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Neonatal Care Report. Clinical Document Architecture (CDA) Release 2 ∙ Version 3. Neonatal Care Report. Children’s Hospitals Neonatal Consortium (CHNC). Background & Rationale collaborative of 24 children’s hospital Neonatal ICUs multidisciplinary initiative, started in 2006

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Neonatal Care Report

Clinical Document Architecture (CDA)Release 2 ∙ Version 3

Children s hospitals neonatal consortium chnc l.jpg

Neonatal Care Report

Children’s Hospitals Neonatal Consortium (CHNC)

  • Background & Rationale

  • collaborative of 24 children’s hospital Neonatal ICUs

  • multidisciplinary initiative, started in 2006

  • limited knowledge about best practices & outcomes for the unique population of infants in tertiary NICUs:

  • complex & uncommon neonatal diseases

    • preterm infants with co-morbidities/complications

    • ill term infants requiring emergent intervention

      • e.g., ECMO, surgery, dialysis

  • congenital anomalies

  • genetic & metabolic syndromes

  • typically referred for surgical and other subspecialty care

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    Neonatal Care Report

    CHNC Mission

    • Aims of the Initiative:

    • To evaluate & optimize the tertiary neonatal intensive care provided at children’s hospitals

      • determine variations in care

      • evaluate efficacy of current practices

      • promote safety & facilitate research efforts

      • spearhead benchmarking & quality improvement initiatives

    • ultimately improve clinical outcomes

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    Neonatal Care Report

    Development of Database - CHND

    CHNC Partnership with Child Health Corporation of America (CHCA)

    In 2008, CHNC partnered with CHCA, a business alliance of 43 leading children’s hospitals

    Developed a comprehensive clinical database:

    Children’s Hospitals Neonatal Database (CHND)

    • Establishment of a Core Data Set

    • In 2009, CHNC/CHCA completes specifications for a core data set of about 700 defined data fields

    • Data collection primarily manual abstraction from current systems of clinical documentation (costly)

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    Neonatal Care Report

    Children’s Hospitals Neonatal Database Participants

    • Atlanta

    • Birmingham

    • Boston

    • Chicago

    • Columbus

    • Cincinnati

    • Dallas

    • Detroit

    • Denver

    • Fort Worth

    • Houston

    • Kansas City

    • Little Rock

    • Los Angeles

    • Memphis

    • (Le Bonheur)

    • Oakland

    • Philadelphia

    • Pittsburgh

    • St. Louis

    • San Diego

    • Salt Lake City

    • St. Petersburg

    • Washington, DC

    • Wilmington, DE

    *13 additional CHCA hospitals and 8 non CHCA sites considering future participation.

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    Neonatal Care Report (NCR)

    Employing HL7 standards to facilitate electronic extraction

    • HL7 Clinical Document Architecture (CDA) Release 2

      Selection of Subset of Data Elements for the NCR

    • unambiguous data fields, well established standards

    • present in majority of centers (varied stages of EHR development)

    Messaging a Subset of Data

    • Acuity Scoring

    • severity of illness assessment

    • derived from existing mortality models:

      • Pediatric Risk of Mortality: PRISM-III

      • Pediatric Index of Mortality: PIM-II

      • Clinical Risk Index for Babies: CRIB-II

      • Score for Neonatal Acute Physiology: SNAPPE II

    • Predominantly laboratory and physiologic data

    • Scored at several intervals

      • 1st 12 hours, Day 3, Day 7 of admission

    • Demographic data

    • Name, MRN, Maternal Zip

    • Birth Data

    • Birth weight

    • Gestational Age

    • Apgar scores (1, 5, prolonged)

    • Admission/Discharge Information

    • Dates

    • Measurements (weights, head circ.)

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    Neonatal Care Report

    Working Group Contributors

    Co-Chair/Co-Editor: Robert H. Dolin, MD Semantically Yours, [email protected]

    Co-Chair/Co-Editor: LioraAlschulerAlschuler Associates, [email protected]

    Co-Chair: Calvin Beebe Mayo [email protected]

    Co-Chair: Keith W. Boone GE [email protected]

    Primary Editor: Gay Giannone, MSN RNAlschuler Associates, [email protected]

    Co-Editor: Joy Kuhl, MBA, CPF Principal | Optimal Accords, [email protected]

    Co-Editor: Michael A. Padula, MD Neonatologist, Clinical Informaticist The Children's Hospital of [email protected]

    Co-Editor: Feliciano Yu, M.D. Information Technology Division

    Pediatrics Professor University of Alabama at Birmingham

    School of [email protected]

    Co-Editor: David J. Durand, MD Director, Division of Neonatology Children's Hospital and Research Center [email protected]

    Co-Editor: Karna Murthy, MD Neonatologist, Children's Memorial Hospital Assistant Professor of Pediatrics Northwestern [email protected]

    Co-Editor: Jacqueline Kueser Vice President, Strategy/R&D Children’s Hospitals Corporation of America [email protected]

    Co-Editor: Kirk Elrod

    CHCA IT Liaison/Business Analyst Children’s Hospitals Corporation of America [email protected]

    Current Working Group also includes:

    Kate Conrad, Bobby George,

    Andy Spooner David Muraco,

    Diane Ward Celeste Milton,

    Jean Millar Ann Watt

    Shaun Shakib Sandy Stuart

    Brett MarquardJingdong (JD) Li

    AnnekeGoossen William Goossen

    Teresa Finitzo