Reconciling the pediatric requirements with the EHR model May 2006 Pediatric Data Standards SIG Functional Requirements Review

Pe

D S SIG

Reconciling the pediatric requirements with the EHR model May 2006

Pediatric Data Standards SIG

Functional Requirements Review

Pe

D S SIG


V10 Document Statements

Each slide's title is the general area of functionality Bullets represent:

the current wording of the function statement the closest matching conformance criterion from the

November 2005 EHR TC document whether the above two represent a "match," and an arbitrary ID number to reference an internal database

Next steps: Work groups/individuals review categories based on

assignments and suggest edits; Review suggested edits together through a series of webcasts to be scheduled soon

Pe

D S SIG


Four Sets of Conformance Criteria

INCLUDED (74 CCs): Our CC are easily found in the DSTU: INCLUDED.ppt

NOT INCLUDED (47 CCs): Can’t find anything like our CC in the DSTU: NOT INCLUDED.ppt

ALMOST INCLUDED (32 CCs): Something close to our CC is in the DSTU: ALMOST INCLUDED.ppt

GRAY AREA (19 CCs): The SIG needs to decide what it means, exactly: GRAY AREA.ppt

Pe

D S SIG


32 Categories to Assign

Age Representation Allergies (Miller, Omlor, Yu) Archiving Communications Consent Custody (Weigle) Decision Support (Akhtar, Del Beccaro,

Warren) E-prescribing and Ordering (Yu, Del

Beccaro) Epidemiology Family Linkage (Murray) Gender (Murray) Gestational Age (Murray) Growth (Sedman, Weigle) Guardianship Immunizations (Yu, Akhtar) Interface

Lab Results (Rocca) Medical Home (Schneider, Sedman,

Warren) Miscellaneous Norms Parental Data Entry (Schneider) Patient Identification (Miller, Underwood) Pedigree (Schneider) Preferences Prenatal Privacy Registries Reports Research (Miller) Telehealth (Akhtar, Rocca) Terminology (Underwood, Rocca) Vocabulary (Underwood, Rocca) Suggested New Category: RHIO

(Schneider)

Pe

D S SIG


V10 Document Statements

Each slide's title is the general area of functionality Bullets represent:

the current wording of the function statement the closest matching conformance criterion from the

November 2005 EHR TC document whether the above two represent a "match," and an arbitrary ID number to reference an internal database

Possible next steps: Work groups/individuals review and suggest edits; Review

suggested edits together through a series of webcasts

Pe

D S SIG


Allow recording of post conceptional age and distinguish it from post-natal age

Closest conformance criterion: N/A… DC.1.2 (Manage patient demographics) comes closest ([no CC contains this specific concept]).

NOT INCLUDED, noncontroversial

Reference number: 2

Age Representation

Pe

D S SIG


Allow recording of the exact time of birth down to the minute

Closest conformance criterion: N/A… DC.1.2 (Manage patient demographics) comes closest ([no CC contains this specific concept]).


Reference number: 3

Age Representation

Pe

D S SIG


Display age with the appropriate units, based on the child's age (for example, infants who are four days old should have their age displayed in days, as opposed two weeks or months)

Closest conformance criterion: N/A… DC.1.2 (Manage patient demographics) comes closest (N/A).


Reference number: 4

Age Representation

Pe

D S SIG


[Allergies] could include items such as foods or environmental agents.

Closest conformance criterion: DC.1.3.2 #1 (The system SHALL capture true allergy, intolerance, and adverse reaction to drug, dietary or environmental triggers as unique, discrete entries.).

INCLUDED, noncontroversial

Reference number: 5

Allergies

Pe

D S SIG


Allow the classification of reactions into allergic reactions, side effects, and intolerances

Closest conformance criterion: DC.1.3.2 #1 (The system SHALL capture true allergy, intolerance, and adverse reaction to drug, dietary or environmental triggers as unique, discrete entries.).


Reference number: 6

Allergies

Pe

D S SIG


List food allergies and medication allergies separately

Closest conformance criterion: DC.1.3.2 #1 (The system SHALL capture true allergy, intolerance, and adverse reaction to drug, dietary or environmental triggers as unique, discrete entries. Do we really want to ask for this? What do we really mean by separate?).

Possibly included, controversial

Reference number: 7

Allergies

Pe

D S SIG


The user determines what defines an allergy or adverse reaction

Closest conformance criterion: DC.1.3.2 #4 (The system SHOULD provide the ability to capture the reaction type).


Reference number: 8

Allergies

Pe

D S SIG


Store data until the statutorily designated time

Closest conformance criterion: I.1.2.1 #1 (The system SHALL provide for the storage and retrieval of health record data and clinical documents for legally proscribed (sic) time. ).


Reference number: 9

Archiving

Pe

D S SIG


The user may indicate who they are sending results to and the system will track this

Closest conformance criterion: DC.1.10.1 #8 (The system MAY route results to patients by methods such as phone, fax, electronically or in the form of a letter).


Reference number: 10

Communications

Pe

D S SIG


In cases where advanced directives are managed by the system, provide forms appropriate to both patients and guardians where the patient is below the legal age of consent

Closest conformance criterion: DC.1.11.2 (The system MAY be able to indicate that the patient’s personal representative (guardian/surrogate) has completed advanced directive(s) on their behalf. ).



Consent

Pe

D S SIG


Allow recording of both consent and assent to treatment

Closest conformance criterion: DC.1.11.3 #7 (EHR systems SHOULD allow documentation of an assent as appropriate for patients legally unable to consent. ).



Consent

Pe

D S SIG


In cases where consent forms are managed by the system, allow adolescent patients to participate as if they were adults under appropriate conditions

Closest conformance criterion: DC.1.11.3: Manage consents and authorizations ((Does not explicitly mention this function)).

NEEDS NEW CC IN THIS FUNCTION


Consent

Pe

D S SIG


Identify a child who has been removed from a home

Closest conformance criterion: N/A ((This would simply be an item in the child's history, e.g. Social Hx)).

VOCABULARY ISSUE: …


Custody

Pe

D S SIG


Indicate when a child is in foster care




Custody

Pe

D S SIG


Indicate when a child is under ongoing investigation for abuse or neglect




Custody

Pe

D S SIG


Indicate when the child has been adopted




Custody

Pe

D S SIG


Provide patient identification mechanisms that can withstand changes in family structure, such as loss of a child from the family in a custody decision

Closest conformance criterion: N/A ((I am pretty sure this needs some significant clarification)).



Custody

Pe

D S SIG


Provide patient identification mechanisms that can withstand changes in family structure, such as removal of the child from the home

Closest conformance criterion: N/A ((I am pretty sure this needs some significant clarification)).



Custody

Pe

D S SIG


Provide authentication procedures for adults who claim to be parents or guardians of a child, in cases where the child is under investigation four abuse and neglect

Closest conformance criterion: Needs more detail… hard to put this one into a conformance criterion (Perhaps this one could be achieved merely by supporting some kind of alerting mechanism for kids whose custody is not straightforward).



Custody

Pe

D S SIG


Incorporate age, weight, and disease criteria into alerts related to laboratory results

Closest conformance criterion: DC.1.10.1 #11 (The system MAY trigger decision support algorithms from [test] results. ).



Decision Support

Pe

D S SIG


Integrate patient and family preferences into clinical decision support

Closest conformance criterion: DC.1.11.1 #3 (The system SHOULD integrate patient and family preferedecision support systems).



Decision Support

Pe

D S SIG


Link care processes to the problem list

Closest conformance criterion: DC.1.5 #9 (The system MAY associate encounters, orders, medications, notes with one or more problems.).



Decision Support

Pe

D S SIG


Link lab values to problem list




Decision Support

Pe

D S SIG


Link medical imaging to items all on the problem list




Decision Support

Pe

D S SIG


Link orders to problems [in problem lists]




Decision Support

Pe

D S SIG


Provide problem lists link to medical orders, lab, medical imaging, disease specific guidelines, or care processes including rationale for care.




Decision Support

Pe

D S SIG


Provide decision support for special immunizations such as palivizumab

Closest conformance criterion: DC.1.6.1 #1 (The system SHALL support presentation of guidelines and protocols to clinicians).



Decision Support

Pe

D S SIG


Indicate in the case of decision support function whether the function applies to the pediatric population

Closest conformance criterion: DC.1.6.1 #1, 3, 4, 5 (assuming decision support = guidelines) ((Comes close)).



Decision Support

Pe

D S SIG


Link disease specific guidelines to the problem list

Closest conformance criterion: DC.1.6.1 #4 (The system SHALL present guidelines and protocols appropriate for the patient’s problem list. ).



Decision Support

Pe

D S SIG


Apply patient age to all decision support functions

Closest conformance criterion: DC.1.6.1 #5 (The system SHALL support context-sensitive care plans, guidelines and protocols (function DC.2.2.1.2) ).

INCLUDED if we make minor mods in a CC


Decision Support

Pe

D S SIG


Facilitate selection of guidelines based on patient age

Closest conformance criterion: DC.1.6.1 #5 (The system SHALL support context-sensitive care plans, guidelines and protocols (function DC.2.2.1.2) (provided "context" = "age")).



Decision Support

Pe

D S SIG


Indicate the source of any applicable guidelines or decision support rules

Closest conformance criterion: DC.1.6.2 #4 (The system SHOULD allow tracking of updates to care plans by: authors, creation date, version history, references, local sources, non-local sources).



Decision Support

Pe

D S SIG


Allow for disease specific health maintenance schedules with accompanying decision support

Closest conformance criterion: DC.2.1.1 #2 (The system SHALL enable access to standards and practices related to age, gender, normal growth and development and medical conditions [this assumes that "assessments" refers to forms for data collection]).



Decision Support

Pe

D S SIG


In cases where forms vary with age, select forms to be presented based on age.




Decision Support

Pe

D S SIG


Modify displays based on age




Decision Support

Pe

D S SIG


Modify displays based on gestational age at birth

Closest conformance criterion: DC.2.1.1 #2 (The system SHALL enable access to standards and practices related to age, gender, normal growth and development and medical conditions [this assumes that "assessments" refers to forms for data collection] [assumes gestational age could be treated as a "medical condition," which is reasonable]).



Decision Support

Pe

D S SIG


Remind users of anticipatory guidance topics based on age

Closest conformance criterion: DC.2.2.1.2 #1 (assuming that "anticipatory guidance topics" can be considered a "care plan") (The system SHALL support access to resources for care plans that are context sensitive to patient specific data and assessment, and are appropriate to the age, gender, developmental stage and medical condition of the patient (DC 1.3.1, DC 1.4, DC 1.5, DC 1.6)).



Decision Support

Pe

D S SIG


Remind users of anticipatory guidance topics based on risk factors

Closest conformance criterion: DC.2.2.1.2 #1 (assuming that "anticipatory guidance topics" can be considered a "care plan") (The system SHALL support access to resources for care plans that are context sensitive to patient specific data and assessment, and are appropriate to the age, gender, developmental stage and medical condition of the patient (DC 1.3.1, DC 1.4, DC 1.5, DC 1.6)).



Decision Support

Pe

D S SIG


Remind users of anticipatory guidance topics based on topics previously discussed

Closest conformance criterion: DC.2.5.1 (sort of) (The system SHOULD present alerts for all patient specific preventive services to the provider (is anticipatory guidance a preventive service?)).



Decision Support

Pe

D S SIG


Alert clinicians to the need for developmental screening based on guidelines

Closest conformance criterion: DC.2.5.1 #1 (The system SHOULD identify services for preventive care and wellness from patient demographics (eg. age, sex, region) ).



Decision Support

Pe

D S SIG


Alert clinicians to the need for hearing and vision screening per guidelines

Closest conformance criterion: DC.2.5.1 #1 (The system SHOULD identify services for preventive care and wellness from patient demographics (eg. age, sex, region) ).



Decision Support

Pe

D S SIG


Based on the record of encounters, the patient's current age, and existing guidelines, calculate whether the patient is current on the health maintenance schedule

Closest conformance criterion: DC.2.6.3 (as long as failure to participate in well-care is considered a health risk, which pediatricians generally do) AND DC.2.5.1 (The system SHALL provide a means to identify those patients who have not received appropriate action in response to a health risk alert. (Care Plan Function Links) --> How to modify this to deal with health maintenance? AND The system SHOULD present alerts for all patient specific preventive services to the provider. ).



Decision Support

Pe

D S SIG


Allow the deferral of alerts and reminders to a subsequent episode of care

Closest conformance criterion: N/A ((If a system decided that service X was needed today, and the user decided not to do it, then the system generally would decide that is needed tomorrow, too, right?)).



Decision Support

Pe

D S SIG


Display deferred actions

Closest conformance criterion: N/A ((If a system decided that service X was needed today, and the user decided not to do it, then the system generally would decide that is needed tomorrow, too, right?)).



Decision Support

Pe

D S SIG


In cases where gender is unknown, and in the case where certain decision support is gender specific, provide both male and female versions in cases where the gender is unknown

Closest conformance criterion: N/A (N/A).



Decision Support

Pe

D S SIG


Include body weight (or any other data used to decide dose, like gestational age or diagnosis) in the data sent with a prescription

Closest conformance criterion: (These data elements would be dictated by e-prescribing standards).



E-Prescribing & Ordering

Pe

D S SIG


Allow export of data to national drug databases designed to detect adverse drug events

Closest conformance criterion: COVERED IN "REGISTRIES PACKAGE" ((DC.1.3.3 Manage immunizations; S.1.1 Registry notification; S.3.1.2 Encounter-specific functionality; S.3.3.6 Health service reports at the conclusion of an episode of care; I.1.3.1 Unique identity, registry, and directory services; I.3.2 Distributed registry access; I.5.4 Interchange agreements; I.6 Business rules management)).




Pe

D S SIG


Handle immunization separately from other medications

Closest conformance criterion: DC.1.3.3 ([Manage immunizations]).




Pe

D S SIG


Allow drug dose and based on compounded oral solutions, in the case where no oral solution is available in standard formularies

Closest conformance criterion: DC.1.8.1 ([Order Medication]).




Pe

D S SIG


Allow drug dosing based on ideal body weight for a given medication





Pe

D S SIG


In weight-based dosage functions, reflect maximum dose per day in the resulting prescription





Pe

D S SIG


Link to FDA drug alerts





Pe

D S SIG


Offer drug dosing decision support for those drugs with a recommended starting dose range (e.g., methylphenidate) and graduated dosage increments





Pe

D S SIG


Support calculations for the preparation of intravenous infusions

Closest conformance criterion: DC.1.8.1 (Now that standard concetrations are the law of the land, we may need to give up on this one.).

DELETE?



Pe

D S SIG


Support standard concentrations for infusions

Closest conformance criterion: DC.1.8.1 (Hard to imagine an IV prescribing system that did not include data on the concentration of infusions… is this a peditric issue?).

DELETE?



Pe

D S SIG


Allow recording of dose per meter squared of body surface area, so that the prescription can be replicated later at the same dose per meter-square

Closest conformance criterion: DC.1.8.1 #14 (The system MAY support medication re-prescribing by allowing a prior prescription to be reordered without re-entering previous data (e.g. administration schedule, quantity). --> Probably should be promoted to SHOULD and the dosage per kg should be available so one can replicate the prescription at the same dosage (i.e., at the new body surface area)).




Pe

D S SIG


Allow recording of the dose per kilogram in the record of a prescribed medication, so that the prescription can be replicated later at the same dose per kilogram

Closest conformance criterion: DC.1.8.1 #14 (The system MAY support medication re-prescribing by allowing a prior prescription to be reordered without re-entering previous data (e.g. administration schedule, quantity). --> Probably should be promoted to SHOULD and the dosage per kg should be available so one can replicate the prescription at the same dosage (i.e., at the new body weight)).




Pe

D S SIG


Link adverse drug reactions, including allergies, to the activity of ordering or modifying a prescription

Closest conformance criterion: DC.1.8.1 #15 (The system SHOULD check and report allergies, drug-drug interactions, and other potential adverse reactions, when new medications are ordered. ).




Pe

D S SIG


Allow recording of exceptions to medication administration, such as refusal of medication, vomiting of the dose, or intravenous access not available

Closest conformance criterion: DC.1.8.2 ([Manage medication administration]).




Pe

D S SIG


Allow recording of over-the-counter medications, herbal remedies, and vitamin preparations in the medication list

Closest conformance criterion: DC.1.8.3 (The system SHALL provide a user interface to enter non-prescription medications including over the counter and complementary medications such as vitamins, herbs and supplements. ).




Pe

D S SIG


When allow ordering of blood products in units appropriate to pediatric care

Closest conformance criterion: DC.1.9.4 ([Order blood products and other biologics]).




Pe

D S SIG


When a medication is discontinued, the user would have the ability to indicate if a medication was ineffective.

Closest conformance criterion: DC.2.3.1.1 #8 (The system SHOULD allow checking of medications against a list of drugs noted to be ineffective for the patient in the past. ).




Pe

D S SIG


Allow the use of other data in dosing decision support, such as a lab value (e.g., urine specific gravity) of clinical characteristic (e.g., gestational age)

Closest conformance criterion: DC.2.3.1.2 #2 (The system SHALL identify specific and appropriate drug dosages for each patient condition at the time of medication ordering. ).




Pe

D S SIG


Indicate when dosing decision support is based on evidence

Closest conformance criterion: DC.2.7.1 #1 (Upon request, the system SHALL provide appropriate evidence-based documentation for clinical care recommendations. ).




Pe

D S SIG


Communicate with pediatric providers on medication use: Weight/height/BSDA, conditions and any disease management information from pharmacy.

Closest conformance criterion: Makes no sense (These data elements would be dictated by e-prescribing standards).




Pe

D S SIG


Make the patients age, weight, body surface area, and gestational age visible when viewing orders at every stage of the ordering process





Pe

D S SIG


Transmit relevant body measurements (usually weight) with prescriptions

Closest conformance criterion: N/A ([EHRs are going to do what the eRx messaging standards say to do… if weight is a field, then they'll send it. If not, they won't.]).




Pe

D S SIG


Provide patient education materials that are appropriate for patients in varying age ranges

Closest conformance criterion: DC.3.2.4 #9 (The system MAY enable age-appropriate and/or reading-ability appropriate educational materials for the patient and/or patient representative ).



Education

Pe

D S SIG


identify patients by parent's employer in cases of epidemiologic surveillance involving an occupational exposure

Closest conformance criterion: D.3.5.4 #1 (The system MAY support the identification of patients related by employer and work location for purposes of epidemiological exposure and public health analysis and reporting --> Needs to include PARENT'S employer as well).



Epidemiology

Pe

D S SIG


Allow recording of the location of day care center, institutional food source, camps, schools, and so forth for the purposes of environmental monitoring

Closest conformance criterion: DC.2.6.2 #1 (The system SHALL provide identification of the individual care providers or care managers within a cared for population --> Only if schools, camps, and day care centers are classified as "providers or care managers").



Epidemiology

Pe

D S SIG


Facilitate notification of schools, camps, day care settings, and so forth of health risks that apply to populations of children within those institutions

Closest conformance criterion: DC.2.6.2 #4 (The system MAY have the ability to disseminate a notification of a health risk to the identified individual care providers or care-managers through one or more alternative means --> Only if schools, camps, and day care centers are classified as "providers or care managers").



Epidemiology

Pe

D S SIG


Facilitate epidemiologic studies by recording living situation

Closest conformance criterion: S.1.4.3 #1 & #2 (The system SHOULD provide a mechanism to identify the patient’s primary residence. The system MAY provide a mechanism to identify the patient’s secondary or alternate residence. ).



Epidemiology

Pe

D S SIG


Allow the recording of a relationship by living situation




Family Linkage

Pe

D S SIG


Facilitate the scheduling of siblings to be seen as a group or in contiguous time slots

Closest conformance criterion: N/A (S.1.6: Scheduling) (N/A).



Family Linkage

Pe

D S SIG


Allow linkages between siblings charts

Closest conformance criterion: S.3.5.1 #1 (The system MAY support the identification of persons related by genealogy.).



Family Linkage

Pe

D S SIG


Allow linkages between the charts of parents and children




Family Linkage

Pe

D S SIG


Allow the creation of family groups of records within the system, for the purpose of moving between records within a family, subject to patient preferences, family preferences, and privacy regulations




Family Linkage

Pe

D S SIG


Link records in cases where there is a medical reason to do so, such as in cases of familial disease




Family Linkage

Pe

D S SIG


Allow the assignment of an unknown gender

Closest conformance criterion: N/A (This may simply be a matter of allowing the value of "unknown" in the a gender field).



Gender

Pe

D S SIG


Allow recording of gestational age at the time of delivery as a permanent feature of the patient that can be accessed at all times during the care of the patient, in much the same way as a "problem"

Closest conformance criterion: N/A (This may simply be a matter of allowing gestational age to be an item on the problem list).



Gestational Age

Pe

D S SIG


Allow the recording of head circumference

Closest conformance criterion: DC.1.10.2 #2 comes close (The system MAY capture other clinical measures as discrete elements such as peak expiratory flow rate, size of lesions, oxygen saturation, body mass index and severity of pain.).



Growth

Pe

D S SIG


Allow graphic display of growth data against a user-selectable set of normative curves

Closest conformance criterion: DC.1.4? (Growth charting is briefly mentioned in the text of DC.1.4 "Manage Assessments," but there are no specifics).



Growth

Pe

D S SIG


Plot body mass index against normative curves




Growth

Pe

D S SIG


Provide graphical growth chart and norms for children with varying conditions (e.g., Down syndrome and Turner syndrome)




Growth

Pe

D S SIG


include the appropriate templates for growth data fields, which would be presented to the caregiver using CDC standards based on demographic data (i.e., length, weight, head circumference for < 36 months; height; weight, BMI for over 36 months).

Closest conformance criterion: Makes no sense (Either the EHR allows the entering of head circumference or it does not. Either it calculates BMI or it does not. Whether these "fields" come up depend on the age-dependent templates the system implements (see Decision Support).).

DELETE?


Growth

Pe

D S SIG


Provide alerts about variances in the growth chart

Closest conformance criterion: Needs more detail… hard to put this one into a conformance criterion (Growth charting is briefly mentioned in the text of DC.1.4 "Manage Assessments," but there are no specifics).



Growth

Pe

D S SIG


Provide mechanism for monitoring of growth over time

Closest conformance criterion: Needs more detail… hard to put this one into a conformance criterion (Growth charting is briefly mentioned in the text of DC.1.4 "Manage Assessments," but there are no specifics).



Growth

Pe

D S SIG


Support the recording of multiple guardians and residences for given child whose parents are divorced or who have joint custody




Guardianship

Pe

D S SIG


Allow reference to subsets of the demographic data of the patient’s guardian to serve for parts of the patient’s demographic data, to avoid re-entry of data and avoid data anomalies




Guardianship

Pe

D S SIG


Allow recording of a guarantor, who may be different from the parent or guardian

Closest conformance criterion: S.3.5.2 #1 (The system MAY support the identification of persons related by insurance plan. ).



Guardianship

Pe

D S SIG


Allow recording of immunizations including lot numbers and vaccine information statements

Closest conformance criterion: DC.1.3.3 #1 & #2 (The system SHALL record as discrete data elements data associated with any immunization given including date, type, lot number and manufacturer. The system SHOULD allow the association of standard codes with discrete data elements associated with an immunization.).



Immunizations

Pe

D S SIG


Allow reporting of immunization status of populations of children within the practice

Closest conformance criterion: DC.1.3.3 #3 ([This is not directly mentioned in the conformance criteria, but it would be a derivative of the process used to compute immunizations for individuals]).



Immunizations

Pe

D S SIG


Based on known immunization data, calculate immunization status (current versus delayed) and display in summary lists

Closest conformance criterion: DC.1.3.3 #3 (The system SHALL determine any required immunizations during an encounter based on a current accepted schedule such as that from the Centers for Disease Control and Prevention. ).



Immunizations

Pe

D S SIG


Provide alerting and reminders for missedimmunizations

Closest conformance criterion: DC.1.3.3 #3 (The system SHALL determine any required immunizations during an encounter based on a current accepted schedule such as that from the Centers for Disease Control and Prevention.).



Immunizations

Pe

D S SIG


Allow user level updating of immunization guidelines

Closest conformance criterion: DC.1.3.3 #5 (The system SHALL allow for the updating of the immunization schedule --> Does not include "user level… is this important?).



Immunizations

Pe

D S SIG


Include mechanisms for immunization decision support that includes easy updating as recommendation change is included.

Closest conformance criterion: DC.1.3.3 #5 (The system SHALL allow for the updating of the immunization schedule).



Immunizations

Pe

D S SIG


Allow flexible reporting of immunizations in a given practice to support required vaccine program reporting

Closest conformance criterion: DC.1.3.3 #8 (The system SHOULD prepare a report of a patient's immunization history upon request for appropriate authorities such as schools or day-care centers. ).



Immunizations

Pe

D S SIG


Allow recording of parental consent to immunizations, according to applicable state law, as part of the point of care interface




Immunizations

Pe

D S SIG


Compute immunization recommendations for a time other than the time of the current encounter (for example if a parent wants to know what immunizations are due at the next visit, the system would facilitate this analysis)




Immunizations

Pe

D S SIG


Display immunizations by antigen




Immunizations

Pe

D S SIG


Include age and DOB on every display, both printed and on the screen




Interface

Pe

D S SIG


In the case of laboratories, allow recording of verification and communication to family members

Closest conformance criterion: DC.3.2.3 #1, 3, 4 (The system SHALL facilitate documentation of communications between providers and patients or their representatives. The system SHALL capture details of provider communications with patients or family (e.g. date, provider id, details of communication, result of communication requests). The system SHALL document communication originating with the patient or patient representative (e.g. date, entity, details of communication)).



Lab Results

Pe

D S SIG


Allow the designation of Advocate for the patient, who can append information to the chart

Closest conformance criterion: DC.1.1.4 ((Mentions surrogate for patient in the description, but lists no conformance criteria)).



Medical Home

Pe

D S SIG


Allow the recording of a primary care physician for each patient

Closest conformance criterion: N/A (N/A - this has GOT to be an oversight).



Medical Home

Pe

D S SIG


have the capability to identify multiple primary providers as well as multiple sub-specialists




Medical Home

Pe

D S SIG


Indicate multiple primary care providers, in the case were a pediatrician and a family practitioner are assuming that role




Medical Home

Pe

D S SIG


If the system provides a directory of providers, indicate which of those providers see pediatric patients, or who are pediatric specialists

Closest conformance criterion: S.1.3.1 #5 (The system MAY provide a directory of clinical personnel external to the organization that are not users of the system to facilitate documentation communication and information exchange --> Needs addition of data on peds specificity).



Medical Home

Pe

D S SIG


Links to a source where living wills are stored

Closest conformance criterion: DC.1.11.2 #2 (The system SHOULD be able to indicate the type of advanced directives such as living will, durable power of attorney, or a "Do Not Resuscitate order".).



Miscellaneous

Pe

D S SIG


Coordinate bed identification between facilities, for transport from general hospital to children's hospital or to NICU.

Closest conformance criterion: S.1.4.2 #1 (The system SHOULD identify and display/view the patient’s assigned location, unambiguously. ).



Miscellaneous

Pe

D S SIG


Provide age based norms for data when such norms exist

Closest conformance criterion: DC.1.10.1 ().



Norms

Pe

D S SIG


The system should accept normal ranges supplied by the external reference laboratory. Ideally, lab values are linked to ""disease-specific state"" values.

Closest conformance criterion: DC.1.10.1 (Receiving normal ranges and critical ranges from external sources is the default behavior for systems that accept lab values from external sources; this is not explicitly mentioned in the functional model).



Norms

Pe

D S SIG


Indicate normal ranges for values for which there are mutliple normal ranges within each age range (example: blood pressure, for whuch there are different normal values for each height range within each age range)




Norms

Pe

D S SIG


Provide an indicator of abnormal vital signs in cases where the vital signs fall outside the range of normal for age




Norms

Pe

D S SIG


Calculate and immeditely display, along with the original data, percentile values for any piece of data entered into the system for which a percentile distribution is known (height, weight, head circumference, body mass index, blood pressure)




Norms

Pe

D S SIG


Indicate normal range for items (lab values and physical exam data) based on stage of sexual maturity




Norms

Pe

D S SIG


Incorporate documentation from external sources

Closest conformance criterion: DC.1.1.3 #1, and DC.3.2.3 #4 (The system SHALL allow external documents to be stored in the system, and The system SHALL document communication originating with the patient or patient representative (e.g. date, entity, details of communication) ).



Parental Data Entry

Pe

D S SIG


provide a Web-based interface for entering data by parents, patients, school nurses, pharmacy labs/medical devices technicians.

Closest conformance criterion: DC.1.1.4 #3 (specifying "web-based" is beyond the scope of this document; this CC should handle the EHR end of this requirement) (The system SHALL capture, explicitly label the source of clinical data provided on behalf of the patient.).



Parental Data Entry

Pe

D S SIG


Distinguish data provided by the clinician from data provided by the parent, guardian, teacher, translator, or family

Closest conformance criterion: DC.1.1.4 #3 & #4 (The system SHALL capture, explicitly label the source of clinical data provided on behalf of the patient. The system SHALL present patient-originated data for use by care providers.).



Parental Data Entry

Pe

D S SIG


Provide patients with a web-based tool to access their medical record information.

Closest conformance criterion: DC.3.2.3 #5 (The system SHALL enable a secure web connection to support communications between providers and patients or their representatives ).



Parental Data Entry

Pe

D S SIG


Support entry of information by parents, patients, school nurses via the Web

Closest conformance criterion: DC.3.2.3 #5 (The system SHALL enable a secure web connection to support communications between providers and patients or their representatives ).



Parental Data Entry

Pe

D S SIG


Allow designation of a given patient as competent to enter his or her own information at a point selected by the clinician




Parental Data Entry

Pe

D S SIG


Permit oversight by parents of the patient entered information

Closest conformance criterion: N/A (May be to ill-defined in this form).



Parental Data Entry

Pe

D S SIG


Allow the assignment of temporary identifiers in cases where a government issued identifier is not available.

Closest conformance criterion: DC.1.1.1 #2 (The system SHALL provide the ability to uniquely identify a patient and tie the record to a single patient. ).



Patient Identification

Pe

D S SIG


Support administrative transactions before an official, government issued identifier is available

Closest conformance criterion: DC.1.1.1 #2 (The system SHALL provide the ability to uniquely identify a patient and tie the record to a single patient. ).




Pe

D S SIG


Allow cross-referencing of multiple identifiers that may identify the same patient

Closest conformance criterion: DC.1.1.1 #6 (The system SHALL provide the ability to query and retrieve appropriate parts of a patient record using a primary identifier, secondary identifiers, or other information which are not identifiers, but could be used to help identify the patient. ).




Pe

D S SIG


Allow changes in identifying data at the time of family changes due to adoption

Closest conformance criterion: DC.1.1.1 #6 almost works (The system SHALL provide the ability to query and retrieve appropriate parts of a patient record using a primary identifier, secondary identifiers, or other information which are not identifiers, but could be used to help identify the patient. ).




Pe

D S SIG


Allow entry of mother’s identifying data as part of the patient’s identifying data

Closest conformance criterion: DC.1.1.1 #6 almost works (Closest CC doesn't quite do it: The system SHALL provide the ability to query and retrieve appropriate parts of a patient record using a primary identifier, secondary identifiers, or other information which are not identifiers, but could be used to help identify the patient. ).




Pe

D S SIG


Allow name changes, and retain old names for the purpose of searching for patient records

Closest conformance criterion: DC.1.1.1 #6 almost works (The system SHALL provide the ability to query and retrieve appropriate parts of a patient record using a primary identifier, secondary identifiers, or other information which are not identifiers, but could be used to help identify the patient. ).




Pe

D S SIG


Allow entry of temporary ID numbers, which can be replaced with more formal identification number systems





Pe

D S SIG


To the extent afforded by existing national patient identifier systems, allow replacement of an identifier assigned in the pediatric period to a new, “adult” identifier at the age of majority





Pe

D S SIG


Allow the retention (and use as search criteria) the multiple names applied to a patient

Closest conformance criterion: S.1.4.1 ((Mentions changing names in the description, but there are no conf criteria mentioning how name changes would affect subsequent system operation)).




Pe

D S SIG


Allow users to be able to find a patient in the system based on multiple search criteria

Closest conformance criterion: S.1.4.1 ((Mentions changing names in the description, but there are no conformance criteria mentioning how name changes would affect subsequent system operation)).




Pe

D S SIG


Allow construction of graphical patient pedigrees




Pedigree

Pe

D S SIG


Alert users to preferences based on religion, such as transfusions in Jehovah's Witness patients

Closest conformance criterion: DC.1.11.1 #1 (The system SHALL capture, present, and store patient preferences such as language, religion and culture.).



Preferences

Pe

D S SIG


Allow parents to append information to the chart, per HIPAA guidelines

Closest conformance criterion: Redundant, since all products must comply with HIPAA (N/A).



Preferences

Pe

D S SIG


Allow creation of a record of a patient before the patient’s birth




Prenatal

Pe

D S SIG


Allow the retention of data related to prenatal procedures within the record of the patient postnatally




Prenatal

Pe

D S SIG


Label clinical information as requiring special privacy consideration, based on patient's age and applicable laws (this applies to so-called adolescent privacy)

Closest conformance criterion: DC.1.1.6 #2 (The system SHALL restrict access to summarized information based on applicable rules for confidentiality of patient health information --> assuming the rules can respond to age and sensitive diagnoses).



Privacy

Pe

D S SIG


In cases of care given to patients during adolescence, provide the ability to flag certain encounters, problems, diagnoses, and results as requiring special privacy handling

Closest conformance criterion: DC.1.1.6 #2 and I.1.9 #8 (The system SHALL restrict access to summarized information based on applicable rules for confidentiality of patient health information AND System MAY allow varying levels of confidentiality based on patient class and/or diagnosis).



Privacy

Pe

D S SIG


Allow user to mark sections or patients as confidential. This allows the practice to not print demographics, certain confidential sections, or other items

Closest conformance criterion: I.1.1.9 #8 (if "age" is added to it) (System MAY allow varying levels of confidentiality based on patient class and/or diagnosis. --> System SHOULD allow varying levels of confidentiality based on patient class, age, and/or diagnosis.).



Privacy

Pe

D S SIG


Protect the genetic identity of the child, when desired, when assisted reproductive technology is used

Closest conformance criterion: I.1.9 #1 (The system SHOULD enforce the applicable jurisdictional and organizational patient privacy rules).



Privacy

Pe

D S SIG


Allow labeling of data for special privacy considerations

Closest conformance criterion: I.1.9 #8 (System MAY allow varying levels of confidentiality based on patient class and/or diagnosis. ).



Privacy

Pe

D S SIG


In cases of care given to patients during adolescence, offer reminders based on diagnoses of the need for special privacy handling




Privacy

Pe

D S SIG


Include donor management support: Functions in an EMR related to organ and tissue donation may need to accommodate information about the gamete or zygote donated that resulted in pregnancy that gave rise to the patient, within applicable privacy laws.

Closest conformance criterion: S.1.2: Donor Management Support… but does not include ART ().



Privacy

Pe

D S SIG


Allow linkage to registries maintained in the public sector




Registries

Pe

D S SIG


Exchange data with newborn metabolic screening registries




Registries

Pe

D S SIG


Exchange data with other public health registries of relevance to children




Registries

Pe

D S SIG


Exchange immunization data with immunization registries




Registries

Pe

D S SIG


Link to registries such as the newborn screening systems at the hospital, state, and national level to ensure optimal communication including timely notification and follow-up.




Registries

Pe

D S SIG


Provide a linkage of adverse drug reactions in children to feed national databases involving the Safe Pharmaceutical Act for Children




Registries

Pe

D S SIG


provide data fields that allow information (potentially coded) that is then passed to another data based to link epidemiologic database




Registries

Pe

D S SIG


Report adverse drug reactions




Registries

Pe

D S SIG


Include gestational age on data reported to registries

Closest conformance criterion: N/A (Wouldn’t this be up to the registry? Would not the registry be the one to specify whether it wanted gestational age?).

DELETE?


Registries

Pe

D S SIG


Produce treatment plan reports for schools, day care, camp, and so forth

Closest conformance criterion: DC.1.1.7 #1 (The system SHOULD allow authorized users to create customized views of summarized information based on sort and filter controls for date or date range, problem, or other clinical parameters. ).



Reports

Pe

D S SIG


Provide communications to pediatric providers, including physicians, nurse practitioners, school nurses, developmental and behavioral health providers.




Reports

Pe

D S SIG


Provide discharge summary documents for parents and guardians




Reports

Pe

D S SIG


Provide treatment plans to parents and guardians




Reports

Pe

D S SIG


Support generation and maintenance of summary reports for parents




Reports

Pe

D S SIG


include nationally approved/endorsed pediatric measures, such as JCAHO, AHRQ, Health Plan Employer Data and Information Set (HEDIS); Title V Maternal and Child Health program indicators; National Quality Forum (NQF) initial hospital indicator set (pediatric-specific measures); Child and Adolescent Health Measurement Initiative (CAHMI).

Closest conformance criterion: S.2.1.1 (Outcome measures and analysis) (This sort of thing is less a function of the end-user system as it is a function of the data repository report-writing application.).



Reports

Pe

D S SIG


Provide flexibility to change the reports per changing requirements




Reports

Pe

D S SIG


Provide reports based on pediatric quality measures to quality monitoring organizations




Reports

Pe

D S SIG


Prepare age appropriate forms for external distribution, including camp physicals, athletic forms, and so forth

Closest conformance criterion: S.2.2.2 #all (The system SHOULD be capable of generating reports of structured clinical and administrative data through either internal or external reporting tools. The system MAY be capable of including information extracted from unstructured clinical and administrative data in the report generation process, using internal or external tools. The system SHALL be capable of generating reports, using either internal or external reporting tools. Reports generated SHALL be capable of being exported. The system SHOULD allow the user to specify report parameters, based on patient demographic and/or clinical data, which would allow sorting and/or filtering of the data. The system (or an external application, using data from the system) MAY allow users to save report parameters for generating subsequent reports. The system (or an external application, using data from the system) MAY allow users to modify one or more parameters of a saved report specification when generating a report using that specification.).



Reports

Pe

D S SIG


provide support for the management of patients enrolled in research protocols and management of patients enrolled in research protocols.

Closest conformance criterion: DC.2.2.3 #4 (The system SHOULD support the management and tracking of patients participating in research studies. ).



Research

Pe

D S SIG


Capture, track referrals between healthcare providers or health care organizations. (DC.1.4.4)

Closest conformance criterion: DC.1.9.5: Manage Referrals, e.g., #1 (The system SHALL support the capture of referral(s) to other care provider (s), whether internal or external to the organization).



Telehealth

Pe

D S SIG


Capture, track teleconsultations between healthcare providers or health care organizations. (DC.1.4.4)

Closest conformance criterion: DC.1.9.5: Manage Referrals, e.g., #1 (The system SHALL support the capture of referral(s) to other care provider (s), whether internal or external to the organization).



Telehealth

Pe

D S SIG


Provide access to the electronic medical record to sites where telehealth is being implemented

Closest conformance criterion: N/A (Whether an application is available through a network is an implementation issue).



Telehealth

Pe

D S SIG


include special terminology used in pediatric care: Example: EMR systems include common pediatric terms (pediatric lexicon) used to describe pediatric preventive health care (e.g., developmental milestones, educational progress, and anticipatory guidance) and physical findings (e.g., weak cry, bulging anterior fontanels, and umbilical granuloma).

Closest conformance criterion: Nonsensical; making terminology systems adequate for pediatric care is beyond the present scope (We need an entirely separate document detailing what we mean by pediatric terminology.).



Terminology

Pe

D S SIG


Support terminology systems specifically designed for use in pediatrics

Closest conformance criterion: Nonsensical; no such terminoligy systems exist ().



Terminology

Pe

D S SIG


Allow recording of immunization status (current versus delayed) in summary lists




Vocabulary

Pe

D S SIG


Allow recording of educational status in summary lists




Vocabulary

Pe

D S SIG


Allow the recording of developmental assessments in summary lists




Vocabulary

Pe

D S SIG


Allow the recording of health maintenance status as part of summary lists




Vocabulary

Documents

Reconciling the pediatric requirements with the EHR model May 2006 Pediatric Data Standards SIG Functional Requirements Review