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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

Neonatal Care Report

Clinical Document Architecture (CDA)Release 2 ∙ Version 3

children s hospitals neonatal consortium chnc

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
chnc mission

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

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)
children s hospitals neonatal database participants

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.

messaging a subset of data

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.)
working group contributors

Neonatal Care Report

Working Group Contributors

Co-Chair/Co-Editor: Robert H. Dolin, MD Semantically Yours,

Co-Chair/Co-Editor: LioraAlschulerAlschuler Associates,

Co-Chair: Calvin Beebe Mayo

Co-Chair: Keith W. Boone GE

Primary Editor: Gay Giannone, MSN RNAlschuler Associates,

Co-Editor: Joy Kuhl, MBA, CPF Principal | Optimal Accords,

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

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

Pediatrics Professor University of Alabama at Birmingham

School of

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

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

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

Co-Editor: Kirk Elrod

CHCA IT Liaison/Business Analyst Children’s Hospitals Corporation of America

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