IHE QRPHMaternal and Child Health

IHE Webinar SeriesLori Fourquet e-HealthSign LLC

Maternal and Child Health Content

• Health at Birth Summary (HBS) content profile containing a summary of all the information impacting on the newborn’s health status evaluation as presented in the birth certificate.

• Child Growth Summary (CGS) content profile representing information about the child’s development (medical and social conditions) that can be submitted to health authorities for possible intervention or general epidemiological studies.

Maternal and Child Health Profile

• Value Proposition– Allow for communications of vital records through

electronic EHR sources:• Birth Certificate• Fetal Death Certificate• Health Certificate at Birth• Health Certificate at Nine Months• Health Certificate at Two Years

– Minimize duplicate data entry– Improve efficiency and accuracy

US Extension

• Use Retrieve Form For Data Capture• Provides specific mapping to US Vital Records

Forms and Data Elements• Provides Value sets supporting the mapping

IT Infrastructure Components Supporting Public Health

• Cross-Enterprise Document Sharing (XDS)• Cross-Enterprise Document Reliable Interchange (XDR)• Cross-Enterprise Document Media Interchange (XDM)• Patient Identifier Cross Reference Manager (PIX)• Patient Demographics Supplier (PDQ) • Pediatric Demographics Option (PDO)• Retrieve Form for Data Capture (RFD)• Audit Record Repository (ATNA)• Time Server (CT)• Personnel White Pages (PWP)• Cross-Enterprise User Assertion (XUA)• Cross Community Access (XCA)• Basic Patient Privacy Consents (BPPC)• Cross-enterprise Sharing of Scanned Documents (XDS-SD)• Document Digital Signature (DSG)• Enhanced Sharing Value Sets (ESVS)• Document Metadata Subscription (DSUB)• Multi-Patient Queries (MPQ)

• Sharing Value Sets • Addresses synchronization of content terminologies across applications• Key to semantic interoperability for quality, research and public health

analysis.• Supports communication of value set groups supporting specific functions

(e.g. Value Sets associated with Vital Records data pre-population

• Retrieve Form for Data Capture• Supports integration of form-based data capture directly within the EHR• Supports communication of Routine EHR-generated HL7 CDA Structured

Clinical Documents to enable pre-population of form data delivered to the user via the EHR interface

• XDS/XDM/XDR• Supports communication of CDA document with Vital Records Content

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MCH Infrastructure Profiles Supporting Public Health

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Vital Records Birth and Fetal Death Data Capture

Form Filler

Form Manager

Retrieve Form [ITI-34] along with pre-population data

Continuity of Care Document (CCD)

Form

Delivery of Form along with pre-population data bound to the form

Labor & Delivery Document

LDR + DE Birth/FD MessageXSLT

Reference ImplementationForm Manager

Form Receiver

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PCC ProfilesMedical Summaries

Emergency Department

Referral

ExchangingPHR

Content

AntepartumCare

Summary

EmergencyDepartmentEncounter Summary

FunctionalStatus

Assessments

2005-062005-062006-072006-072007-082007-082008-09 2008-09 2009-102009-10

Int

egra

tion

Cont

ent

Query for Existing Data

AntepartumRecord

ImmunizationRegistryContent

Care ManagementRequest for

Clinical Guidance

Labor and Delivery Record

Patient Plan of Care

EMS Transfer of

Care

Antepartum Record ScopeElectronically share data related to antepartum care between systems found in settings such as:

• Ambulatory offices• Specialists offices• Hospitals/birthing facilities

Antepartum Record Profile Abstract• APR is a folder of content profiles that contains the record

of antepartum care including:

• Antepartum History and Physical• Antepartum Summary• Antepartum Laboratory• Antepartum Education

Labor and Delivery Record

• The LDR Profile provides information to the health care providers about the labor and delivery and the newborn in an in-patient setting

• Useful for – Transfers of care in the in-patient setting (OR or NICU)– Post-partum outpatient care– Pre-population of Birth/Fetal Death Certificate

(QRPH)

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Maternal Child Health• Content profile describes to automating data

capture in vital records such as the birth certificate or early childhood health certificates.

• Pre-populate certificate with data from the EHR• Submit certificate to interested organizations– Retrieve Form for Data Capture (RFD)– Uses transactions and content modules defined in

other IHE profiles to provide interoperable data exchange.

– Provides value sets supporting data mining of Labor and Delivery Documents for form pre-population

• Provides Specific Rules to pre-populate US Birth and Fetal Death Certificate forms from the IHE-PCC Labor and Delivery Document

• Detailed value sets are provided supporting this US-specific data mapping that may be utilized for multiple national extensions

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Maternal Child Health: US National Extension

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Maternal Child Health

MCH US National Extension: Pre-population Rules

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US Attri-bute code

Birth

FD

Form Data

Element

Definition Derivation Rule

MCH Code Value sets

APGAR5

Y N Apgar Score: 5 Minute

A systematic measure for evaluating the physical condition of the infant at specific intervals following birth. Enter the infant’s Apgar score at 5 minutes.

If (Result Type CONTAINS ValueSet (5 Min Apgar Score)), THEN “APGAR5” = (Result Value)

Newborn Delivery Information1.3.6.1.4.1.19376.1.5.3.1.1.21.2.4Coded ResultsResult Type 1.3.6.1.4.1.19376.1.5.3.1.3.28

MCH HBS 5 Min Apgar Score Value Set1.3.6.1.4.1.19376.1.7.3.1.1.13.8.12

Newborn Delivery Information1.3.6.1.4.1.19376.1.5.3.1.1.21.2.4Coded ResultsResult Value1.3.6.1.4.1.19376.1.5.3.1.3.28

MECS Y N Characteristics of labor and delivery: Meconium staining

Moderate or heavy meconium staining of the amniotic fluid Staining of the amniotic fluid caused by passage of fetal bowel contents during labor and/or at delivery that is more than enough to cause a greenish color change of an otherwise clear fluid. Information about the course of labor and delivery.

IF (Problem Code CONTAINS ValueSet (MCH HBS Meconium staining Value Set) THEN “MECS” SHALL = “Y” LSE “N”E

Labor and Delivery1.3.6.1.4.1.19376.1.5.3.1.1.21.2.3 Active ProblemsProblem Code 1.3.6.1.4.1.19376.1.5.3.1.3.6

MCH HBS Meconium staining Value Set1.3.6.1.4.1.19376.1.7.3.1.1.13.8.36

Potential Demonstration Scenario

Scene Description Profiles/ Constructs

PCP Mother is seen by OB/GYN for care during Pregnancy Antepartum Record, XDS,

Hospital of Birth

Mother delivers child. Labor and Delivery Report is generated and used to pre-populate the Birth Certificate Request.

LDR, RFD

Public Health (VR)

The Birth Certificate is Received by Public Health Vital Records. Form Manager is reviewed including interface with CDC hosted Value Sets supporting the pre-population. Data is sent routinely to CDC over the NHIN

RFD, ESVS, LDR, NHIN Connect

CDC CDC receives routine birth certificate information from all states. Statistic for US Births are conducted to monitor the health status of the population.

NHIN Connect

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Questions?

Lori Fourquetlfourquet@ehealthsign.com