Pediatric Informatics: Computer Applications in Child Health (Health ...

32 Developing Pediatric Data Standards 423
public commentary and balloting before final acceptance and publication. CCHIT
originally developed as a coalition of three organizations, the American Health
Information Management Association (AHIMA), the Healthcare Information and
Management Systems Society (HIMSS) and The National Alliance for Health
Information Technology (Alliance), which came together in 2004 to create a certification
organization. In September 2005, the US Government Department of
Health and Human Services awarded CCHIT a 3-year contract to develop objective
criteria and a process for certifying EHR systems. In 2006, CCHIT released its first
directory of certified EHR systems, and since then, the certification criteria and
listing of certified vendors have evolved as SDOs have expanded lists of functional
standards.
32.5 Case Study: Pediatric Growth Chart Standards
Let us explore the role of standards as they pertain to a real case. At Vanderbilt
University Medical Center (VUMC), developers elected to add pediatric growth
charts to the institutional EHR system in 2002. In 2002, there were no clear standards
for how developers should create growth charts in EHR systems, and there were
no lists of the tasks and features that they should cover. While the AAP had published
in 2001 its “Special Requirements for Electronic Medical Record Systems in
Pediatrics,” this document only provided high-level standards for growth charts
in EHR systems. In addition, at that time VUMC hosted several locally developed
and commercial EHR system components, including a standalone inpatient computerized
provider order entry (CPOE) system and an integrated electronic nursing
intake form in which nurses could enter patient vital signs and measurements.
While users could enter patient measurements, such as patient weight, in any of the
systems, the values were not encoded the same way across systems and not all data
were shared among systems.
To create EHR system-based growth charts, the VUMC developers needed to
develop or adopt standards to allow growth data to be shared among EHR system
components. The standards included content, syntactic, and semantic standards.
The content standards were developed by a team that included practicing general
pediatricians and pediatric subspecialists, informaticians, and software engineers.
The content standards were expanded from those previously defined by the
AAP, and specified that EHR system based growth charts should have the ability
to record height, weight, and head circumferences; to plot these data against
population-based curves such as those published by the United States Centers for
Disease Control and Prevention (CDC) and its National Center for Health Statistics
(NCHS); to adjust the normative curves based on patient age, gender, and possibly
other demographic or diagnostic features; to calculate body mass index (BMI) and
population-based percentiles; and to integrate into a busy clinical practice, among
others. The complete list of growth chart specifications is in Table 32.3.