Copyright 2009, Children’s Hospitals Neonatal Database – All Rights ReservedIn affiliation with Child Health Corporation of America

Neonatal Care ReportClinical Document Architecture (CDA)Release 2 ∙ Version 3

Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America

Children’s Hospitals Neonatal Consortium (CHNC)

2

Background & Rationale collaborative of 24 children’s hospital Neonatal ICUs multidisciplinary initiative, started in 2006 limited knowledge about best practices & outcomes for the

unique population of infants in tertiary NICUs:

Neonatal Care Report

complex & uncommon neonatal diseases preterm infants with co-morbidities/complications ill term infants requiring emergent intervention

e.g., ECMO, surgery, dialysis congenital anomalies genetic & metabolic syndromes

typically referred for surgical and other subspecialty care

Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America

3

Aims of the Initiative: To evaluate & optimize the tertiary neonatal intensive care

provided at children’s hospitals determine variations in care evaluate efficacy of current practices promote safety & facilitate research efforts spearhead benchmarking & quality improvement initiatives

CHNC Mission

Neonatal Care Report

ultimately improve clinical outcomes

Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America

CHNC Partnership with Child Health Corporation of America (CHCA) In 2008, CHNC partnered with CHCA, a business alliance of 43

leading children’s hospitals Developed a comprehensive clinical database:

Children’s Hospitals Neonatal Database (CHND)

4Neonatal Care ReportDevelopment of Database - CHND

Establishment of a Core Data Set In 2009, CHNC/CHCA completes specifications for a core data

set of about 700 defined data fields Data collection primarily manual abstraction from current

systems of clinical documentation (costly)

Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America

Children’s Hospitals Neonatal Database Participants

5

AtlantaBirmingham

BostonChicago

ColumbusCincinnati

DallasDetroitDenver

Fort Worth Houston

Kansas CityLittle Rock

Los AngelesMemphis (Le Bonheur)OaklandPhiladelphiaPittsburghSt. LouisSan DiegoSalt Lake CitySt. PetersburgWashington, DCWilmington, DE

*13 additional CHCA hospitals and 8 non CHCA sites considering future participation.

Neonatal Care Report

Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America

Messaging a Subset of DataEmploying HL7 standards to facilitate electronic extraction HL7 Clinical Document Architecture (CDA) Release 2

Selection of Subset of Data Elements for the NCR unambiguous data fields, well established standards present in majority of centers (varied stages of EHR development)

6Neonatal Care Report (NCR)

Demographic data• Name, MRN, Maternal ZipBirth Data • Birth weight• Gestational Age • Apgar scores (1, 5, prolonged)Admission/Discharge Information• Dates• Measurements (weights, head circ.)

Acuity Scoring• severity of illness assessment • derived from existing mortality models:

• Pediatric Risk of Mortality: PRISM-III• Pediatric Index of Mortality: PIM-II• Clinical Risk Index for Babies: CRIB-II • Score for Neonatal Acute Physiology: SNAPPE II

• Predominantly laboratory and physiologic data• Scored at several intervals

• 1st 12 hours, Day 3, Day 7 of admission

Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America

Working Group ContributorsCo-Chair/Co-Editor: Robert H. Dolin, MD

Semantically Yours, LLCbobdolin@gmail.com

Co-Chair/Co-Editor: Liora AlschulerAlschuler Associates, LLCliora@alschulerassociates.com

Co-Chair: Calvin BeebeMayo Cliniccbeebe@mayo.edu

Co-Chair: Keith W. BooneGE Healthcarekeith.boone@ge.com

Primary Editor: Gay Giannone, MSN RNAlschuler Associates, LLCgay@alschulerassociates.com

Co-Editor: Joy Kuhl, MBA, CPFPrincipal | Optimal Accords, LLCjoy@optimalaccords.com

Co-Editor: Michael A. Padula, MDNeonatologist, Clinical InformaticistThe Children's Hospital of Philadelphiapadula@email.chop.edu

Co-Editor: Feliciano Yu, M.D.Information Technology Division Pediatrics Professor University of Alabama at Birmingham School of Medicinefyu@peds.uab.edu

Co-Editor: David J. Durand, MDDirector, Division of NeonatologyChildren's Hospital and Research Center Oaklandddurand@mail.cho.org

Co-Editor: Karna Murthy, MDNeonatologist, Children's Memorial HospitalAssistant Professor of PediatricsNorthwestern Universityk-murthy@northwestern.edu

Co-Editor: Jacqueline KueserVice President, Strategy/R&DChildren’s Hospitals Corporation of America jacqueline.kueser@chca.com

  Co-Editor: Kirk ElrodCHCA IT Liaison/Business AnalystChildren’s Hospitals Corporation of America kirk.elrod@chca.com

 

Current Working Group also includes: Kate Conrad, Bobby George, Andy Spooner David Muraco, Diane Ward Celeste Milton, Jean Millar Ann WattShaun Shakib Sandy Stuart Brett Marquard Jingdong (JD) Li Anneke Goossen William GoossenTeresa Finitzo

7Neonatal Care Report