician clinicians
• Children's advocacy organizations
• Medicaid
• Vendor
• Office of the National Coordinator for Health IT

Slide 7

Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)

• Section 401 (f) Development of Model EHR Format for Children Enrolled in Medicaid or CHIP.
• By 1/1/2010 the Secretary shall establish a program to encourage the development & dissemination of a model EHR Format for children.

Slide 8

By law, the model EHR Format for children must be:

Accessible:

• Accessible to Parents, Caregivers and Consumers

Interoperable:

• Designed to allow interoperable exchanges

Compatible:

• Compatible with other standards

Viewable:

• Viewable and understandable by Parents & Caregivers to assure quality

Slide 9

What is a "Format?"

• Requirements for:
  • A minimum set of data elements
  • Applicable data standards
  • Usability
  • Functionality
  • Interoperability

Slide 10

Foundational Work

• HL7 EHR-S Functional Model R1
• HL7 Functional Profile—Child Health
• HL7 EHR-S Functional Model R2 (in development)
• NIEM semantic interoperability standards
• MITA
• CCHIT certification criteria:
  • Inpatient
  • Ambulatory
  • Child Health

Slide 11

Scope of the Project—Clinical

• Incremental functionality for children.
• Appropriate external links:
  • Foster Care, Medicaid/MITA, CHIP, School Health, Immunization Registries
• Family medical record.
• Chronic diseases.
• Specialized Care Settings:
  • NICU, Hospice, others.
• Quality Reporting and Improvement

Slide 12

Scope of the Project—Technical

• Appropriate Standards (e.g., HL7, CCR, CCD)
• National health system efforts (e.g., NIEM, MITA, NHIN, FHA)
• Formal requirements management tools:
  • Metadata, Traceability, Dependencies
• Support for user-specific views:
  • System developers (comprehensive)
  • System developers (single function)
  • System selection and implementation

Slide 13

Target Audiences for Format

• CHIPRA Demonstration grantees
• Developers of existing EHR products
• New developers
• System purchasers
• Certifying bodies
• Standards groups
• Regulators
• Users/developers of "Meaningful Use" criteria

Slide 14

Component Tasks

• Environmental Scan and Gap Analysis
• Development of the Model Format
• Conformance Assessment
• Prototype Development
• Dissemination

Slide 15

Environmental Scan

• Publications (inc. gray literature)
• Relevant draft and final standards
• Recommendations from professional societies
• Product Web sites
• Niche products
• Product prevalence

An image of a man holding his hand over his eye like a visor is shown.

Slide 16

Gap Analysis

• Current- and future-state assessment
• High level requirements
• Supporting information (metadata):
  • Sources
  • Reliability
  • Importance

An image of two individuals looking ove data is shown.

Slide 17

Sources for Gap Analysis

• Experienced EHR Users Work Group
• Technical Expert Panel (TEP)
• Subject Matter Experts (SMEs):
  • AAP
  • AAFP
  • HIMSS EHR-A

Slide 18

Format Development

• Develop Format Consumption Models
• Define the Format Design/Structure
• Select the Environment for Format Development
• Test and Refine and Format Design/Structure
• Capture the Existing HL7 Child Health Functional Profile into the Format
• Additional Child Health Requirements:
  • Develop Format for areas in project scope
  • Articulate areas beyond project scope

Slide 19

Conformance Assessment

• How well do widely installed products conform to the Format?
  • Vendor attestation
  • Product inspection
• "Buyer's Guide"

An image of a guy on a computer is shown.

Slide 20

Prototype Development

• Three small projects
• Demonstrate use/consumption of the Format

Image: A person at a computer is shown lecturing three students.

Slide 21

Dissemination

• Presentations
• Publications
• Public access to the Format
• Development of targeted extracts

Images: Two tin cans connected by a string, and a little girl holding a telephone are shown.

Slide 22

Project Timeline

An image of a project timeline is shown.

The key dates are:

• Oct. 2010—Format Work Plan
• Nov. 2010—Format Structure & Design
• Jun. 2011—Format Development
• Nov. 2011—Comformance Assessment
• Mar 2012—Prototype
• Apr. 2012—CHIPRA Impact Assessment

Slide 23

CHIPRA Demonstration Projects

Section 401, Model EHR Format provision: "demonstrate the impact of the model EHR format for children developed and disseminated under subsection (f) on improving pediatric health, including the effects of chronic childhood conditions, and pediatric health care quality, as well as reducing health care costs."

Slide 24

Evaluating the Model Children's EHR Format

• CMS awarded North Carolina and Pennsylvania funding (CHIPRA Quality Grants) in 2009 to evaluate the impact of the model children's EHR format:
  • Will evaluate the impact of use of a children's EHR that most conforms to the format (as determined by WESTAT), looking particularly at children with chronic conditions.
  • 4 year grants, still just in planning phase now.

Slide 25

Model Children's EHR Format and Meaningful Use

• The goal is that the model format will be integrated into the EHR certification requirements for a future stage of Meaningful Use:
  • MU definition in future stages to include additional pediatric-relevant objectives and clinical quality measures.
  • ONC EHR certification criteria to follow suit.

Slide 26

Questions?

Slide 27

Contact Information

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