A National Web Conference on the Use of Health IT To Improve Health Care Delivery for Children Presented by: Jonathan Wald, M.D., M.P.H. Elizabeth Alpern, M.D., M.S.C.E. Moderated By: Edwin Lomotan, M.D. Agency for Healthcare Research and Quality June 30, 2016 1
Agenda • Welcome and Introductions • Presentations • Q&A Session With Presenters • Instructions for Obtaining CME Credits Note: After today’s Webinar, a copy of the slides will be emailed to all participants. 2
Presenters and Moderator Disclosures The following presenters and moderator have no financial interests to disclose: • Jonathan Wald, M.D., M.P.H. • Elizabeth Alpern, M.D., M.S.C.E. • Edwin Lomotan, M.D. This continuing education activity is managed and accredited by the Professional Education Services Group (PESG), in cooperation with AHRQ, AFYA, and RTI. PESG, AHRQ, AFYA, and RTI staff have no financial interests to disclose. Commercial support was not received for this activity. 3
How To Submit a Question • At any time during the presentation, type your question into the “Q&A” section of your WebEx Q&A panel. • Please address your questions to “All Panelists” in the drop-down menu. • Select “Send” to submit your question to the moderator. • Questions will be read aloud by the moderator. 4
Learning Objectives At the conclusion of this activity, the participant will be able to: 1. Describe recommendations for electronic health record (EHR) functionalities expected to improve the safety and quality of care provided to children. 2. Discuss the development and potential impacts of multisite performance measure reporting, using an EHR data-driven pediatric registry. 5
Children’s EHR Format The 2015 Priority List Jonathan Wald, M.D., M.P.H. Director, Digital Health and Clinical Informatics Division of eHealth, Quality, and Analytics RTI International 6
Acknowledgements Vanderbilt University Medical RTI International Center • Jonathan S. Wald, M.D., M.P.H. • Kevin B. Johnson, M.D., M.S. • Jennifer R. Webb, M.A. • Christoph U. Lehmann, M.D. • Stephanie Rizk, M.S. • Mark Frisse, M.D., M.B.A. • Saira Haque, Ph.D., M.H.S.A. • Stephen Brown, M.S. American Academy of • Pediatrics (AAP) Shellery Ebron, M.S.P.H. • Vanessa A. Shorte, M.P.H. AHRQ • c3 Consulting Edwin Lomotan, M.D. • Vicki Estrin CMS • Sarah France • Barbara Dailey This project was funded by the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The opinions expressed in this report are those of the authors and do not reflect the official position of CMS, AHRQ, or the Department of Health and Human Services. 7
Background Problem: EHRs are not fully effective in the care of children without improvements in their design, implementation, and use. In response: • 2009: HITECH Act ► Under Children’s Health Insurance Program Reauthorization Act (CHIPRA), the Health Information Technology for Economic and Clinical Health (HITECH) Act called for improvements in health IT • 2010-2013: Children’s EHR Format ► Development and public release of the Children’s EHR Format ► Interactive release (December 2013) via the U.S. Health Information Knowledgebase Web site at http://ushik.ahrq.gov • 2012-2015: State Evaluation of the Children’s EHR Format ► CHIPRA-funded evaluation by grantees in North Carolina and Pennsylvania • 2014-2015 Children’s EHR Format Enhancement ► Development of the 2015 Priority List & Recommended Uses for the Children’s EHR Format 8
Children’s EHR Format Work 2010-2013 • Children’s EHR Format = 547 functional requirements ► “The system shall…” o Title: Flag special health care needs (Req-2014) o Description: The system shall support the ability for providers to flag or unflag individuals with special health care needs or complex conditions who may benefit from care management, decision support, and care planning; and shall support reporting. ► 26 topic areas ► Published and available for download: http://ushik.ahrq.gov ► Based on an assessment of EHRs used in the care of children o Environmental scan and gap analysis o Interaction with standards organizations o Engagement of diverse stakeholders 9
26 Topics in the 2013 Format Topic # Topic # Early and Periodic Screening, Diagnostic, 14 Well Child/Preventive Care 131 and Treatment (PSDT) Genetic Information 4 Security and Confidentiality 24 Patient Identifier 9 Medication Management 38 Prenatal Screening 17 Primary Care Management 47 School-Based Linkages 4 Child Welfare 24 Specialized Scales/Scoring 39 Growth Data 60 Activity Clearance 8 Newborn Screening 16 Adolescent Obstetrics 5 Immunizations 16 Community Health 4 Patient Portals - PHR 13 Parents, Guardians & Family Relationship 27 Birth Information 66 Data Quality Measures 5 Children with Special Health Care Needs 25 Records Management 17 Registry Linkages 18 Special Terminology and Information 10 Child Abuse Reporting 29 10
State Grantee Experiences in NC and PA • Practicing pediatricians and their vendors were asked to review Format items, one by one, to: ► Assess if their EHR “matched” the capability ► “Implement” the capability (i.e., meet the functional requirement), if possible • RTI team ► Reviewed project artifacts ► Conducted site visits ► Interviewed providers, vendors, practice managers, information technology (IT) staff, and CHIPRA program leaders 11
Grantees Reported Format Benefits • Positive overall grantee perceptions of the Format ► The Format provided a helpful framework for conversations about pediatric needs for EHRs among members of a practice and between practitioners and vendors. ► Grantees gained a better understanding of their EHR’s capabilities. • Priority areas identified by grantees ► Automatically calculating percentiles for blood pressure, body mass index (BMI), and growth ► Accommodating specialized calculations tailored for a child’s condition, such as Down syndrome ► Integration of existing screening tools and educational resources into decision support and practitioner workflows ► Information exchange ► Integrated reporting and decision support to manage patient panels and support the care of individual patients ► Family linkage to siblings 12
Grantees Also Reported Format Challenges • Difficulty interpreting requirements ► Use of technical language, vague language, leading to differing interpretations by different stakeholders ► Examples and supporting materials ambiguous or lacking • Difficulty prioritizing requirements ► 547 items made it difficult to determine what to focus on • Limited success adapting their use of the EHRs due to inflexibility • Some missing requirements/gaps in the Format ► Social factors such as socioeconomic status ► Religious and cultural considerations ► Food insecurity ► Conditions in the home ► Women, infants, and children (WIC) assessments ► Language considerations 13
Multi-Stakeholder Work Group (Jan.-Jun. 2015) ► Kevin Johnson, M.D., M.S. (Chair) ► Chip Hart Vanderbilt University School of Medicine PCC—Physician’s Computer Company Nashville, TN ► Beth Morrow, J.D. ► Christoph U. Lehmann, M.D. (Co-chair) The Children’s Partnership Vanderbilt University School of Medicine ► Karen Parr, R.N., M.S. Nursing ► William G. Adams, M.D. Oregon Community Health Information Boston Medical Center Network (OCHIN) ► Gregg Alexander, D.O. ► Fred Rachman, M.D. Health Nuts Media, Madison Pediatrics Alliance of Chicago Mary Applegate, M.D. Judith Shaw, Ed.D., M.P.H., R.N. ► ► Ohio Medicaid UVM NIPN program Louise Bannister, R.N., J.D. Mark L. Wolraich, M.D. ► ► University of Massachusetts Medical Oklahoma University Health Sciences School Center Bobbie Byrne, M.D., M.B.A., F.A.A.P. Feliciano “Pele” Yu, Jr, M.D., M.S.H.I., ► ► Edwards Health System M.S.P.H. St. Louis Children’s Hospital Ajit Dhavle, Dr.Ph. ► Surescripts ► Alan Zuckerman, M.D. Georgetown University Medical Center ► Laurie Dameshek EHR Association (HIMSS) ► Sheila Driver, R.N. Formerly: Siemens Medical Solutions Ashe Pediatrics ► Charles Anthony Gallia, Ph.D. 14 State of Oregon Medicaid program
Federal Work Group Name Org Name Org Kamila Mistry, Ph.D., M.P.H.` AHRQ Romuladus Azuine, Dr.P.H., M.P.H., R.N. HRSA CAPT Alicia Morton, D.N.P., R.N.-B.C. ONC Katherine Beckmann, Ph.D., M.P.H. ACF Michelle Ruslavage, D.N.P., R.N., N.E.-B.C., IHS Linda Bergofsky, M.S.W., M.B.A. AHRQ C.P.E. Denise Daugherty, Ph.D. AHRQ CDR Samuel Schaffzin, M.P.A. CMS Nicole Fehrenbach, M.P.P. CDC COL John Scott DOD Erin Grace, M.H.A. AHRQ LT Anca Tabokova, M.D. HRSA Steven Hirschfeld, M.D., Ph.D. NIH Albert Taylor, M.D., F.A.C.O.G. ONC Cara Mai, Dr.P.H., M.P.H. CDC Kate Tipping, J.D. SAMHSA Marie Mann, M.D., M.P.H. HRSA Michael Toedt, M.D., F.A.A.F.P. IHS Samantha Wallack Meklir, M.P.Aff. ONC 15
How the 2015 Priority List Was Developed Inclusion criteria • Ambulatory…. • Pediatric specific… Exclusion criteria • Inpatient only • Adult only • Addressed in Meaningful Use (MU) • Already common in EHRs • Solved using a template • Too vague and/or broad • Specific, and covered under a general feature 16
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