HL7 Pediatric Data Standards Special Interest Group Meeting

February 27, 2004
3:00 – 4:00 CT (1:00 – 2:00 PT; 2:00 – 3:00 MT; 4:00 – 5:00 ET)
Call in Number: 877-629-3048
Passcode 210349

Conference Call Participants:

David Classen, MD

Andy Spooner, MD

Cheri Throop

Ellen Schwalenstocker

Feliciano Yu, MD

Aileen Sedman, MD

Philip Gioia, MD

Noorullah Akhtar, MD

Ellen Hansen

David and Andy called the meeting to order at 3:00 PM CST.

January HL7 meeting Highlights:

David and Andy shared some of the key learnings from their participation in various HL7 meetings representing our SIG. The importance of the work of the EHR SIG and the significance of this work to our SIG’s effort was discussed. The EHR SIG has formally applied to HL7 to become a technical committee.

Andy shared his experience with the Patient Care Committee as a very positive one including helpful guidance on how our SIG needs to proceed.

David and Andy have requested that Cheri be able to serve as administrative chair for our SIG going forward at HL7 technical committee meetings when neither of our co-chairs is available.

Introductions of New Members:

Noorullah Akhtar, MD, Pediatric Intensivist, Driscoll Children’s Hospital, is completing masters in informatics and has special interest in the area of data standards.

Ellen Hansen, RN, BSN, MS is Director, Clinical Informatics, Children’s Healthcare of Atlanta. In her role, she is accountable to develop and oversee the information technology plan including CPOE implementation.

Leslie Sedehi, Associate Director, Systems Development, NACHRI, has extensive experience in systems design and informatics.

New members were welcomed and encouraged to participate at whatever level they feel comfortable. Additionally, they are asked to seek others with expertise that will assist our SIG to achieve our goals.

Formal Meeting Policies:

A copy of Decision-Making Practices Document, Version [1] was distributed for discussion during the January 18, 2004 meeting. There was consensus to use the generic document content and further describe our proxy voting process to ensure members who are unable to attend face-to-face meetings will have the opportunity to provide this critical feedback.

David led the discussion on possible options for SIG members to participate in voting through an approved proxy process including:

Offer option for SIG member to call in during HL7 meeting
Set up electronic voting mechanism
Absentee member tells another participating SIG member who they would like to vote and this representative casts two votes

In discussion, it was reiterated that this voting process applies only to SIG activities and does not relate to the formal HL7 balloting process. The general consensus was, given how new our SIG is, and how collaborative discussion drives our current decision-making, many details that may be pertinent to a full understanding of what is being voted on will not be understood prior to our face-to-face meetings.

Group consensus of those participating on this conference call was to offer the option for SIG members to call in during the HL7 meeting as the issue up for voting is discussed. If the absentee SIG member knows issues or has feedback that he/she would like included, please e-mail this to the two co-chairs or Cheri ahead of time and this will be distributed to all participants.

ACTION:
Group Consensus:

Our SIG proxy voting process will provide an opportunity for the absent SIG member to call in at a designated time to participate in topic discussion as well as cast their vote.

SIG members who will be absent from HL7 meeting are asked to submit their feedback or any issues focused on the topic up for vote prior to the meeting for distribution

A revised copy of the decision-making process document will incorporate this action and will be distributed at the May 3 meeting for final approval by SIG members.

HL7 Project Updates:

Growth Chart (Eileen Sedman)

Eileen has been working with Paul Biondich and Gunther Shadows in this early project stage. There is agreement that we should adopt the CDC Year 2000 data standards for growth charts. This version contains appropriate standards, calculations and supporting information.

Eileen shared that Paul has further developed a standard methodology for growth chart plotting and Regenstrief would be willing to allow our SIG to use this. Growth charts’, using the plotting method, has been fully implemented at Riley Children’s Hospital.

Eileen also clarified that the work thus far incorporates only normal growth charts.

Eileen asked for SIG recommendation on next steps. Andy recommended that the project include writing the story (see EHR SIG site () for a working example of how to frame the growth chart story).

Eileen also raised the issue of the need for a technical expert to help us convert our standardized content to HL7 language. Andy and David have agreed to seek additional guidance in this area from the Patient Care Technical Committee and have asked them to come talk to our SIG during the May meeting.

Prenatal to Perinatal Project (Andy Spooner)

Andy shared that he is in the beginning stages of this project and has learned that there is no standardized prenatal record. He mentioned the Hollister form as the document probably most widely used currently. Andy discussed writing a story about the clinical process and creating a count of the data elements. Possible next steps include looking at the EHR standards and using this functional approach for this project. This follows the EHR concept of standardized definition of the problem list.

Developmental Care Project (Paul Biondich)

Paul was not available to present and this update will be tabled until our next meeting in March.

Structured Documents – WIC (Cheri Throop and Ellen Schwalenstocker)

Cheri presented initial steps including collection of various WIC forms used by children’s hospitals. She learned there is no standardized collection form since state data requirements vary. Request, referral or substitution forms seems to be integrated in many cases.

Cheri is working with Liora Alschuler who has offered to provide our SIG with a pilot template to use for this project. Liora has also outlined critical document use questions for incorporation. Cheri has prepared a draft of the data elements across all the collected documents.

EHR Pediatric Profile (Feliciano Yu)

Feliciano (Pele) described his first draft model based on the work of the HL7 EHR functional requirements currently under review. Using this model, a pediatric information profile is used to identify and enumerate the specific pediatric information requirements applicable to the EHR specification. This profile details what pediatric specific data are needed for the EHR. Pele further outlined the following goals:

Create a model or framework of pediatric information requirements for the EMR (Ontology of pediatric information requirements)
Solicit information from domain experts (clinical, administrative, technical, operations, research, vendors, etc)
Use existing data standards and data sets
Criteria for HL7 pediatric data standard adoption
Scalable information needs.

Within this conceptual model, there are four key components including information requirements, information statements, data elements, and references.

Pele also developed a glossary and outlined steps in developing this pediatric profile including:

Model domains/realms of specificity for pediatrics
Identify information needs in each realm/domain
Identify commonalities of information among domains
Determine functional requirements for delivering specified information
Determine standards for capturing, storing, retrieving, presenting information needs
Determine data requirements for the specific information

Using these concepts, an example of how the electronic health record functional descriptors with pediatric information requirements might look was shared.

In discussion, the need to develop a version useful to the practitioner versus the vendor was identified. SIG participants were very interested in what Pele has developed to this point and will continue to offer their thoughts had suggestions as this project progresses.

Asthma Core Measures – (Cheri Throop/Ellen Schwalenstocker)

Cheri provided a quick overview of activities related to the proposed asthma core measures. The Joint Commission is working on final development of the pilot process anticipated to begin this spring. Once the pilot process has been completed, the refined data elements will be finalized and ready for use nationally. In discussion, it is unclear whether the appropriate HL7 process is messaging. Andy suggested that we work on telling the story and also look for existing messages within the HL7 approved structure that may support these measures.

April 13, 2004 HL7 Education Day (San Antonio)

Cheri confirmed this date is set and agenda has been distributed. Please contact Cheri or fax back the registration form to confirm your participation.

May 3, 2004 HL7 Meeting (San Antonio)

Please register for the upcoming on site SIG meeting (see details below).

Other Business:

Philip Gioia shared that he will be attending the March Public Health Data Standards Consortium and he will provide a summary from this meeting at our May 3 meeting. He will also try to recruit someone from this meeting as a potential SIG member.

The conference call ended at 4:10 PM CST. SIG participants will be notified of March conference call date/time.

May 3, 2004 Meeting Revised Draft Agenda (San Antonio)

Introductions

Review of conference call minutes

SIG revised decision-making process document

Presentation on Balloting process

Action Items for Vote

Outcome of April 13 HL7 Education & Training Day

Pilot Project Updates:

Growth Charts Project - Dr. Aileen Sedman (champion)
Prenatal to Perinatal Care Project - Dr. Andy Spooner (champion)
Developmental Care Project - Dr. Paul Biondich (champion)
Structured documents - WIC certification form - Ellen Schwalenstocker and Cheri Throop (Co-champions)
EHR Pediatric Profile Project – Dr. Feliciano Yu (champion)
Asthma Core Measures – Ellen Schwalenstocker and Cheri Throop

Update on Public Health Data Standards Consortium Meeting – Dr. Philip Gioia

Clinical Decision Support SIG Presentation

Update on Clinical Documents Architecture TC and pilot template – Liora Alschuler

Patient Care Technical Committee Presentation

Vocabulary Process Presentation –Clem McDonald

Update from Netherlands Perinatal Group

Please mark your calendars!

CHCA Sponsored HL7 Education training day scheduled for April 13, 2004. To participate, please contact or (913) 262-1436

May 3 is our next on-site working meeting as part of upcoming HL7 meeting in San Antonio!
HL7 Conference dates: May 2 - 7, 2004
Location: Hyatt Regency San Antonio
Contact: (); Phone number: 210-222-1234; Early Bird Registration & Hotel Cutoffs: April 12, 2004

Pediatric Data Standards Special Interest Group Tracking Log:

ITEM: / Responsible
Party: / Date
Initiated / Date
Closed / Additional Comments:
Finalize education day / Cheri Throop / November 14, 2003 /

CLOSED

2/15 / April 13, 2004 in San Antonio
Recruitment / All SIG members / November 14, 2003 / Formal letter to FDA (David/Andy)
-See 1/19/04 minutes for specialty members still needed.
2/27/04: Efforts to enroll international pediatrician participant underway
Request Liona Altshuler to attend May 5, 2004 meeting / Cheri Throop / January 19, 2004 / 2/27: Liora has agreed to present
Request Clem McDonald to attend May 3, 2004 meeting / Paul Biondich / January 19, 2004
Request Clinical Decision Support SIG presentation at May 3, 2004 meeting / Cheri Throop / December 22, 2003 / 2/27: Request made and DCS S:IG representative plans to attend
Growth Chart Project Update / Aileen Sedman / January 19, 2004 / 2/27: See minutes
Prenatal to Perinatal Care Project / Andy Spooner / January 19, 2004 / 2/27: See minutes
Developmental Care Project / Paul Biondich / January 19, 2004
WIC documentation form project / Cheri Throop
Ellen Schwalenstocker / January 19, 2004 / 2/27: See minutes
Strawman proxy ballot process / Andy Spooner
David Classen / January 19, 2004 / 2/27: See minutes
IOM Electronic Health Record framework –distribution to SIG members / David Classen / January 19, 2004 / CLOSED / 2/9/04: Distributed

Parking Lot Issues:

ISSUE / Date Identified / Date Resolved:
Aileen asked how we prevent redundant work across HL7 groups as well as across national entities / January 19, 2004
Aileen asked for further guidance on what format our SIG projects need to be for delivery to other HL7 groups. / February 27, 2004

HL7 Pediatric Data Standards SIG Advisory Group Members

Andy Spooner, MD, FAAPSIG Co-Chair:

Director of General Pediatrics

University of Tennessee and Le Bonheur Children's Medical Center

50 N. Dunlap, #4624

Memphis, TN 38103

(901) 572-3292

David Classen, MD, MSSIG Co-Chair:

VP, First Consulting Group

561 E. Northmont Way

Salt Lake City, UT 84103

Kay Fendt

2814 Fendt Meadows Drive

Hillsborough, NC 27278

Stephen Lawless, MB, MBA

Chief Knowledge Officer

Nemours

1600 Rockland Road

Wilmington, DE 19803

Carl Weigle, MD

Medical Director, Informatics, Children’s Hospital of Wisconsin

424 Grand Ave

Mukwonago WI 53149

Feliciano Yu, MD, FAAP, CPHIMS

Center for Outcomes and Effectiveness Research and Education (COERE)

University of Alabama at Birmingham

1717 11th Ave. South, MT 401

Birmingham, Al 35294

205-934-6838

Ellen Schwalenstocker, MBA

Director, Child Health Quality
NACHRI
401 Wythe Street
Alexandria, VA 22314
703-797-6045

Cheri Throop, RN, MHSA, RHIT, CPHQSIG Coordinator

VP, Quality & Improvement

CHCA

6803 West 64th Street, Suite 208

Shawnee Mission, KS 66202

(913) 262-1436

(913) 262-1575 (fax)

Noorullah Akhtar, MD

Pediatric Intensivist

Driscoll Children’s Hospital

3323 S. Alameda

Corpus Christi, TX 78411

(361) 694-5445

Ellen Hansen, RN, BSN, MS

Director, Clinical Informatics

Children’s Healthcare of Atlanta

1655 Tullie Circle, NE, Suite B

Atlanta, GA 30329

(404) 785-7155

(404) 785-7157 (fax)

Aileen Sedman, MD

Professor Emeritus University of Michigan Medical School

Medical Advisor, NACHRI

University of Michigan Medical Center

C201 Med Inn Bldg Box 0825

Ann Arbor, MI 48109

(239) 498-0185

Paul Biondich, MD, MS

Assistant Professor of Pediatrics/Informatics

Children’s Health Services Research Program

Riley Hospital for Children/The Regenstrief Institute

1050 Wishard Blvd, RG5

Indianapolis, IN 46202

(317) 630-7785

David Milov, MD

Pediatric Gastroenterology

Clinical Director, EHR

Nemours

1600 Rockland Road

Wilmington, DE 19803

Sharon Lau, MS

Medical Management Planning, Inc. (MMP)

23945 Calabasas Road #100

Calabasas, CA 91302

Warren Williams

Lead Public Health Analyst

Center for Disease Control (CDC)

1600 Clifton Road

Atlanta, GA 30333

Philip Gioia, MD, MPH

Children’s Health Specialists

37 West Garden Street, Suite 201

Auburn, NY 13021

Matthew Scanlon, MD

Patient Safety Officer

Children’s Hospital of Wisconsin

9000 West Wisconsin Ave, Box 1997

Milwaukee, WI 53201

(414) 266-2000

Lesley Sedehi

Associate Director, Systems Development

NACHRI

401 Wythe St, Alexandria, VA 22304

703-797-6025

Harry Rhodes, MBA, RHIA, MPHHL7 Mentor:

Director, HIM Products and Services

AHIMA
233 N. Michigan Ave

Suite 2150

Chicago, IL 60601

HL7 Pediatric Data Standards Special Interest Group (SIG) Meeting Minutes

February 27, 2004 Conference Call Meeting