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Model Children's EHR Format: History and Process (Text Version)

Slide presentation from the AHRQ 2011 conference.

On September 19, 2011, Erin Grace made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (1.4 MB). Plugin Software Help.

Slide 1

Model Children's Electronic Health Record (EHR) Format: History and Process

AHRQ 2011 Annual Conference
September 19, 2011
3:30 PM-5:00 PM

Scott Finley, MD MPH, Principal Investigator, Westat

Slide 2

Project Team

Image: Logos of team members are shown. The Prime Contractor is Westat. Subcontractors are the American Academy of Pediatrics, the American Academy of Family Physicians, the University of Maryland Robert H. Smith School of Business, Duke Medicine, Intermountain Healthcare, and FOX Systems.

Slide 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.
  • Applicable data standards.
  • Usability.
  • Functionality.
  • Interoperability.

Slide 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."
  • Shall / Should / May.

Slide 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.

Slide 6

Scope of Work

  • 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:
    • Schedule for Format development.
    • Not a standards-setting process.

Slide 7

Prior Work

  • Health Level 7 (HL7) EHR-S Functional Model:
    • Hierarchy.
    • Not child-specific.
  • HL7 Child Health Functional Profile:
    • 125-150 child-specific changes from Functional Model.
  • Numerous publications.
  • Selected home-grown systems.

Slide 8

Technical Expert Panel (TEP)

  • Provide guidance to project.
  • Review key documents and deliverables.
  • Provide expertise on issues with EHRs used for children.
  • Serve as a resource on specific clinical, technical, and child welfare issues.

Slide 9

TEP Representation

  • Physician Informaticians:
    • Children's health focus.
    • More general health focus.
  • Non-Physician clinicians.
  • Children's advocacy organizations.
  • State Medicaid agencies.
  • Vendors and product developers.
  • Office of the National Coordinator for Health IT.
  • Indian Health Service.

Slide 10

Other Input

  • CHIPRA Category D Grantees:
    • Pennsylvania.
    • North Carolina.
  • Federal Workgroup.

Slide 11

Gap Analysis

  • Conducted by Intermountain Healthcare.
  • Identified key topic areas.
  • Drafted initial requirements.

Slide 12

Topic Areas in Format

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

Slide 13

Requirements Development Process

For each topic area:

  • Review findings from gap analysis.
  • Initial requirements drafted by subject matter expert (SME).
  • Project team review.
  • Outside SME and TEP review(s).

Slide 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."

Slide 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."

Slide 16

Format Characteristics

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

Slide 17

Requirements Tool

Image: A screen shot of the requirement tool is shown.

Slide 18

Requirement Details

Image: A screen shot of the requirement tool is shown.

Slide 19


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

Slide 20

Contact Information

Slide 21


Page last reviewed October 2014
Internet Citation: Model Children's EHR Format: History and Process (Text Version). October 2014. Agency for Healthcare Research and Quality, Rockville, MD.


The information on this page is archived and provided for reference purposes only.


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