SDOs support the generation and production of communication, usability, and functional requirements standards for healthcare industry stakeholders. SDOs for healthcare that might find the 2015 Priority List, useful include: HL7, ANSI and NIST. The list can serve as a guide when developing technical and workflow specifications as well as functional requirements such as prescribing rules, care guidelines, clinical workflow best practices, clinical content specifications, end user usability design and testing methods, among others. The scope of the standards may vary from terminology work to domain analysis models.
The 2015 Priority List for the Children’s EHR Format may help to highlight important gaps in current standards and opportunities for standards development. Req-2001 calls for capture of birth data, since the standards for the child’s EHR do not match those advocated by ACOG for maternal prenatal records. There is an urgent need for better standards for birth data for infants and electronic messages or documents to share this data between the birth hospital and ambulatory setting. Req-2002 lists a comprehensive set of pediatric vital signs and growth data that should be maintained with necessary LOINC codes to support entry and sharing of this data. Req-2042 calls for a range of growth charts and there is great demand but very limited availability for specialized growth charts for special populations and specific diseases. Standards that have been used for the CDC and WHO growth charts could be applied to development of new growth charts that could be disseminated to vendors and implemented using the same tools suggested for currently available growth charts. Immunization messaging standards used in Req-2011 are very mature but vendors indicate that they are incomplete when it comes to transmission and security protocols for sending or receiving the existing standard messages with local immunization information systems (IIS) or registries. Work is needed to help vendors make standard immunization messages that are included in their EHR functional in any location with minimal configuration or testing beyond practice identification codes. This will require considerable advancement in standards so that an EHR that can communicate in one State can be expected to communicate immunization data in another State or be able to interact with multiple State registries when required. Req-2043 calls for reconciliation of immunization data between the practice EHR and the local IIS. More work is needed on standards to manage requests for changes and how to prevent obtaining the same error messages every time an immunization history is requested. Req-2043 calls for including many specialized scales and scoring in a child’s EHR and electronic standards are needed for distribution of this scales that can facilitate automated implementation in an EHR rather than custom programming. Req-639 calls for sharing of well-child preventive care guidelines from EPSDT (which can vary locally) and Bright Futures. Standards for sharing these guidelines in machine-readable form that can also be used to track compliance will require new standards development. Standards for sharing ACIP immunization guidelines have been developed and implemented at CDC but are too complex to implement in each EHR. This task is best delegated to an IIS or decision support server but standards are needed to share the recommendations of immunization forecasting and integrate this approach to remote clinical decision support for immunizations in child EHR.
If the SDOs adopt standards that support elements of the 2015 Priority List, then the specific child health requirements will be incorporated in the body of the standards or supported by the standards. When vendors of clinical systems follow the standards, then the end users will benefit from these functions. For example, if the 2015 Priority List describes the requirements for developmental screening for child health, SDOs such as HL7 can leverage this functionality and then develop a set of very granular functional requirements related to child health developmental screening that will complement the Children’s EHR Format developed through AHRQ/CMS.
SDOs usually promote standards by consensus methods. One of the barriers for encouraging SDOs to adopt elements of the 2015 Priority List is the limited participation of child health champions within the SDO. This can be overcome by 1) identifying existing SDOs with existing child health champions and promoting/sharing the 2015 Priority List, and 2) soliciting child health champions/stakeholders for relevant SDOs without pediatric champions. Child health stakeholders within the SDOs can then work within the SDO framework to develop relevant standards that support the 2015 Priority List.