Transcript Pediatric Requirements Review Project Assignments

Pe DS SIG
Pediatric
Data Standards SIG
Functional Requirements Review
Reconciling the pediatric requirements with the EHR model
May 2006
V10 Document Statements
Pe DS SIG
 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
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS 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
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
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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
Reconciling the pediatric requirements with the EHR model
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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)
May 2006
Pe DS 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
Reconciling the pediatric requirements with the EHR model
May 2006
Age Representation
Pe DS SIG
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Allow recording of post conceptional age and
distinguish it from post-natal age
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Closest conformance criterion: N/A… DC.1.2
(Manage patient demographics) comes closest ([no
CC contains this specific concept]).
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NOT INCLUDED, noncontroversial
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Reference number: 2
Reconciling the pediatric requirements with the EHR model
May 2006
Age Representation
Pe DS SIG
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Allow recording of the exact time of birth down to
the minute
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Closest conformance criterion: N/A… DC.1.2
(Manage patient demographics) comes closest ([no
CC contains this specific concept]).
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NOT INCLUDED, noncontroversial
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Reference number: 3
Reconciling the pediatric requirements with the EHR model
May 2006
Age Representation
Pe DS SIG
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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)
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Closest conformance criterion: N/A… DC.1.2
(Manage patient demographics) comes closest
(N/A).
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NOT INCLUDED, noncontroversial
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Reference number: 4
Reconciling the pediatric requirements with the EHR model
May 2006
Allergies
Pe DS SIG
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[Allergies] could include items such as foods or
environmental agents.
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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.).
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INCLUDED, noncontroversial
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Reference number: 5
Reconciling the pediatric requirements with the EHR model
May 2006
Allergies
Pe DS SIG
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Allow the classification of reactions into allergic
reactions, side effects, and intolerances
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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.).
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INCLUDED, noncontroversial
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Reference number: 6
Reconciling the pediatric requirements with the EHR model
May 2006
Allergies
Pe DS SIG
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List food allergies and medication allergies
separately
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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?).
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Possibly included, controversial
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Reference number: 7
Reconciling the pediatric requirements with the EHR model
May 2006
Allergies
Pe DS SIG
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The user determines what defines an allergy or
adverse reaction
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Closest conformance criterion: DC.1.3.2 #4 (The
system SHOULD provide the ability to capture the
reaction type).
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INCLUDED, noncontroversial
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Reference number: 8
Reconciling the pediatric requirements with the EHR model
May 2006
Archiving
Pe DS SIG
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Store data until the statutorily designated time
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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. ).
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INCLUDED, noncontroversial
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Reference number: 9
Reconciling the pediatric requirements with the EHR model
May 2006
Communications
Pe DS SIG
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The user may indicate who they are sending
results to and the system will track this
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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).
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INCLUDED, noncontroversial
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Reference number: 10
Reconciling the pediatric requirements with the EHR model
May 2006
Consent
Pe DS SIG
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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
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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. ).
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INCLUDED, noncontroversial
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Reference number: 12
Reconciling the pediatric requirements with the EHR model
May 2006
Consent
Pe DS SIG
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Allow recording of both consent and assent to
treatment
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Closest conformance criterion: DC.1.11.3 #7 (EHR
systems SHOULD allow documentation of an
assent as appropriate for patients legally unable to
consent. ).
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INCLUDED, noncontroversial
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Reference number: 11
Reconciling the pediatric requirements with the EHR model
May 2006
Consent
Pe DS SIG
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In cases where consent forms are managed by the
system, allow adolescent patients to participate as
if they were adults under appropriate conditions
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Closest conformance criterion: DC.1.11.3: Manage
consents and authorizations ((Does not explicitly
mention this function)).
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NEEDS NEW CC IN THIS FUNCTION
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Reference number: 13
Reconciling the pediatric requirements with the EHR model
May 2006
Custody
Pe DS SIG
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Identify a child who has been removed from a
home
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Closest conformance criterion: N/A ((This would
simply be an item in the child's history, e.g. Social
Hx)).
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VOCABULARY ISSUE: …
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Reference number: 14
Reconciling the pediatric requirements with the EHR model
May 2006
Custody
Pe DS SIG
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Indicate when a child is in foster care
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Closest conformance criterion: N/A ((This would
simply be an item in the child's history, e.g. Social
Hx)).
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VOCABULARY ISSUE: …
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Reference number: 15
Reconciling the pediatric requirements with the EHR model
May 2006
Custody
Pe DS SIG
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Indicate when a child is under ongoing
investigation for abuse or neglect
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Closest conformance criterion: N/A ((This would
simply be an item in the child's history, e.g. Social
Hx)).
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VOCABULARY ISSUE: …
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Reference number: 16
Reconciling the pediatric requirements with the EHR model
May 2006
Custody
Pe DS SIG
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Indicate when the child has been adopted
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Closest conformance criterion: N/A ((This would
simply be an item in the child's history, e.g. Social
Hx)).
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VOCABULARY ISSUE: …
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Reference number: 17
Reconciling the pediatric requirements with the EHR model
May 2006
Custody
Pe DS SIG
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Provide patient identification mechanisms that can
withstand changes in family structure, such as loss
of a child from the family in a custody decision
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Closest conformance criterion: N/A ((I am pretty
sure this needs some significant clarification)).
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NOT INCLUDED, noncontroversial
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Reference number: 19
Reconciling the pediatric requirements with the EHR model
May 2006
Custody
Pe DS SIG
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Provide patient identification mechanisms that can
withstand changes in family structure, such as
removal of the child from the home
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Closest conformance criterion: N/A ((I am pretty
sure this needs some significant clarification)).
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NOT INCLUDED, noncontroversial
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Reference number: 20
Reconciling the pediatric requirements with the EHR model
May 2006
Custody
Pe DS SIG
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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
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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).
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NOT INCLUDED, noncontroversial
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Reference number: 18
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG
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Incorporate age, weight, and disease criteria into
alerts related to laboratory results
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Closest conformance criterion: DC.1.10.1 #11 (The
system MAY trigger decision support algorithms
from [test] results. ).
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INCLUDED, noncontroversial
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Reference number: 31
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG
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Integrate patient and family preferences into
clinical decision support
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Closest conformance criterion: DC.1.11.1 #3 (The
system SHOULD integrate patient and family
preferedecision support systems).
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INCLUDED, noncontroversial
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Reference number: 34
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG
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Link care processes to the problem list
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Closest conformance criterion: DC.1.5 #9 (The
system MAY associate encounters, orders,
medications, notes with one or more problems.).

INCLUDED, noncontroversial
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Reference number: 35
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG

Link lab values to problem list
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Closest conformance criterion: DC.1.5 #9 (The
system MAY associate encounters, orders,
medications, notes with one or more problems.).

INCLUDED, noncontroversial
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Reference number: 37
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG
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Link medical imaging to items all on the problem
list
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Closest conformance criterion: DC.1.5 #9 (The
system MAY associate encounters, orders,
medications, notes with one or more problems.).
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INCLUDED, noncontroversial
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Reference number: 38
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG
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Link orders to problems [in problem lists]
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Closest conformance criterion: DC.1.5 #9 (The
system MAY associate encounters, orders,
medications, notes with one or more problems.).
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INCLUDED, noncontroversial
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Reference number: 39
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG
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Provide problem lists link to medical orders, lab,
medical imaging, disease specific guidelines, or
care processes including rationale for care.
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Closest conformance criterion: DC.1.5 #9 (The
system MAY associate encounters, orders,
medications, notes with one or more problems.).

INCLUDED, noncontroversial
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Reference number: 43
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG
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Provide decision support for special immunizations
such as palivizumab
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Closest conformance criterion: DC.1.6.1 #1 (The
system SHALL support presentation of guidelines
and protocols to clinicians).
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INCLUDED, noncontroversial
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Reference number: 42
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG
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Indicate in the case of decision support function
whether the function applies to the pediatric
population
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Closest conformance criterion: DC.1.6.1 #1, 3, 4, 5
(assuming decision support = guidelines) ((Comes
close)).
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NEEDS NEW CC IN THIS FUNCTION
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Reference number: 32
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG
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Link disease specific guidelines to the problem list
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Closest conformance criterion: DC.1.6.1 #4 (The
system SHALL present guidelines and protocols
appropriate for the patient’s problem list. ).
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INCLUDED, noncontroversial
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Reference number: 36
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG
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Apply patient age to all decision support functions
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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) ).
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INCLUDED if we make minor mods in a CC
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Reference number: 25
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG

Facilitate selection of guidelines based on patient
age
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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")).
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INCLUDED if we make minor mods in a CC
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Reference number: 28
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG

Indicate the source of any applicable guidelines or
decision support rules
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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).
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INCLUDED, noncontroversial
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Reference number: 33
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG
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Allow for disease specific health maintenance
schedules with accompanying decision support
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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]).
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INCLUDED, noncontroversial
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Reference number: 23
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG

In cases where forms vary with age, select forms
to be presented based on age.
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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]).
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INCLUDED, noncontroversial
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Reference number: 29
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG

Modify displays based on age

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]).

INCLUDED, noncontroversial
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Reference number: 40
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS 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]).
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INCLUDED, noncontroversial
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Reference number: 41
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS SIG

Remind users of anticipatory guidance topics based on age
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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)).
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INCLUDED, noncontroversial

Reference number: 44
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS 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)).

INCLUDED, noncontroversial

Reference number: 45
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS 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?)).

INCLUDED, noncontroversial

Reference number: 46
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS 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) ).

INCLUDED, noncontroversial

Reference number: 21
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS 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) ).

INCLUDED, noncontroversial

Reference number: 22
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS 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. ).

INCLUDED if we make minor mods in a CC

Reference number: 26
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS 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?)).

NOT INCLUDED, noncontroversial

Reference number: 24
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS 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?)).

NOT INCLUDED, noncontroversial

Reference number: 27
Reconciling the pediatric requirements with the EHR model
May 2006
Decision Support
Pe DS 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).

NOT INCLUDED, noncontroversial

Reference number: 30
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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).

NOT INCLUDED, noncontroversial

Reference number: 58
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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)).

INCLUDED, noncontroversial
Reconciling the pediatric requirements with the EHR model

Reference number: 49
May 2006
Pe DS SIG
E-Prescribing & Ordering

Handle immunization separately from other
medications

Closest conformance criterion: DC.1.3.3 ([Manage
immunizations]).

INCLUDED, noncontroversial

Reference number: 56
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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]).

NOT INCLUDED, noncontroversial

Reference number: 47
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

Allow drug dosing based on ideal body weight for a
given medication

Closest conformance criterion: DC.1.8.1 ([Order
Medication]).

NEEDS NEW CC IN THIS FUNCTION

Reference number: 48
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

In weight-based dosage functions, reflect
maximum dose per day in the resulting prescription

Closest conformance criterion: DC.1.8.1 ([Order
Medication]).

NEEDS NEW CC IN THIS FUNCTION

Reference number: 57
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

Link to FDA drug alerts

Closest conformance criterion: DC.1.8.1 ([Order
Medication]).

NEEDS NEW CC IN THIS FUNCTION

Reference number: 61
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

Offer drug dosing decision support for those drugs
with a recommended starting dose range (e.g.,
methylphenidate) and graduated dosage
increments

Closest conformance criterion: DC.1.8.1 ([Order
Medication]).

NEEDS NEW CC IN THIS FUNCTION

Reference number: 63
Reconciling the pediatric requirements with the EHR model
May 2006
E-Prescribing & Ordering
Pe DS 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?

Reference number: 64
Reconciling the pediatric requirements with the EHR model
May 2006
E-Prescribing & Ordering
Pe DS 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?

Reference number: 65
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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)).

INCLUDED if we make minor mods in a CC

Reference number: 50
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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)).

INCLUDED if we make minor mods in a CC

Reference number: 53
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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, drugdrug interactions, and other potential adverse
reactions, when new medications are ordered. ).

INCLUDED, noncontroversial

Reference number: 60
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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]).

NEEDS NEW CC IN THIS FUNCTION

Reference number: 51
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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. ).

INCLUDED, noncontroversial

Reference number: 52
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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]).

NOT INCLUDED, noncontroversial

Reference number: 68
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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. ).

INCLUDED, noncontroversial

Reference number: 67
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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. ).

Possibly included, controversial

Reference number: 54
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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. ).

INCLUDED, noncontroversial

Reference number: 59
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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 eprescribing standards).

NOT INCLUDED, noncontroversial

Reference number: 55
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

Make the patients age, weight, body surface area,
and gestational age visible when viewing orders at
every stage of the ordering process

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 62
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
E-Prescribing & Ordering

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.]).

NOT INCLUDED, noncontroversial

Reference number: 66
Reconciling the pediatric requirements with the EHR model
May 2006
Education
Pe DS 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 ).

INCLUDED, noncontroversial

Reference number: 69
Reconciling the pediatric requirements with the EHR model
May 2006
Epidemiology
Pe DS 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).

INCLUDED if we make minor mods in a CC

Reference number: 73
Reconciling the pediatric requirements with the EHR model
May 2006
Epidemiology
Pe DS 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").

INCLUDED if we make minor mods in a CC

Reference number: 70
Reconciling the pediatric requirements with the EHR model
May 2006
Epidemiology
Pe DS 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").

INCLUDED if we make minor mods in a CC

Reference number: 72
Reconciling the pediatric requirements with the EHR model
May 2006
Epidemiology
Pe DS 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. ).

INCLUDED, noncontroversial

Reference number: 71
Reconciling the pediatric requirements with the EHR model
May 2006
Family Linkage
Pe DS SIG

Allow the recording of a relationship by living
situation

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 77
Reconciling the pediatric requirements with the EHR model
May 2006
Family Linkage
Pe DS 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).

NOT INCLUDED, noncontroversial

Reference number: 78
Reconciling the pediatric requirements with the EHR model
May 2006
Family Linkage
Pe DS 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.).

INCLUDED, noncontroversial

Reference number: 74
Reconciling the pediatric requirements with the EHR model
May 2006
Family Linkage
Pe DS SIG

Allow linkages between the charts of parents and
children

Closest conformance criterion: S.3.5.1 #1 (The
system MAY support the identification of persons
related by genealogy.).

INCLUDED, noncontroversial

Reference number: 75
Reconciling the pediatric requirements with the EHR model
May 2006
Family Linkage
Pe DS 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

Closest conformance criterion: S.3.5.1 #1 (The
system MAY support the identification of persons
related by genealogy.).

INCLUDED, noncontroversial

Reference number: 76
Reconciling the pediatric requirements with the EHR model
May 2006
Family Linkage
Pe DS SIG

Link records in cases where there is a medical
reason to do so, such as in cases of familial
disease

Closest conformance criterion: S.3.5.1 #1 (The
system MAY support the identification of persons
related by genealogy.).

INCLUDED, noncontroversial

Reference number: 79
Reconciling the pediatric requirements with the EHR model
May 2006
Gender
Pe DS 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).

VOCABULARY ISSUE: …

Reference number: 80
Reconciling the pediatric requirements with the EHR model
May 2006
Gestational Age
Pe DS 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).

VOCABULARY ISSUE: …

Reference number: 81
Reconciling the pediatric requirements with the EHR model
May 2006
Growth
Pe DS 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.).

INCLUDED if we make minor mods in a CC

Reference number: 83
Reconciling the pediatric requirements with the EHR model
May 2006
Growth
Pe DS 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).

NOT INCLUDED, noncontroversial

Reference number: 82
Reconciling the pediatric requirements with the EHR model
May 2006
Growth
Pe DS SIG

Plot body mass index against 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).

NOT INCLUDED, noncontroversial

Reference number: 85
Reconciling the pediatric requirements with the EHR model
May 2006
Growth
Pe DS SIG

Provide graphical growth chart and norms for
children with varying conditions (e.g., Down
syndrome and Turner syndrome)

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).

NOT INCLUDED, noncontroversial

Reference number: 87
Reconciling the pediatric requirements with the EHR model
May 2006
Growth
Pe DS 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?

Reference number: 84
Reconciling the pediatric requirements with the EHR model
May 2006
Growth
Pe DS 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).

NOT INCLUDED, noncontroversial

Reference number: 86
Reconciling the pediatric requirements with the EHR model
May 2006
Growth
Pe DS 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).

NOT INCLUDED, noncontroversial

Reference number: 88
Reconciling the pediatric requirements with the EHR model
May 2006
Guardianship
Pe DS SIG

Support the recording of multiple guardians and
residences for given child whose parents are
divorced or who have joint custody

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 90
Reconciling the pediatric requirements with the EHR model
May 2006
Guardianship
Pe DS 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

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 91
Reconciling the pediatric requirements with the EHR model
May 2006
Guardianship
Pe DS 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. ).

INCLUDED, noncontroversial

Reference number: 89
Reconciling the pediatric requirements with the EHR model
May 2006
Immunizations
Pe DS 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.).

INCLUDED, noncontroversial

Reference number: 93
Reconciling the pediatric requirements with the EHR model
May 2006
Immunizations
Pe DS 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]).

NOT INCLUDED, noncontroversial

Reference number: 95
Reconciling the pediatric requirements with the EHR model
May 2006
Immunizations
Pe DS 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. ).

INCLUDED, noncontroversial

Reference number: 97
Reconciling the pediatric requirements with the EHR model
May 2006
Immunizations
Pe DS 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.).

INCLUDED, noncontroversial

Reference number: 101
Reconciling the pediatric requirements with the EHR model
May 2006
Immunizations
Pe DS 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?).

INCLUDED if we make minor mods in a CC

Reference number: 96
Reconciling the pediatric requirements with the EHR model
May 2006
Immunizations
Pe DS 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).

INCLUDED, noncontroversial

Reference number: 100
Reconciling the pediatric requirements with the EHR model
May 2006
Immunizations
Pe DS 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. ).

INCLUDED, noncontroversial

Reference number: 92
Reconciling the pediatric requirements with the EHR model
May 2006
Immunizations
Pe DS SIG

Allow recording of parental consent to
immunizations, according to applicable state law,
as part of the point of care interface

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 94
Reconciling the pediatric requirements with the EHR model
May 2006
Immunizations
Pe DS 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)

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 98
Reconciling the pediatric requirements with the EHR model
May 2006
Immunizations
Pe DS SIG

Display immunizations by antigen

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 99
Reconciling the pediatric requirements with the EHR model
May 2006
Interface
Pe DS SIG

Include age and DOB on every display, both
printed and on the screen

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 102
Reconciling the pediatric requirements with the EHR model
May 2006
Lab Results
Pe DS 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)).

INCLUDED, noncontroversial

Reference number: 103
Reconciling the pediatric requirements with the EHR model
May 2006
Medical Home
Pe DS 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)).

NEEDS NEW CC IN THIS FUNCTION

Reference number: 104
Reconciling the pediatric requirements with the EHR model
May 2006
Medical Home
Pe DS 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).

NOT INCLUDED, noncontroversial

Reference number: 105
Reconciling the pediatric requirements with the EHR model
May 2006
Medical Home
Pe DS SIG

have the capability to identify multiple primary
providers as well as multiple sub-specialists

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 106
Reconciling the pediatric requirements with the EHR model
May 2006
Medical Home
Pe DS SIG

Indicate multiple primary care providers, in the
case were a pediatrician and a family practitioner
are assuming that role

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 108
Reconciling the pediatric requirements with the EHR model
May 2006
Medical Home
Pe DS 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).

INCLUDED if we make minor mods in a CC

Reference number: 107
Reconciling the pediatric requirements with the EHR model
May 2006
Miscellaneous
Pe DS 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".).

INCLUDED, noncontroversial

Reference number: 110
Reconciling the pediatric requirements with the EHR model
May 2006
Miscellaneous
Pe DS 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. ).

INCLUDED, noncontroversial

Reference number: 109
Reconciling the pediatric requirements with the EHR model
May 2006
Norms
Pe DS SIG

Provide age based norms for data when such
norms exist

Closest conformance criterion: DC.1.10.1 ().

NEEDS NEW CC IN THIS FUNCTION

Reference number: 114
Reconciling the pediatric requirements with the EHR model
May 2006
Norms
Pe DS 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).

NEEDS NEW CC IN THIS FUNCTION

Reference number: 116
Reconciling the pediatric requirements with the EHR model
May 2006
Norms
Pe DS 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)

Closest conformance criterion: DC.1.10.2 ().

NEEDS NEW CC IN THIS FUNCTION

Reference number: 113
Reconciling the pediatric requirements with the EHR model
May 2006
Norms
Pe DS SIG

Provide an indicator of abnormal vital signs in
cases where the vital signs fall outside the range of
normal for age

Closest conformance criterion: DC.1.10.2 ().

NEEDS NEW CC IN THIS FUNCTION

Reference number: 115
Reconciling the pediatric requirements with the EHR model
May 2006
Norms
Pe DS 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)

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 111
Reconciling the pediatric requirements with the EHR model
May 2006
Norms
Pe DS SIG

Indicate normal range for items (lab values and
physical exam data) based on stage of sexual
maturity

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 112
Reconciling the pediatric requirements with the EHR model
May 2006
Parental Data Entry
Pe DS 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) ).

INCLUDED, noncontroversial

Reference number: 119
Reconciling the pediatric requirements with the EHR model
May 2006
Parental Data Entry
Pe DS 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.).

NOT INCLUDED, noncontroversial

Reference number: 121
Reconciling the pediatric requirements with the EHR model
May 2006
Parental Data Entry
Pe DS 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 patientoriginated data for use by care providers.).

INCLUDED, noncontroversial

Reference number: 118
Reconciling the pediatric requirements with the EHR model
May 2006
Parental Data Entry
Pe DS 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 ).

INCLUDED if we make minor mods in a CC

Reference number: 122
Reconciling the pediatric requirements with the EHR model
May 2006
Parental Data Entry
Pe DS 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 ).

INCLUDED if we make minor mods in a CC

Reference number: 123
Reconciling the pediatric requirements with the EHR model
May 2006
Parental Data Entry
Pe DS SIG

Allow designation of a given patient as competent
to enter his or her own information at a point
selected by the clinician

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 117
Reconciling the pediatric requirements with the EHR model
May 2006
Parental Data Entry
Pe DS SIG

Permit oversight by parents of the patient entered
information

Closest conformance criterion: N/A (May be to illdefined in this form).

NOT INCLUDED, noncontroversial

Reference number: 120
Reconciling the pediatric requirements with the EHR model
May 2006
Patient Identification
Pe DS 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. ).

INCLUDED, noncontroversial

Reference number: 129
Reconciling the pediatric requirements with the EHR model
May 2006
Patient Identification
Pe DS 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. ).

INCLUDED, noncontroversial

Reference number: 132
Reconciling the pediatric requirements with the EHR model
May 2006
Patient Identification
Pe DS 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. ).

Possibly included, controversial

Reference number: 125
Reconciling the pediatric requirements with the EHR model
May 2006
Patient Identification
Pe DS 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. ).

NEEDS NEW CC IN THIS FUNCTION

Reference number: 124
Reconciling the pediatric requirements with the EHR model
May 2006
Patient Identification
Pe DS 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. ).

NEEDS NEW CC IN THIS FUNCTION

Reference number: 126
Reconciling the pediatric requirements with the EHR model
May 2006
Patient Identification
Pe DS 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. ).

NEEDS NEW CC IN THIS FUNCTION

Reference number: 128
Reconciling the pediatric requirements with the EHR model
May 2006
Patient Identification
Pe DS SIG

Allow entry of temporary ID numbers, which can
be replaced with more formal identification number
systems

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 127
Reconciling the pediatric requirements with the EHR model
May 2006
Patient Identification
Pe DS 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

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 133
Reconciling the pediatric requirements with the EHR model
May 2006
Patient Identification
Pe DS 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)).

NEEDS NEW CC IN THIS FUNCTION

Reference number: 130
Reconciling the pediatric requirements with the EHR model
May 2006
Patient Identification
Pe DS 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)).

NEEDS NEW CC IN THIS FUNCTION

Reference number: 131
Reconciling the pediatric requirements with the EHR model
May 2006
Pedigree
Pe DS SIG

Allow construction of graphical patient pedigrees

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 134
Reconciling the pediatric requirements with the EHR model
May 2006
Preferences
Pe DS 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.).

INCLUDED, noncontroversial

Reference number: 135
Reconciling the pediatric requirements with the EHR model
May 2006
Preferences
Pe DS 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).

INCLUDED, noncontroversial

Reference number: 136
Reconciling the pediatric requirements with the EHR model
May 2006
Prenatal
Pe DS SIG

Allow creation of a record of a patient before the
patient’s birth

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 137
Reconciling the pediatric requirements with the EHR model
May 2006
Prenatal
Pe DS SIG

Allow the retention of data related to prenatal
procedures within the record of the patient
postnatally

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 138
Reconciling the pediatric requirements with the EHR model
May 2006
Privacy
Pe DS 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).

INCLUDED if we make minor mods in a CC

Reference number: 144
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
Privacy

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).

Possibly included, controversial
Reconciling the pediatric requirements with the EHR model

Reference number: 142
May 2006
Privacy
Pe DS 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.).

INCLUDED if we make minor mods in a CC

Reference number: 140
Reconciling the pediatric requirements with the EHR model
May 2006
Privacy
Pe DS 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).

Possibly included, controversial

Reference number: 145
Reconciling the pediatric requirements with the EHR model
May 2006
Privacy
Pe DS 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. ).

INCLUDED, noncontroversial

Reference number: 139
Reconciling the pediatric requirements with the EHR model
May 2006
Privacy
Pe DS SIG

In cases of care given to patients during
adolescence, offer reminders based on diagnoses
of the need for special privacy handling

Closest conformance criterion: N/A (N/A).

NOT INCLUDED, noncontroversial

Reference number: 141
Reconciling the pediatric requirements with the EHR model
May 2006
Privacy
Pe DS 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
().

NOT INCLUDED, noncontroversial

Reference number: 143
Reconciling the pediatric requirements with the EHR model
May 2006
Registries
Pe DS SIG

Allow linkage to registries maintained in the public sector

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)).

INCLUDED, noncontroversial

Reference number: 146
Reconciling the pediatric requirements with the EHR model
May 2006
Registries
Pe DS SIG

Exchange data with newborn metabolic screening registries

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)).

INCLUDED, noncontroversial

Reference number: 147
Reconciling the pediatric requirements with the EHR model
May 2006
Registries
Pe DS SIG

Exchange data with other public health registries of relevance
to children

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)).

INCLUDED, noncontroversial

Reference number: 148
Reconciling the pediatric requirements with the EHR model
May 2006
Registries
Pe DS SIG

Exchange immunization data with immunization registries

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)).

INCLUDED, noncontroversial

Reference number: 149
Reconciling the pediatric requirements with the EHR model
May 2006
Registries
Pe DS 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.

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)).

INCLUDED, noncontroversial

Reference number: 151
Reconciling the pediatric requirements with the EHR model
May 2006
Registries
Pe DS SIG

Provide a linkage of adverse drug reactions in children to
feed national databases involving the Safe Pharmaceutical
Act for Children

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)).

INCLUDED, noncontroversial

Reference number: 152
Reconciling the pediatric requirements with the EHR model
May 2006
Registries
Pe DS SIG

provide data fields that allow information (potentially coded)
that is then passed to another data based to link
epidemiologic database

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)).

INCLUDED, noncontroversial

Reference number: 153
Reconciling the pediatric requirements with the EHR model
May 2006
Registries
Pe DS SIG

Report adverse drug reactions

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)).

INCLUDED, noncontroversial

Reference number: 154
Reconciling the pediatric requirements with the EHR model
May 2006
Registries
Pe DS 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?

Reference number: 150
Reconciling the pediatric requirements with the EHR model
May 2006
Reports
Pe DS 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. ).

INCLUDED, noncontroversial

Reference number: 157
Reconciling the pediatric requirements with the EHR model
May 2006
Reports
Pe DS SIG

Provide communications to pediatric providers,
including physicians, nurse practitioners, school
nurses, developmental and behavioral health
providers.

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. ).

INCLUDED, noncontroversial

Reference number: 158
Reconciling the pediatric requirements with the EHR model
May 2006
Reports
Pe DS SIG

Provide discharge summary documents for parents
and guardians

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. ).

INCLUDED, noncontroversial

Reference number: 159
Reconciling the pediatric requirements with the EHR model
May 2006
Reports
Pe DS SIG

Provide treatment plans to parents and guardians

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. ).

INCLUDED, noncontroversial

Reference number: 162
Reconciling the pediatric requirements with the EHR model
May 2006
Reports
Pe DS SIG

Support generation and maintenance of summary
reports for parents

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. ).

INCLUDED, noncontroversial

Reference number: 163
Reconciling the pediatric requirements with the EHR model
May 2006
Reports
Pe DS 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 enduser system as it is a function of the data repository reportwriting application.).

INCLUDED, noncontroversial

Reference number: 155
Reconciling the pediatric requirements with the EHR model
May 2006
Reports
Pe DS SIG

Provide flexibility to change the reports per
changing requirements

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.).

INCLUDED, noncontroversial

Reference number: 160
Reconciling the pediatric requirements with the EHR model
May 2006
Reports
Pe DS SIG

Provide reports based on pediatric quality
measures to quality monitoring organizations

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.).

INCLUDED, noncontroversial

Reference number: 161
Reconciling the pediatric requirements with the EHR model
May 2006
Pe DS SIG
Reports

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.).

INCLUDED, noncontroversial
Reconciling the pediatric requirements with the EHR model
May 2006
Research
Pe DS 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. ).

INCLUDED, noncontroversial

Reference number: 164
Reconciling the pediatric requirements with the EHR model
May 2006
Telehealth
Pe DS 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).

INCLUDED, noncontroversial

Reference number: 165
Reconciling the pediatric requirements with the EHR model
May 2006
Telehealth
Pe DS 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).

INCLUDED, noncontroversial

Reference number: 166
Reconciling the pediatric requirements with the EHR model
May 2006
Telehealth
Pe DS 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).

NOT INCLUDED, noncontroversial

Reference number: 167
Reconciling the pediatric requirements with the EHR model
May 2006
Terminology
Pe DS 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.).

NOT INCLUDED, noncontroversial

Reference number: 168
Reconciling the pediatric requirements with the EHR model
May 2006
Terminology
Pe DS SIG

Support terminology systems specifically designed
for use in pediatrics

Closest conformance criterion: Nonsensical; no
such terminoligy systems exist ().

NOT INCLUDED, noncontroversial

Reference number: 169
Reconciling the pediatric requirements with the EHR model
May 2006
Vocabulary
Pe DS SIG

Allow recording of immunization status (current
versus delayed) in summary lists

Closest conformance criterion: N/A (N/A).

VOCABULARY ISSUE: …

Reference number: 170
Reconciling the pediatric requirements with the EHR model
May 2006
Vocabulary
Pe DS SIG

Allow recording of educational status in summary
lists

Closest conformance criterion: N/A (N/A).

VOCABULARY ISSUE: …

Reference number: 171
Reconciling the pediatric requirements with the EHR model
May 2006
Vocabulary
Pe DS SIG

Allow the recording of developmental assessments
in summary lists

Closest conformance criterion: N/A (N/A).

VOCABULARY ISSUE: …

Reference number: 172
Reconciling the pediatric requirements with the EHR model
May 2006
Vocabulary
Pe DS SIG

Allow the recording of health maintenance status
as part of summary lists

Closest conformance criterion: N/A (N/A).

VOCABULARY ISSUE: …

Reference number: 173
Reconciling the pediatric requirements with the EHR model
May 2006