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).
Track B: Update on CHIPRA Model Children's EHR Format
AHRQ 2010 Annual Conference
September 28, 2010
Erin Grace, MPH, AHRQ Project Officer
Jessica Kahn, MPH, CMS Project Lead
Scott Finley, MD, MPH, Principal Investigator, Westat
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.
- Westat | Excellence in Research (Image: Westat's logo is shown)
- 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.
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.
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.
- Physician Informaticians:
- Children's health focus
- More general health focus
- Non-Physician clinicians
- Children's advocacy organizations
- Office of the National Coordinator for Health IT
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.
By law, the model EHR Format for children must be:
- Accessible to Parents, Caregivers and Consumers
- Designed to allow interoperable exchanges
- Compatible with other standards
- Viewable and understandable by Parents & Caregivers to assure quality
What is a "Format?"
- Requirements for:
- A minimum set of data elements
- Applicable data standards
- HL7 EHR-S Functional Model R1
- HL7 Functional Profile—Child Health
- HL7 EHR-S Functional Model R2 (in development)
- NIEM semantic interoperability standards
- CCHIT certification criteria:
- Child Health
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
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
Target Audiences for Format
- CHIPRA Demonstration grantees
- Developers of existing EHR products
- New developers
- System purchasers
- Certifying bodies
- Standards groups
- Users/developers of "Meaningful Use" criteria
- Environmental Scan and Gap Analysis
- Development of the Model Format
- Conformance Assessment
- Prototype Development
- 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.
- Current- and future-state assessment
- High level requirements
- Supporting information (metadata):
An image of two individuals looking ove data is shown.
Sources for Gap Analysis
- Experienced EHR Users Work Group
- Technical Expert Panel (TEP)
- Subject Matter Experts (SMEs):
- HIMSS EHR-A
- 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
- How well do widely installed products conform to the Format?
- Vendor attestation
- Product inspection
- "Buyer's Guide"
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- Three small projects
- Demonstrate use/consumption of the Format
Image: A person at a computer is shown lecturing three students.
- 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.
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
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."
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.
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.