HL7 Pediatric Data Standards Special Interest Group Meeting Minutes
July 6, 2004
1:00 – 2:00 CT (11:00 – 12:00 PT; 12:00 – 1:00 MT; 2:00 – 3:00 ET)
Dial in number: 866-365-4406
Passcode: 1436132

Meeting Objective:

Develop workplan to incorporate AAP position paper on electronic health record functional requirements into HL7-approved EHR-S.

Call Participants:

David Classen, MDAndy Spooner, MDKay Fendt

Cheri ThroopFeliciano Yu, MDAileen Sedman, MD

Paul Biondich, MDHema BisaryaSteve Lawless, MD

Carl Weigle, MDWarren WilliamsJoe Schneider, MD

Samuel WaltersNoorullah Akhtar, MD

The meeting was called to order by Andy and David at 1:00 PM Central Time.

Introduction of new members:

Samuel Walters, Associate Information Programs, NACHRI, has joined our SIG.

Agenda Item #1:June 1, 2004 Meeting Minutes

The June 1, 2004 meeting minutes were approved (see

Agenda Item #2: Review of June 1, 2004 Meeting Resolutions

  • HL7 Project Scope submitted to ARB on PDSSIG behalf. Project scope also reviewed by Patient Care TC and EHR TC.
  • Resolution: Paul Biondich will serve as pediatric representative to SNOMED CT.
  • Andy and David will follow up with Kent Spackman and Ed Hammond regarding SNOMED CT.
  • Andy will contact NLM regarding any available funding for pediatric participation in SNOMED CT
  • Andy will discuss our SIG’s work and promote recruitment, publication and funding at September AAP meeting

Paul accepted our SIG recommendation that he represent pediatrics regarding SNOMED CT. A conference call with Kent Spackman is being scheduled. Paul agreed to continue as our liaison to LOINCS as well since he is already engaged in that effort. David and Paul reiterated that the federal government has endorsed additional data standards (e.g. RxNORM) and we need to keep apprised of these activities. This endorsement is based on the recommendation of the IOM Committee on Data Standards for Patient Safety. David recommended SIG members re-review the IOM Committee report (Patient Safety: Achieving A New Standard For Care, 2004 –

AGENDA ITEM #3: NHII Meeting

Four AAP representatives will be attending this meeting including Paul. Andy suggested that a “one-pager” on our SIG be distributed. Andy, David, and Cheri will develop this, send to our SIG members for their feedback and provide to AAP representatives for distribution on or before July 21.

AGENDA ITEM #4: Use of PDSSIG draft logo

Pele designed our logo that has subsequently been sent to the ARB for their approval. The ARB has granted us permission to use this logo for internal documents including our minutes. All external documents and communications that represent HL7 require the HL7 logo.

AGENDA ITEM #5: Possible grant funding for May 2005 meeting

CHCA has had preliminary discussions with AHRQ. Based on grant requirements, CHCA may not be able to be the grant awardee. Conversations have been initiated with AAP to determine if they are interested in being the awardee and contracting the meeting logics to CHCA. Monthly updates will continue. The plan is to request grant funding for 20 PDSSIG participants to attending the May 2005 WGM.

AGENDA ITEM #6: Develop EHR project workplan

Andy initiated discussion of our EHR project goal through discussion and mutual agreement that we will achieve only the functional requirements as our initial step (see diagram). He explained that HL7 is developing a framework “kit” that we may find helpful to proceed through the later stages of work. In using the Version 3 structure, there was discussion on how far our SIG needs to take our work through this process or do we enlist outside assistance at some point. This remains a “parking lot” issue as we proceed to identify the pediatric functional requirements. David C. stressed the critical importance of identifying and communicating gaps, as they are uncovered in this initial work phase. Paul reiterated that the functionality would naturally flow into storyboard and ultimately as logic for IT systems. Kay stressed that the standards work continues nationally at its own pace and is not driven by the HL7 process, thus we need to continue to be aware of these parallel courses. Joe also identified the critical importance of the CCR work including current harmonization efforts with HL7 EHER but that this process also was not being driven by HL7.

Pele has started mapping the AAP functional requirements to the EHR model. Through this process, he identified issues regarding separating inpatient and outpatient care. In group discussion, there was consensus to eliminate any separation but rather concentrate on pediatric functional requirements across the care continuum.

There was considerable discussion on how to incorporate pediatric specificity into the current EHR model particularly how to parcel the work between and among SIG members. Kay recommended that we add a column titled “special populations” that could be used by our SIG but also by other specialty groups as they form to work on functional requirements.

ASSIGNMENTS:

Cheri will combine the EHR model and Pele’s mapping into one working document including the addition of the “special populations” column (Pediatrics) and also an area to identify gaps (David C’s recommendation). This document will be sent electronically to all members the week of July 12.

Our charge is to map the AAP recommended functional requirements and our January 19 PDSSIG WGM brainstorm recommendations. The following have been assigned lead accountability by EHR section:

  • DIRECT CARE (DC1) assigned to Aileen
  • DIRECT CARE (DC2 and DC3) assigned to Steve
  • SUPPORTIVE CARE assigned to Pele
  • INFORMATION INFRASTRUCTURE assigned to Andy and Kay
  • OVERVIEW OF DECISION SUPPORT/VOCABULARY NEEDS assigned to Paul

All PDSSIG members will be asked to sign up to assist in any of these areas. (See AAP functional requirements and January 19 WGM brainstorm summary below for your reference).

TARGET: Send your initial drafts to Cheri on or before July 30 ahead of the August 3 conference call.

From our June 1, 2004 conference call.

David C. stressed that we will need to share any functional gaps with the EMR TC as they surface.

Tracking Log Issues:

Recruitment of international representatives continues with no success to date. There may be additional opportunities to recruit ahead of and during the May 2005 international meeting.

Other Issues:

  • Final version of the HL7 approved HL7 EHR (with ballot revisions) will be available to our SIG for use in our PIR-EHR project (working document received July 6)

Next conference call:August 3, 2004 at 1:00 – 2:00 Central Time (same dial-in and passcode)

Please e-mail any documents you would like distributed to . Thank you!

Please mark your calendars! OUR PDSSIG MEETS ALL DAY SEPTEMBER 29
September 26 — October 1, 2004
18th Plenary & Annual Working Group Meeting
Location: Sheraton Atlanta Hotel
165 Courtland Street
Atlanta, GA 30303
Hotel Phone: 404 659 6500
Rate is $159 per night
Contact: ()
Phone number: 800-833-8624
Early Bird Registration & Hotel Cutoffs: August 25, 2004

Candidate functions derived from American Academy of Pediatrics: Task Force on Medical Informatics: Special requirements for electronic medical record systems in pediatrics, Pediatrics. 2001 Aug;108(2):513-5.

Each of these should find a home within the HL7 EHR-S specification; each bears explanation, in accordance with the format of the HL7 EHR-S specification.

Once all these functions (and new ones from other sources) have been incorporated into the EHR-S specification, the resulting modifications of the EHR-S spec will be a pediatric profile of the EHR-S spec.

Functions that I have added as being very closely related to the AAP document but are not actually in the document are enclosed in square brackets.

Growth data: Recording

Growth data: Graphic display

Growth data: Special calculations

Growth data: Percentiles

Growth data: Comparison with norms

Growth data: BMI and comparison with norms

Growth data: Ethnic differences in norms

Growth data: Geographic differences in norms

Growth data: Head circumference

Growth data: Sufficient granularity

Patient identifier: Prenatal

Patient identifier: Neonatal

Patient identifier: Linking from prenatal to natal

Patient identifier: Linking from natal to infant

Special terminology: Representation of pediatric concepts

Age-based normal ranges: Vital signs

[Age/height-based normal ranges: Blood pressure]

Age-based normal ranges: Laboratory values

Age-based normal ranges: Altering lab normal ranges for special circumstances

Time of birth

Prescribing: Weight basis

Prescribing: BSA basis

[Prescribing: Practical rounding algorithms]

Immunizations: Efficient input

Immunizations: Display

Immunizations: Decision Support

Immunizations: Flexibility with changing guidelines

Immunizations: Communication with registries

Immunizations: Reports in multiple formats

Immunizations: Reminders to parents

Immunizations: Reminders to physicians

Parents’ documentation: Parental appendices to chart

Parents’ documentation: Information about special needs children

Reporting: School health forms

Reporting: Camp health forms

Reporting: School nurse communications

Privacy: Adolescent: Variation of access privileges based on state laws and clinical topic

Privacy: Adolescent: Variation of access privileges based on practice policies

Privacy: Genetic information

Privacy: Flexibility in designating identity of guardian

Privacy: Adoption

Privacy: Foster care

Privacy: Foster care: Social service reporting

Privacy: Abuse and neglect

Privacy: Flexibility in designating the identity of those bearing financial responsibility

[Privacy: Segregation of clinical data from those bearing financial responsibility]

Work settings: accommodation of noise for voice recognition

Work settings: [nonspecific other requirements]

Family member links from record to record

Registry linkages: Metabolic screening

[Registry linkages: other public health registries, like lead poisoning]

FROM OUR JANUARY 19, 2004 HL7 WGM MINUTES:

Group Brainstorming:

Through HL7 discussions and presentations, it was stressed that our SIG’s key accountability is to work on content standards and building a pediatric-specific vocabulary. Andy led us through some initial discussions based on a recent publication he co-authored with Dr. Shiffman as a possible organizing template. This document outlined the minimum pediatric functional requirements of electronic medical record based on their research:

Data Representation:

  • Growth data
  • Patient Identifier
  • Special terminology (clinical phenomena i.e. excessive crying)
  • Age based normals (“age adjusted” Alkaline phosphatase as an example)
  • Time of birth

Data Processing:

  • Prescribing of medications
  • Immunizations
  • Parents – special documentation requirements (camp forms; school permission to give medications; privacy and confidentiality issues with consents)

System Design:

  • Privacy issues (adolescent “teenage confidentiality”)
  • Adoption
  • Guardian status
  • Financial responsibility
  • Genetic information
  • Family Member links
  • Registry linkages

From this discussion, the following key areas were identified:

  • Growth data (Content; Communication; Representation)
  • Patient Identifier
  • Age based normals (“age adjusted” Alkaline phosphatase as an example)
  • Time of Birth
  • Communication with schools
  • Developmental screening (hearing; lead)
  • Developmental assessment (testing)
  • Site-specific domains
  • Dental information
  • Prescribing medications
  • Immunizations
  • Parents special documentation (consents; camp forms)
  • Privacy issues (i.e. teenage confidentiality)
  • Adoption
  • Guardian status
  • Financial responsibility
  • Genetic information
  • Family member links (i.e. sibling history)
  • Medical Home (proactive systematic and coordinated care supporting children with special healthcare needs)
  • Prenatal care
  • Sexual development
  • Mental Health
  • Developmental findings
  • Anticipatory guidance
  • Child Abuse/Sexual abuse
  • Nutrition
  • Special Services

Group Prioritization (Multi-voting) Results:

Area / Multi-Vote
(Each participant selected top 6 choices) / Final Multi-Vote
(Each participant selected top three choices)
Growth data (Content; Communication; Representation) / 10 / 6
Patient Identifier / 1
Age based normals / 3
Time of Birth / 3
Communications with schools / 1
Developmental screening/testing/findings / 8 / 6
Site-specific domains (inpatient; outpatient, etc) / 3
Dental information / 0
Prescribing medications / 4 / 3
Immunizations / 2
Parents special documentation/special consents / 3
Privacy issues / 1
Adoption / 1
Guardian status / 0
Financial responsibility / 0
Genetic information / 5 / 1
Family member links / 5 / 0
Medical home / 1
Prenatal care / 7 / 6
Sexual development / 0
Anticipatory guidance (i.e. counseling) / 3
Child abuse/sexual abuse / 0
Nutrition / 1
Special Services / 0 / Selected as CDA pilot

Based on this prioritization process, the following three tied as our initial projects:

Developmental Screening (vocabulary)

Pre-natal Care (HL 7 V3)

Growth Charts (data modeling)

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
3/31: Andy/Cheri develop draft brochure
5/3: Recruitment continues; need for international representation.
Request Liora Alshuler to attend May 3, 2004 meeting / Cheri Throop / January 19, 2004 / CLOSED
5/3/04 / 2/27: Liora has agreed to present
4/20/04: Follow up with Liora
Request Clem McDonald to attend May 3, 2004 meeting / Paul Biondich / January 19, 2004 / CLOSED
5/3/04 / 4/20/04: Communication to Paul regarding Clem’s availability.
4/25/04: Paul contacted Stan Huff who will be presenting at our meeting.
Request Clinical Decision Support SIG presentation at May 3, 2004 meeting / Cheri Throop / December 22, 2003 / CLOSED
4/21/04 / 2/27: Request made and DCS S:IG representative plans to attend
4/21: Matt Sailor to present
Growth Chart Project Update / Aileen Sedman / January 19, 2004 / 2/27: See minutes
4/13: Update at education day
5/3: Update at WGM
5/3/04: integrate in to PIR-EHR
Prenatal to Perinatal Care Project / Andy Spooner / January 19, 2004 / 2/27: See minutes
4/13: Update at education day
5/3: Update at WGM
5/3/04: integrate in to PIR-EHR
Developmental Care Project / Paul Biondich / January 19, 2004 / 4/13: Update provided for education day
5/3: Update provided for WGM
5/3/04: integrate in to PIR-EHR
WIC documentation form project / Cheri Throop
Ellen Schwalenstocker / January 19, 2004 / 2/27: See minutes
3/31: Hema Bisarya will assist with this project.
4/13: Update at education day
5/3: Update at WGM
5/3/04: integrate in to PIR-EHR
Pediatric Electronic Health Record Project / Feliciano Yu / February 27, 2004 / 3/31: David Milov will assist wit this project.
4/13: Update provided for education day
4/13: Noorullah Akhtar will assist with this project
5/3: Update at WGM
5/3/04: integrate in to PIR-EHR
Asthma Core Measures / Cheri Throop
Ellen Schwalenstocker / January 19, 2004 / 2/27: see minutes
3/31: Hema Bisarya will assist with this project.
4/13: Update at education day
5/3: Update at WGM
5/3/04: integrate in to PIR-EHR
Strawman proxy ballot process / Andy Spooner
David Classen / January 19, 2004 / CLOSED 5/3/04 / 2/27: See minutes
3/31: Draft document will be sent to SIG members prior to May meeting
4/26: PDSSIG Decision Making document to SIG members for approval
5/3: Agenda item for WGM
IOM Electronic Health Record framework –distribution to SIG members / David Classen / January 19, 2004 / CLOSED2/9/04 / 2/9/04: Distributed
Invite Helga Ripen to PDSSIG conference call / Cheri Throop / May 3, 2004 / 5/3/04: member of NHII group
Form PDSSIG Vocabularies subgroup (Paul Biondich; Clem McDonald; Stan Huff) / Andy Spooner / May 3, 2004 / 5/3/04: See minutes
Recruit and recommend pediatric representation on SNOMED CT working group (Kent Spackman)
  • Funding for representative
/ Andy Spooner/David Classen / May 3, 2004
June 1, 2004 / CLOSED6/1/04
OPEN / 5/3/04: See minutes
6/1/04: See minutes. Paul Biondich is willing to serve in this role.
6/1/04: SIG Co-chairs to work on this issue.
Conference call with Kent Spackman (SNOMED CT)
Discussion with Ed Hammond: Coordination efforts – our SIG and SNOMED CT
Funding inquiries: NLM and AAP / Andy Spooner/David Classen
David Classen
Andy Spooner / June 1, 2004 / OPENCLOSED
OPEN / Pediatric Representation
David had conversation with Ed Hammond on June 29 2004. He advised that we proceed with conference call as planned.
PDSSIG “one-pager” as communication tool / Andy Spooner/David Classen/ Cheri Throop / July 6, 2004 / (Due July 21 for upcoming AAP and NHII meeting)

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
Aileen asked how HL7 work is kept up to date. / May 3, 2004
PDSSIG Logo model under review by HL7 for their approval / May 18, 2004 / July 6, 2004

1

HL7 Pediatric Data Standards Special Interest Group Meeting Minutes

July 6, 2004