I Would Like to Tell You About the PHDSC (Public Health Data Standards Consortium) Meeting

HL7 Pediatric Data Standards Special Interest Group (PDSSIG) Meeting

May 3, 2004

09:00 – 17:00

Hyatt Regency, San Antonio

Attendees:Guests:

David Classen, MDHenry Shapiro, MD (*)

Andy Spooner, MDDan Russler (PCTC)

Kay FendtStan Huff (Vocabularies TC)

Carl Weigle, MDJudith Warren (PCTC)

Noorullah Akhtar, MDKay Avant (PCTC)

Cheri ThroopKent Spackman (PCTC)

Feliciano Yu, MDMatt Sailor (Clinical Decision Support TC)

David Milov, MD

Aileen Sedman, MD

Lesley Sedehi

Paul Biondich, MD (*)

Hema Bisarya

Lorna Dyk

(*) = Via conference call from 09:30 – 10:30 AM.

Andy, serving as presiding co-chair, called the meeting to order at 09:00. During general introductions, Lorna Dyk was welcomed as our new member representing nursing interests. Lorna is Director, Resource Management Services, The Children’s Hospital, Denver. She has a very strong clinical nursing and informatics background in a variety of hospital settings.

AGENDA ITEM: Approval of PDSSIG Decision-Making Process

Highlights of this document, shared with PDDSIG members prior to this meeting, were reviewed including content reflecting prior meeting decisions (see February 27, 2004 meeting minutes):

Page 1: monthly conference calls

Page 5: Eliminate from Absentee voting “when a proxy is not available to represent a participant during working group meetings”

ACTION:

Motion, seconded, and approved

PDSSIG Decision-Making Process document, with the above revisions is approved.

AGENDA ITEM: Summary Update from PHDSC meeting (see tracking log)

Andy shared the following e-mail summary report from Phillip Gioia regarding the recent PHDSC (Public Health Data Standards Consortium) Meeting in Bethesda, MD on March 17 & 18 and the MSSNY (Medical Society of the State of NY) Meeting at Rye, NY on April 16&17:

“At the PHDSC Meeting Helga Ripen, MD, PhD now at the NHII (National Health Information Infrastructure) group with the National Committee for Vital and Health Statistics (NCVHS) discussed the plans for the NHII. The NHII plans to have LHIIs (Local Health Information Infrastructures) that will be linked together as needed for patient care and public health evaluations and interventions only as needed. The NHII would set the standards and code definitions for the LHII, the infrastructure for linking. A NHII study yet to be published estimates that the NHII would save health care payers $40 billion annually through efficiency, decreased duplications of work, and improved patient outcomes. The NHII would like payers to recognize this and pay health care providers for using Electronic Health Record Systems (EHRS). In Maine the Blue Cross Blue Shield Corporation pays providers $5,000 per year per provider to use an EHRS. This has helped to get more providers to use an EHRS.

At the PHSDC Meeting the NLM (National Library of Medicine), NIST (National Institute of Strategic Technology), the CDC (Centers for Disease Control), AHRQ (Agency for Health Research and Quality) and others reported how they now support PHDSs and their future development. They have some resources and grants to help but for major and continuing funding health payer support is definitely needed.

At the PHSDC most perinatal providers recognize the importance of linking and integrating public data systems for patient care and public health, but little has been done so far. The NHII and its LHII may work on this in the future.

At MSSNY the House of Delegates (HOD) voted to work to develop an Electronic Prescription System (EPS) in NY State. MSSNY hopes to work with the existing prescription systems used by insurance companies, Pharmacy Benefits Management Plans (PBMP), Medicaid, pharmacies and NY State Department of Health (NYS DOH) to improve the efficiency and safety of out patient or ambulatory care prescriptions. MSSNY hopes to network with payers, pharmacies, other providers, and NYS DOH. MSSNY might seek funding from AHRQ, CMS and/or NIST to help start the process. The physicians seemed to be motivated by the inevitability of such systems and the need for physician involvement. MSSNY and most physicians feel such a system should be voluntary with a gradual staged implementation to prevent electronic errors and increased stress for providers.”

ACTION:

Everyone agreed further conversation with Helga Ripen would be beneficial. Co-Chairs will invite her to join us on an upcoming conference call.

AGENDA ITEM: Developmental Screening Project Update (via conference call)

Henry Shapiro and Paul Biondich joined our meeting via conference call to discuss other national efforts focused on standardized information sharing for pediatric developmental screening. Henry is working on a national project, funded through Commonwealth Fund, to create a web-based developmental screening tool for use in primary care settings. This project, Bright Futures, has focused on how to produce information that can be widely used through standardization. The desire to use an official framework, such as HL7 is of critical interest. The audience for this web-based tool will include not only clinicians but also consumers.

Paul discussed the importance of integrating this work with the electronic health record functional specifications. Everyone agreed it would be most beneficial to advance the Bright Futures project work through the PDSSIG. Paul has also initiated discussion regarding our SIG to the Informatics Special Interest Group of the AAP Ambulatory Care Section.

Andy described an integrated triad described as the harmonization of efforts focused on developmental screening by the AAP, our HL7 project, and the Society for Developmental and Pediatric Requirements. In discussion, further emphasis was placed on recognizing the importance of standardized developmental screens as an addition to the functional requirements within the pediatric-specific electronic health record framework.

ACTION:

There was general consensus to incorporate developmental screening into electronic health records functional specifications with the guidance of both Paul Biondich and Henry Shapiro.

AGENDA ITEM: Orientation to Vocabularies TC and Update

Stan Huff oriented our SIG to the common vocabularies available including LOINC and SNOMED CT. Available through the National Library of Medicine (NLM) Congress, the UMLS Thesaurus contains ICD-9 and 10, LOINC and SNOMED CT on a browser to look up specific standardized vocabulary codes. Stan advised that when our group identifies gaps in pediatric-specific content, we should recommend needed codes are added to LOIINC or SNOMED CT. The Vocabularies Committee wants our submissions when we find gaps.

Kent Spackman spoke briefly on SNOMED CT and the need to add pediatric representation to the SNOMED Working Group.

Additional discussion initiated during the conference call and from both Stan and Kent’s presentations centered on how to effectively address the inherent gap in appropriate pediatric-specific vocabulary that will continue to surface as our group advances our multiple projects. Eileen suggested that we standardize our vocabulary needs requests to coordinate efforts and create a “community of practice” to identify appropriate vocabulary sources and make recommendations to national organizations when gaps are identified.

ACTIONS:

1. Paul Biondich, Clem McDonald, and Stan Huff will serve as the PDSSIG subgroup to address vocabulary needs and make recommendations to national organizations, on our behalf, when gaps are identified.

2. All gaps will be communicated to the Vocabularies TC.

3. Recruit and recommendation pediatric representation on SNOMED CT Working Group.

AGENDA ITEM: Orientation to Patient Care TC and Update

Dan Russler explained our SIG’s relationship to the parent TC. He asked specifically what our SIG wants to accomplish. When our SIG develops standards that need to be maintained, we are beginning to move toward the scope of a technical committee. There was general consensus, that as domain experts, we will be creating standards. Dan stressed that joint meetings with the PCTC should focus on creating artifacts to go for balloting. As domain experts, our SIG needs to become oriented to the creating storyboards and glossaries. We can use experts from the Modeling and Methodology TC to support our technical information needs.

Dan outlined a description of the major requirements (artifacts) for our orientation indicating that these need to be completed for HL7 compatibility.

Artifact:STORYBOARD (captures decisions that mare made)

Contains multiple use cases

Artifact:GLOSSARY (definitions of all single words)

Mapping to a particular vocabulary

Artifact:ACTIVITY DIAGRAM (UML)

Titles of flow diagram that link back to Glossary

Artifact:STORYBOARD INFORMATION MODEL

Can you combine Glossary and information model to represent the Storyboard?

Instance Diagrams

Finish the four artifacts:

ASK: How much is already available?

NEXT: HL7 Applications (RIM)

Can you match HL7 Instance Diagram?

NEXT: Domain Message Information Model (DMIM)

PRODUCTS:

Decide what we want to produce? ---descriptive of what type of data should be included in pediatric record.

During our discussion with Dan and other representatives of the PCTC, general consensus was reached that our SIG wants to pursue the electronic health record pediatric-speciic functional requirements for HL7.

ACTION:

The PDSSIG will focus their activites on defining electronic health record pediatric-specific for HL7 functional requirements.

AGENDA ITEM: Orientation to Clinical Decision Support and Arden Syntax Committees with Update

Matt Sailors, co-chair of the Clinical Decision Support and Arden Syntax committees provided a broad overview of both committees’ work products and how all SIGs and TC interact with these committees. He described Arden Syntax as framed-based knowledge system and the “step child” of Pascal. Other work products discussed included:

• GELLO: Guideline expression language using object constraint language (OCL). GELLO has just gone to ballot and going through revisions based on responses.
• INFO BUTTON: This is a point-of-care query that creates a simple gateway for multiple applications.
• VIRTUAL MEDICAL RECORDS: This is a simplification of the RIM and a decision support system that can be dropped into any system (rules system).

Matt also discussed the history of Arden Syntax and that version 2.5 will go to ballot this summer.

AGENDA ITEM: Pediatric Information Requirements – Electronic Health Record Project Update

Feliciano (Pele) guided the SIG through discussion of the PIR-EHR Project based on the IOM recommended framework and recently approved HL7 EHR model.

Purpose of PIR-EHR:

• Explicit representation of pediatric specific information necessary to provide quality care
• Methods for provider and vendor input
• Human and computer readable
• Wish list of information to guide pediatric data standard development

Goals of PIR-EHER:

• Create a model or framework of pediatric information requirements for the EHR
• Facilitate the knowledge acquisition from domain experts (clinical, administrative, technical, operational, research, vendors, etc)
• Permits the use of existing data standards and data sets
• Serves as criteria for HL7 pediatric data standard adoption
• Formatted to allow scalability of informational needs

Following this overview, the PDSSIG decided to set the following project target:

ACTION:

The PIR-EHR Profile will be ready for ballot in one year (By May 1,2005).

The scope of this project will include all pediatric care settings. We plan to mirror the newly approved electronic health record requirements to identify pediatric profile. We will work with other HL7 groups to accomplish this goal. We have decided to place our other PDSSIG projects on hold until this initial focus has been achieved.

AGENDA ITEM: Next Conference Calls

Tuesday, June 1 at 1:00 CT (11:00 PT; 12:00 MT; 2:00 ET)

Tuesday, July 6 at 1:00 CT (11:00 PT; 12:00 MT; 2:00 ET)

Tuesday, August 3 at 1:00 CT (11:00 PT; 12:00 MT; 2:00 ET)

DIAL IN NUMBER: 866-365-4406 PASSCODE: 1436132

AGENDA ITEM: September WGM Tentative Agenda

Election of Administrative Co-Chair

• Discussion/Approval of all conference call action items
• Progress/Working session on draft PIR-EHR
• Overview of Balloting process
• EHR SIG joint session
• Patient Care TC joint session

Diagram Designed by Andy Spooner (for further discussion)

Pediatric Data Standards Special Interest Group Tracking Log:

CLOSED

Parking Lot Issues:

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, MD, 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/Acting Administrative Co-Chair

VP, Quality & Improvement

CHCA

6803 West 64th Street, Suite 208

Shawnee Mission, KS 66202

(913) 262-1436

(913) 262-1575 (fax)

Hema Bisarya, RD, MHSA

PI Project Manager

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

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

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

Lorna Dyk, RN, MBA

Director, Resource Management Services

The Children’s Hospital

1056 East 19th Avenue

Denver, CO 80218

(303) 864-5834

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 (PDSSIG)

Vision