Sponsoring Agencies

1. Track B: Update on CHIPRA Model Children’s EHR FormatAHRQ 2010 Annual Conference September 28, 20103PM-4:30PM Erin Grace, MPH, AHRQ Project OfficerJessica Kahn, MPH, CMS Project LeadScott Finley, MD, MPH, Principal Investigator, Westat

2. Sponsoring Agencies AHRQ: Erin Grace, MHA, Project Officer Heather Johnson, MS, Junior Service Fellow Jessica Kahn, MPH, CMS Project Lead Leslie Flaherty, HITECH Specialist

3. Project Team Subcontractors: Prime Contractor: Subcontractors:

4. Project Overview Existing EHR systems often do not optimally support the provision of health care to children. The goal is to develop a model EHR Format for children, demonstrate that it can be readily used, and package it in a way that facilitates broad incorporation into EHR systems. The project will: • Develop a framework for the optimal EHR for children • Identify gaps between existing systems and this framework • Design, develop, test, and disseminate the model Format • Assess existing products for conformance with the Format • Demonstrate consumption of the Format

5. Technical Expert Panel (TEP) Provide input and feedback to project overall Review key documents and deliverables Provide guidance on functionalities and requirements Serve as a resource on specific clinical, technical, and child welfare issues

6. TEP Representation Physician Informaticians Children’s health focus More general health focus Non-Physician clinicians Children’s advocacy organizations Medicaid Vendor Office of the National Coordinator for Health IT

7. Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Section 401 (f) Development of Model EHR Format for Children Enrolled in Medicaid or CHIP By 1/1/2010 the Secretary shall establish a program to encourage the development & dissemination of a model EHR Format for children

8. By law, the model EHR Format for children must be:

9. What is a “Format?” Requirements for: A minimum set of data elements Applicable data standards Usability Functionality Interoperability

10. Foundational Work HL7 EHR-S Functional Model R1 HL7 Functional Profile – Child Health HL7 EHR-S Functional Model R2 (in development) NIEM semantic interoperability standards MITA CCHIT certification criteria Inpatient Ambulatory Child Health

11. Scope of the Project - Clinical Incremental functionality for children Appropriate external links Foster Care, Medicaid/MITA, CHIP, School Health, Immunization Registries Family medical record Chronic diseases Specialized Care Settings NICU, Hospice, others Quality Reporting and Improvement

12. Scope of the Project - Technical Appropriate Standards (e.g., HL7, CCR, CCD) National health system efforts (e.g., NIEM, MITA, NHIN, FHA) Formal requirements management tools Metadata, Traceability, Dependencies Support for user-specific views System developers (comprehensive) System developers (single function) System selection and implementation

13. Target Audiences for Format CHIPRA Demonstration grantees Developers of existing EHR products New developers System purchasers Certifying bodies Standards groups Regulators Users/developers of “Meaningful Use” criteria

14. Component Tasks

15. Environmental Scan • Publications (inc. gray literature) • Relevant draft and final standards • Recommendations from professional societies • Product web sites • Niche products • Product prevalence

16. Gap Analysis • Current- and future-state assessment • High level requirements • Supporting information (metadata) • Sources • Reliability • Importance

17. Sources for Gap Analysis • Experienced EHR Users Work Group • Technical Expert Panel (TEP) • Subject Matter Experts (SMEs) • AAP • AAFP • HIMSS EHR-A

18. Format Development • Develop Format Consumption Models • Define the Format Design/Structure • Select the Environment for Format Development • Test and Refine and Format Design/Structure • Capture the Existing HL7 Child Health Functional Profile into the Format • Additional Child Health Requirements • Develop Format for areas in project scope • Articulate areas beyond project scope

19. Conformance Assessment • How well do widely installed products conform to the Format? • Vendor attestation • Product inspection • “Buyer’s Guide”

20. Prototype Development • Three small projects • Demonstrate use/consumption of the Format

21. Dissemination • Presentations • Publications • Public access to the Format • Development of targeted extracts

22. Project Timeline

23. CHIPRA Demonstration Projects Section 401, Model EHR Format provision: “demonstrate the impact of the model EHR format for children developed and disseminated under subsection (f) on improving pediatric health, including the effects of chronic childhood conditions, and pediatric health care quality, as well as reducing health care costs”

24. Evaluating the Model Children’s EHR Format • CMS awarded North Carolina and Pennsylvania funding (CHIPRA Quality Grants) in 2009 to evaluate the impact of the model children’s EHR format • Will evaluate the impact of use of a children’s EHR that most conforms to the format (as determined by WESTAT), looking particularly at children with chronic conditions • 4 year grants, still just in planning phase now

25. Model Children’s EHR Format and Meaningful Use • The goal is that the model format will be integrated into the EHR certification requirements for a future stage of Meaningful Use. • MU definition in future stages to include additional pediatric-relevant objectives and clinical quality measures • ONC EHR certification criteria to follow suit

26. Questions?

27. Contact Information Scott Finley, MD, MPHPrincipal Investigator, Westatscottfinley@westat.com Lois Olinger, MA Project Manager , Westat loisolinger@westat.com Erin Grace, MHA AHRQ Project Officer Erin.grace@AHRQ.hhs.gov Jessica Kahn, MHA CMS Project Lead Jessica.Kahn@CMS.hhs.gov