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HL7 Pediatric Data Standards Special Interest Group Meeting Materials Town & Country Resort Hotel San Diego, CA Wednesday, September 14, 2005 09:00 AM PT – 05:00 PM PT PLEASE REVIEW IN ADVANCE HARD COPY AVAILABLE AT MEETING IF UNABLE TO ATTEND, PLEASE PARTICIPATE VIA CONFERENCE CALL (SEE AGENDA FOR DIAL-IN INFORMATION)

PLEASE REVIEW IN ADVANCE HARD COPY AVAILABLE AT … Sept 2005 WGM materials.pdf · PDSSIG Storyboard Workgroup. Objectives include inform PDSSIG about storyboard development and collect

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HL7 Pediatric Data Standards Special Interest Group Meeting Materials

Town & Country Resort Hotel San Diego, CA

Wednesday, September 14, 2005 09:00 AM PT – 05:00 PM PT

PLEASE REVIEW IN ADVANCE HARD COPY AVAILABLE AT

MEETING

IF UNABLE TO ATTEND, PLEASE PARTICIPATE VIA CONFERENCE CALL (SEE AGENDA FOR DIAL-IN INFORMATION)

Table of Contents

General Meeting Information Contents

1. Dinner Information 2. Agenda 3. Attendee List

Quarter 1 Objectives include PDSSIG business, national updates, subgroup updates. Contents

1. PDSSIG May 13, 2005 minutes “Out of Cycle” 2. Co-Chair Statement 3. Subgroup updates 4. Tracking Log

Quarter 2 Objectives include introduce Attachments Special Interest Group (ASIG) and PDSSIG activities, inform PDSSIG on how Clinical Document Architecture (CDA) can be used to develop attachment standards, introduce the Children’s Preventive Health Services (CPHS) initiative on electronic claims. Contents

1. Attachment Development Process presentation 2. CPHS Attachment

Quarter 3 National Child Health Data Standards (NCHDS). Objectives include understand role of NCHDS and identify opportunities for collaboration. Contents

1. Child Health Information Technology Standards Projects 2. NCHDS commissioned papers 3. NCHDS/HL7 domains

PDSSIG Storyboard Workgroup. Objectives include inform PDSSIG about storyboard development and collect input on draft Immunizations storyboard and activity diagram. Contents

1. Storyboard tutorial 2. Draft Immunization Registry storyboard and activity diagram

Quarter 4 Objectives are to inform each other on health care-related HL7 activities and discuss techniques being used (knowledge share and networking).

Dinner Meeting

Tuesday, September 13

6:30 PM PT

Café Pacifica An excellent restaurant in the midst of Old Town’s tourist hustle

has showcased fine seafood since 1980.

2414 Sand Diego Ave. San Diego, CA 92110

619.291.6666

Discussion Topic: marketing HL7 PDSSIG

Meet in hotel lobby at 6:15 PM PT to share a cab Or meet at the restaurant

If you plan to attend please email [email protected] by September 9

HL7 Pediatric Data Standards Special Interest Group Meeting Agenda

September 14, 2005 Town & Country Resort Hotel

San Diego, California 9:00 AM – 5:00 PM PT

(Continental Breakfast: 8:00 AM– 9:00 AM) HL7 Q1 Royal Palm 3 9:00 AM - 9:10 AM Welcome, introductions, review of agenda Andy Spooner/David Classen

Dial in Number: 866-365-4406 Passcode: 1436117 9:10AM – 9:20 AM Andy Spooner/David Classen/Kate Collins Approval of May 13, 2005 minutes Subgroup project scopes - approval National issues 2006 national ballot – Draft pediatric EHR standards Updates/Parking Lot Issues 9:20 AM– 09:30 AM Co-Chair Election HL7 9:30 AM– 10:30 AM Project Updates Toolkit for Pediatric EHR Standards Creation Aileen Sedman/Michael Miller Pediatric Use-Case/Storyboard Examples for the EHR Functional Requirements Pele Yu Pediatric EHR Requirements Mapping Andy Spooner/Joe Schneider Harmonize with TEPR/AAP TLC Andy Spooner/Joe Schneider 10:30 PM – 11:00 AM BREAK HL7 Q2 Pacific Salon 211:00 AM –12:30 PM Joint Meeting with Attachments SIG CDA modeling structure Wes Rishel/Penny Sanchez/Maria Ward 12:30 PM – 1:30 PM LUNCH & NETWORKING HL7 Q3 Royal Palm 31:30 PM – 2:00 PM Update on NCHDS Workgroup Lisa Simpson/Donna Ettel Survey results and technical panel content information 2:00 PM– 3:00 PM Review/discuss draft storyboard Feliciano Yu/Dan Russler 3:00 PM – 3:15 PM Review assignments Andy Spooner/David Classen Draft January WGM agenda 3:15 PM – 3:30 PM BREAK HL7 Q4 Terrace Salon 23:30 PM – 5:00 PM Joint Meeting with Patient Care, PHER, Patient Safety

NEXT WGM – JANUARY 8-13, 2006 Point Hilton Squaw Peak, Scottsdale, AZ

Meeting Attendee List

David Classen, M.D., M.S., SIG Co-Chair Associate Professor, University of Utah VP, First Consulting Group 561 E. Northmont Way Salt Lake City UT 84103 (888) 546-8746 (801) 596-3443 (fax) [email protected]

Andy Spooner, M.D., FAAP, SIG Co-Chair Director of Medical Informatics LeBonheur Children's Medical Center 50 North Dunlap Street Memphis TN 38103-2800 (901) 572-3292 (901) 572-5198 (fax) [email protected]

Noorullah Akhtar, M.D., MBI, FAAP Pediatirc Intensivist Medical Director of Information Systems Driscoll Children's Hospital 3533 South Alameda Street Corpus Christi TX 78411-1721 (361) 694-5445 (361) 694-5449 (fax) [email protected]

Noam H. Arzt, M.D. President HLN Consulting LLC 7072 Sante Fe Canyon Place San Diego, CA 92129 (858) 538-2220 (858) 538-2209 (fax) [email protected]

Lorna Dyk, R.N., M.B.A Director of Resource Management Services The Children's Hospital 1056 East 19th Avenue Denver CO 80218 (303) 864-5834 (303) 861-6963 (fax) [email protected]

Donna Lee Ettel, Ph.D. Research Associate University of South Florida Division of Child Health Outcomes 601 4th Street South, CRI 1008 Saint Petersburg, FL 33701 (727) 553-3673 (727) 553-3666 (fax) [email protected]

Terese Finitzo, Ph.D. Vice President Performance Support Services OZ Systems 2515 McKinney Avenue, Suite 850 Dallas TX 75201 (215) 631-6161 [email protected]

Michael Kahn, MD The Children's Hospital 1056 East 19th Avenue Denver CO 80218 [email protected]

Mitra Rocca Director, Pediatric Informatics, MIS National Association of Children's Hospitals & Related Institutions 703-797-6053 (direct) 703-519-8553 (fax) [email protected]

Dan Russler McKessonHBOC 601 East Corporate Drive Lewisville, TX 75057 (404)338-3418 [email protected]

Henry L. Shapiro MD FAAP Medical Director of Developmental-Behavioral Pediatrics All Children’s Hospital 801 6th St. South Saint Petersburg, FL 33701 727-767-8035 (mail) 727-767-8433 (direct) 727-767-4536 (research assistant, Melissa Johnson) [email protected]

Lisa Simpson, MB, BCh, MPH, FAAP Professor & All Children's Hospital Guild Endowed Chair in Child Health Policy Chief, Division of Child Health Outcomes University of South Florida Department of Pediatrics Associate Program Director, Pediatric Clinical Research Center, All Children's Hospital National Director, Child Health Policy National Initiative for Children's Healthcare Quality 601 Fourth Street South, CRI 1008 St. Petersburg, FL 33701 (727) 553-3672 (727) 553-3666 (fax) [email protected]

Ron VanDuyne Informatics CDC Immuniation Registry Support 961 Cumberland Road Atlanta, GA 30306 [email protected]\ [email protected]

Carl Weigle, M.D. Medical Director, Informatics, Children’s Hospital of Wisconsin 424 Grand Ave Mukwonago WI 53149 [email protected]

Feliciano Yu, M.D., FAAP, CPHIMS Children's Hospital of Alabama Center for Outcomes Effectiveness Research and Education (COERE) University of Alabama at Birmingham 1717 11th Avenue South, MT401 Birmingham, AL 35205-4731 (205) 934-6838 [email protected]

Kate Collins, FACHE, SIG Coordinator Vice President, Strategy Development Child Health Corporation of America 6803 West 64th Street, Suite 208 Shawnee Mission, KS 66202 (913) 262-1436 (913) 262-1575 (fax) [email protected]

May 13, 2005 “Out-of-Cycle” Meeting Minutes 08:30 AM – 13:00 PM EST

National Association of Children’s Hospitals and Related Institutions (NACHRI)

401 Wythe Street Conference Room 1

Alexandria, VA 22314

Meeting Participants: David Classen; Andy Spooner; Cheri Throop (Co-Chairs) Noorullah Akhtar; Nancy Anthracite; Hema Bisarya; Lorna Dyke; Phillip Gioia (phone); Gregg Lund; Michael Miller; Rick Moore; Jason Napora; Anna Orlova (phone); Ken Pool; Mitra Rocca; Joseph Schneider; Aileen Sedman; Henry Shapiro; Lisa Simpson (phone); Sam Walters; Carl Weigle; Feliciano Yu

Meeting Objectives: Set priorities for next projects

Draft charters Identify project champions Establish project timelines.

The meeting was called to order at 08:30 AM Eastern Time. Agenda Item #1: National Updates David led the group through a national update on ONCHIT, CCHIT, and other activities of interest related to data standards. Joe, a member of one of the CCHIT workgroups (see section 5 of meeting handout materials), explained this group’s timelines (September 2005) and urgency for our SIG to interface with this work. Based on discussion, the following motion was seconded and approved by those present. ACTION ITEM:

1) Map PDSSIG pediatric requirements for EHR to CCHIT requirements 2) Identify gaps based on this mapping process and incorporate into strategic plan

for years 2006-2008. David also shared that efforts are underway to certify IT products post implementation. Funded by AHRQ, Leapfrog Group, and Robert Wood Foundation, a flight simulator to evaluate the CPOE post implementation is under development. Agenda Item #2: Update on current grant-funded initiatives Hank updated the SIG on his developmental screening project to engineer a roadmap of clinical behavioral issues to guide appropriate data requirements. Lisa shared initial progress as the National Child Health Data Standards Workgroup, a two-year funded project, has been launched. Using our SIG’s prioritization results from January 2004, this group is working to identify clinical specific data standards (e.g. asthma). Technical panels are being formed and based on a comprehensive survey process; papers will be written for publication with a target completion date of October 2005. Lisa asked that the survey results and content information about the technical

1

panels be shared with SIG membership. Lisa plans to hand off their workgroup’s deliverables to our SIG. Another one-day meeting for this workgroup is planned in conjunction with the NICHQ Annual meeting in March 2006. Andy reiterated that AAP has taken the position that informatics will be integrated into each of their guidelines as a new strategic imperative. Aileen suggested we consider developing a template tool for subspecialties to use in identifying critical pediatric requirements for the EHR following the same process steps our SIG used. There was a motion and approval of this recommendation. ACTION ITEM:

3) Create a toolbox including templates for pediatric and other specialties to identify pediatric requirements for the EHR.

Agenda Item #3: EHR-S Project and Beyond Andy shared the PowerPoint presentation he presented to EHR-TC in January. He also shared the outcome of the April 20th conference call including official delivery of the pediatric functional requirements to both the EHR-TC and Patient Care TC. There has been no feedback from either group post Netherlands meeting at this time. As requested by both the EHR and Patient Care TCs, our SIG will provide whatever expertise and assistance needed as the refinement process proceeds ahead of the official 2006 HL7 balloting process. Next steps beyond the pediatric functional requirements were discussed including storyboards, use case scenarios, and how to make the document more user-friendly for vendors, others. Based on the examples included in the current EHR pediatric requirements document, a project is proposed to develop storyboards and send these as scenarios to CCHIT as reference documents. ACTION ITEM: 4) Develop storyboards (use case) based on examples included in current HER pediatric requirements for submission to CCHIT. Joe and Andy updated the SIG on TEPR/AAP TLC harmonization efforts. The SIG recommended that mapping be performed using our pediatric EHR requirements. ACTION ITEM: 5) Harmonize Pediatric EHR requirements and TEPR/AAP TLC. Aileen identified the continued gap between what is coded through the hospital HIM department process versus what is transmitted via tapes, etc. to vendors. Vendors are not required to accept all codes linked to each patient’s hospital encounter due to individual state and other requirements; thus coding information transmitted is often incomplete. This may have a significant impact, particularly related to E coding nomenclature used to identify adverse events. Aileen and Lorna have agreed to champion developing an advocacy statement for possible submission to CMS, AHIMA, others to address this disparate practice.

2

ACTION ITEM: 6) Develop a statement regarding standardized transmission of all ICD-9 codes linked to patient encounters. Agenda Item #4: Public Health SIG Ken Pool and Anna Orlova provided an update on their SIG’s activities and possible interface with the PDSSIG, in particular birth registries and the EHR. Discussion ensued related to PHRs. Cross-mapping capabilities of clinical data with public health data for children at 2 days of life forward (e.g. newborn screening; hearing screening; immunizations) was identified as a critical component. Anna will send a copy of the Public Health EHR requirements (white paper) for dissemination to PDSSIG members. Ken recommends our SIG devote time at the September WGM to public health. Ken will be the key contact and assist in arranging time and key linkages. ACTION ITEM:

7) Public Health SIG representatives to meet with PDSSIG during September 2005 meeting.

Agenda Item #5: CDA clinical specifications Andy walked the SIG through the HL7-approved Children’s Preventive Health Services (CPHS) Attachment document provided by Penny Sanchez. The work to develop this product was launched well before our PDSSIG was formed. Questions regarding how to link our SIG with pediatric efforts like this surfaced including how those working on CDAs such as this one seek input from clinical specialties including clinician approval processes. Everyone agreed further education on the CDA process outlined in this document is a critical next step. Penny Sanchez has already agreed to present to the PDSSIG during the September WGM. Andy stressed the importance of responding to the CPHS when balloted by HL7. Joe described the CCR as the generic tool where there are gaps in the current HL7 approved documents. CDA is the structure. NCQA is using CDA modeling for their current measure requirements. SIG members are encouraged to keep apprised of these activities. Agenda Item #5: Marketing General consensus was reached that our SIG needs to publish what we have learned from our first product deliverable. Vendors need to be informed that this product is immediately available for their use. Although organizations represented within our SIG may understand this, the message may not be getting to the vendors who are not participating. This will be added as an agenda item for the September WGM.

3

HOMEWORK ASSIGNMENTS: Project: Map Pediatric EHR Requirements to CCHIT Requirements Target Completion Date: September 2005 Project Champions: Andy Spooner/Joe Schneider Participants: Aileen Sedman David Classen Nancy Anthracite First Project Deliverable: Complete Project Charter (July) Project: Create a toolbox including templates for pediatric and other specialties to identify pediatric requirements for the EHR Target Completion Date: TBD Project Champions: Michael Miller; Aileen Sedman Participants: Noorullah Akhtar Feliciano Yu Sam Walters Mitra Rocca First Product Deliverable: Complete Project Charter (July) Project: Create storyboards (use case) from the existing examples of the EHR pediatric requirements for submission to CCHIT. Target Completion Date: TBD Project Champion: Feliciano Yu Participants: Terese Finitzo Anna Orlova Noorullah Akhtar First Product Deliverable: Complete Project Charter (July) Project: Harmonize Pediatric EHR requirements and TEPR/AAP TLC Target Completion Date: TBD Project Champions: Andy Spooner; Joe Schneider Participants: First Product Deliverable: Complete Project Charter (July)

4

HL7 Co-chair Election Nominees September 14, 2005

Pediatric Data Standards

• Kate Collins, CHCA - The Pediatric Data Standards SIG (PDSSIG) is our unique opportunity to ensure evidence-based pediatric clinical practice and standards are translated into clinical information systems as the means for child health care professionals to meet the healthcare needs of infants, children, and adolescents. Because this universal capability does not currently exist, defining pediatric data standards required for the interchange of standardized pediatric requirements is our "new frontier" and one I am proud to be part of through the efforts of our SIG. As our charter so explicitly describes, our SIG is accountable to contribute the following to HL7 processes:

• Identify critical pediatric-specific data standards necessary for standardized quality and outcomes reporting and measuring

• Identify and promote required terminology to support reporting and measurement

• Create nomenclature lexicon to meet vendor and clinical decision support needs

• Coordinate and cooperate with other groups interested in using pediatric data standards

• Enable and promote use of these standards nationally

We have a huge road ahead, and an exciting one. In my current role as Vice President, Performance Improvement, CHCA, I have the opportunity to work collaboratively with 42 children's hospitals, including multiple national and international organizations representing the interests of children and children's healthcare, to advance quality and safety practices. I am proud to be a part of HL7 and work yet to be accomplished.

HL7 PDSSIG Subgroup Update: Pediatric use-case/storyboard examples for the EHR functional

requirements (Project # 200500049)

Project Timeline June 1, 2005 to September 30, 2005

Project champion Subgroup Feliciano “Pele” Yu Noorullah Akhtar Noam Arzt Terese Finitzo Steve Lawless Rob Savage Ron Van Duyne Anna Orlova Project Description Create a storyboard(s) to describe the interaction between the primary elements or "actors" (i.e., patient, physician, etc) and processes or "use-cases" (i.e., making an appointment, ordering medical tests, etc) that form the system or application (i.e., well baby check, ER visit). Project Objective(s) (a) Identify and create a storyboard(s) that depict a typical pediatric event described in the EMR functional standard. (b) Develop documentation of the storyboard process to serve as a template for future use. Major Milestones (Meetings on June 6, June 23, July 19, August 10 and August 24) Determined area of focus for Storyboard will be Immunizations Received an overview from Dan Russler on the objectives and process of Storyboard development Determined objective of subgroup was to produce Storyboard for HL7 engineers (CCHIT has interest

in this work because their objective is to certify software) Launched and utilized a collaborative electronic work space (CHCA’s SharePoint beta-teamsite) to

work more effectively/efficiently on Storyboard and Activity Diagram Drafted Immunization Storyboard and Activity Diagram for PDSSIG input

U:\~Production Center\HL7\Tab 2 - Quarter 1\2c HL7 PDSSIG Storyboard Project Update 091405.doc

HL7 PDSSIG Subgroup Update: Pediatric EHR Requirements Mapping

(Project 200500050) Timeline June 1, 2005 to September 30, 2005

Project champions Subgroup Andy Spooner Aileen Sedman Joe Schneider David Classen Nancy Anthracite

Mitra Rocca Project Description Part One -- Map the Pediatric EHR requirements to the Certification Commission for Healthcare Information Technology (CCHIT) present draft requirements. Part Two -- Perform a gap analysis between the two documents. Part Three -- Submit the missing pediatric requirements to the CCHIT for potential inclusion in their equirements for vendors to fulfill to have a complete EHR. r

Project Objective(s) 1) Provide a mapping of the Pediatric EHR document to the CCHIT EHR document. 2) Provide a comprehensive list of pediatric EHR requirements that are not presently included in the

CCHIT Requirements document (ie a gap analysis). 3) Produce a document on the CCHIT template that lists the pediatric requirements that the PDSSIG

feels are critical for EHR certification and have members review to achieve consensus. 4) Submit completed document to CCHIT Major Milestones Mapped PDSSIG EHR standards to CCHIT (June) PDSSIG Subgroup review of mapping (June/July) Submitted project scope to Patient Care Technical Committee (July)

U:\~Production Center\HL7\Tab 2 - Quarter 1\2d HL7 PDSSIG EHR Requirements Project Update 091405.doc

HL7 PDSSIG Subgroup Update:

Toolkit for Pediatric EHR Standards Creation (Project 200500048)

Timeline June 1, 2005 to September 30, 2006

Project champions Subgroup Aileen Sedman Noorullah Akhtar Michael Miller Mitra Rocca Sam Walters

Feliciano Yu Project Description The PDSSIG will produce a document which describes the methodology for creating EHR requirements that any clinician group could use to further extend EHR requirements that fits their particular needs. For example Pediatric Cardiac Surgeons would potentially require special terminology to store and recreate cardiac echocardiogram information, specific anatomic descriptions, or anatomical diagrams. This project would elucidate the steps needed by any subspecialty or clinical group to assess requirements, configure them into the template previously used by the PDSSIG, and show how to submit them to the EHR committee. Project Objective Produce a document which would describe the process of creating EHR requirements, enter them into the EHR template, and submit them to the EHR Committee. This would encourage subspecialty groups to work on appropriate EHR requirements, a long-term HL7 goal, by providing a standard process within the HL7 framework, versus having each subspecialty recreate the process.

U:\~Production Center\HL7\Tab 2 - Quarter 1\2e HL7 PDSSIG Toolkit Project Update 091405.doc

Pediatric Data Standards Special Interest Group Tracking Log (8/30/05):

ITEM: Responsible Party:

Date Initiated

Date Closed

Additional Comments:

Finalize education day Cheri Throop November 14, 2003

CLOSED

2/15/04

April 13, 2004 in San Antonio

Recruitment All SIG members November 14, 2003

ONGOING Formal letter to FDA (David/Andy) -See 1/19/04 minutes for specialty members still needed. 2/27/04: Efforts to enroll international pediatrician participant underway 3/31: Andy/Cheri develop draft brochure (COMPLETED) 5/3: Recruitment continues; need for international representation.

Request Liora Alshuler to attend May 3, 2004 meeting

Cheri Throop January 19, 2004

CLOSED 5/3/04

2/27: Liora has agreed to present 4/20/04: Follow up with Liora

Request Clem McDonald to attend May 3, 2004 meeting

Paul Biondich January 19, 2004

CLOSED 5/3/04

4/20/04: Communication to Paul regarding Clem’s availability. 4/25/04: Paul contacted Stan Huff who will be presenting at our meeting.

Request Clinical Decision Support SIG presentation at May 3, 2004 meeting

Cheri Throop December 22, 2003

CLOSED 4/21/04

2/27: Request made and DCS S:IG representative plans to attend 4/21: Matt Sailor to present

Growth Chart Project Update Aileen Sedman January 19, 2004 OPEN

2/27: See minutes 4/13: Update at education day 5/3: Update at WGM 5/3/04: integrate in to PIR-EHR

Prenatal to Perinatal Care Project

Andy Spooner January 19, 2004 OPEN

2/27: See minutes 4/13: Update at education day 5/3: Update at WGM 5/3/04: integrate in to PIR-EHR

Developmental Care Project Paul Biondich January 19, 2004 OPEN

4/13: Update provided for education day 5/3: Update provided for WGM 5/3/04: integrate in to PIR-EHR

WIC documentation form project Cheri Throop Ellen Schwalenstocker

January 19, 2004 OPEN

2/27: See minutes 3/31: Hema Bisarya will assist with this project. 4/13: Update at education day 5/3: Update at WGM 5/3/04: integrate in to PIR-EHR

Pediatric Electronic Health Record Project

Feliciano Yu February 27, 2004 CLOSED

4/20/05

3/31: David Milov will assist wit this project. 4/13: Update provided for education day 4/13: Noorullah Akhtar will assist with this project 5/3: Update at WGM 5/3/04: integrate in to PIR-HER

U:\~Production Center\HL7\Tab 2 - Quarter 1\2f Tracking log.doc 1

ITEM: Responsible Party:

Date Initiated

Date Closed

Additional Comments:

7/6/04: Accountability for specific sections assigned

Asthma Core Measures Cheri Throop Ellen Schwalenstocker

January 19, 2004 CLOSED

Measures in JCAHO pilot (Spring 2005)

2/27: see minutes 3/31: Hema Bisarya will assist with this project. 4/13: Update at education day 5/3: Update at WGM 5/3/04: integrate in to PIR-EHR

Strawman proxy ballot process Andy Spooner David Classen

January 19, 2004

CLOSED 5/3/04

2/27: See minutes 3/31: Draft document will be sent to SIG members prior to May meeting 4/26: PDSSIG Decision Making document to SIG members for approval 5/3: Agenda item for WGM

IOM Electronic Health Record framework –distribution to SIG members

David Classen January 19, 2004 CLOSED

2/9/04

2/9/04: Distributed

Invite Helga Ripen to PDSSIG conference call

Cheri Throop May 3, 2004 OPEN

5/3/04: member of NHII group

Form PDSSIG Vocabularies subgroup (Paul Biondich; Clem McDonald; Stan Huff)

Andy Spooner May 3, 2004 OPEN

5/3/04: See minutes

Recruit and recommend pediatric representation on SNOMED CT working group (Kent Spackman)

• Funding for representative

Andy Spooner/David Classen

May 3, 2004 June 1, 2004

CLOSED 6/1/04

OPEN

5/3/04: See minutes 6/1/04: See minutes. Paul Biondich is willing to serve in this role. 6/1/04: SIG Co-chairs to work on this issue.

Conference call with Kent Spackman (SNOMED CT) Discussion with Ed Hammond: Coordination efforts – our SIG and SNOMED CT Funding inquiries: NLM and AAP

Andy Spooner/David Classen David Classen Andy Spooner

June 1, 2004

CLOSED 7/20/04

CLOSED 6/29/04

OPEN

Pediatric Representation David had conversation with Ed Hammond on June 29 2004. He advised that we proceed with conference call as planned.

PDSSIG “one-pager” as communication tool

Andy Spooner/David Classen/ Cheri Throop

July 6, 2004 CLOSED 7/20/04

(Due July 21 for upcoming AAP and NHII meeting)

Conference call with Dr. Dale Nordenberg

Andy Spooner/David Classen/Cheri Throop/ Carl

August 3, 2004 CLOSED

9/1/04

Conference call convened; Follow up communication regarding PDSSIG

U:\~Production Center\HL7\Tab 2 - Quarter 1\2f Tracking log.doc 2

ITEM: Responsible Party:

Date Initiated

Date Closed

Additional Comments:

Weigle Obtain copy of EHR-S excel tool from Patient Care TC

Cheri Throop September 29, 2004 CLOSED

10/4/04

Requested post HL7 meeting; received October 4, 2004

Obtain copy of storyboard examples from Patient Care TC

Cheri Throop September 29, 2004 CLOSED

10/4/2004

Provided by Dan Russler to our SIG

SIG Members sign up to monitor SIG/TC listserv

PDSSIG September 29, 2004 OPEN

EHR TC – Andy Spooner Public Health – Therese Finitzo Data Modeling – Sam Walters Patient Safety – Cheri Throop/ Aileen Sedman Community Health - ? Patient Care – Noorullah Akhtar

SNOMED Group: formal request to form pediatric group

Paul Biondich/Andy Spooner/David Classen

October 25, 2004 OPEN

Waiting for formal communication to co-chairs from SNOMED Discussion on publicizing and recruitment needs David to communicate with Ed Hammond

Recommendations to EHR-TC Cheri Throop November 22, 2004 CLOSED

11/24/2004

E-mail of DC recommendations for EHR-TC consideration.

Recommendations to EHR-TC Cheri Throop December 20, 2004 CLOSED

12/23/04

E-mail of Supportive Care recommendation to EHR-TC for their consideration.

Develop more formal business/communication plan for PDSSIG

Cheri Throop David Classen Andy Spooner

January 24, 2005 OPEN

For recruitment needs as communication vehicle

Formal Letter to EHR-TC with global recommendations

Cheri Throop David Classen Andy Spooner

January 24, 2005 OPEN

Post EHR-TC joint meeting on 1/26/05. Formally submit to EHR-TC during April conference call

Publish our project Co-leaders and entire PDSSIG

January 24, 2005 OPEN

Recommendation of EHR-TC during joint meeting on 1/26/05

Map PDSSIG pediatric requirements for EHR to CCHIT requirements

Andy Spooner Joe Schneider

May 13, 2005 OPEN

5/13/05: project team proposed; champions identified; project scope submitted to Patient Care Technical Committee, work completed

Create toolbox including templates for pediatric and other specialties to identify pediatric requirements for EHR

Michael Miller Aileen Sedman

May 13, 2005 OPEN

5/13/05: project team proposed; champions identified; project scope completed

Create storyboards (use case) from the existing examples of the EHR pediatric requirements for submission to CCHIT

Feliciano Yu May 13, 2005 OPEN

5/13/05: project team proposed; champions identified; project scope completed, work in process

U:\~Production Center\HL7\Tab 2 - Quarter 1\2f Tracking log.doc 3

ITEM: Responsible Party:

Date Initiated

Date Closed

Additional Comments:

Harmonize pediatric EHR requirements and TEPR/AAP TLC

Andy Spooner Joe Schneider

May 13, 2005 OPEN

5/13/05: project team proposed; champions identified;

Develop statement regarding standardized transmission of all ICD-9 codes linked to patient encounters

Aileen Sedman Lorna Dyk

May 13, 2005 OPEN

Parking Lot Issues: Date Identified Date Resolved:

Aileen asked how we prevent redundant work across HL7 groups as well as across national entities

January 19, 2004 September 29, 2004 (see meeting minutes)

Aileen asked for further guidance on what format our SIG projects need to be for delivery to other HL7 groups.

February 27, 2004 September 29, 2004 (see meeting minutes)

Aileen asked how HL7 work is kept up to date. May 3, 2004 September 29, 2004 (see meeting minutes)

PDSSIG Logo model under review by HL7 for their approval May 18, 2004 July 6, 2004

How do we handle external vocabularies?(Hank Shapiro) October 25, 2004

How do we deal with existing guidelines in developing a standardized approach?(Hank Shapiro)

October 25, 2004

Issues of functionality of decision support as it relates to vocabulary, context, and measures (Hank Shapiro)

October 25, 2004

U:\~Production Center\HL7\Tab 2 - Quarter 1\2f Tracking log.doc 4

Quarter 2

Joint Session With

Attachments SIG

Attachments SIG Co-Chairs

Michael Cassidy, Siemens Medical Solutions Health Services Penny Sanchez, EDS Corporation Wes Rishel, Gartner Maria Ward, Pricewaterhouse Coopers LLP

Attachment Development Process

Presented by the HL7 Attachments SIG

Why do outreach?

Allows the participation of wide variety of stakeholders for a given attachment type (providers, vendors, health plans)Arrive at consensus for content including acceptable values and cardinality

HL7 Industry Outreach Process

Source Documents Gathered

Approval from ASIG Obtained

Workgroup Leaders Identified and

Contacts Compiled

Participation Letter Drafted and Sent

30-45 Day Response Time

Allowed

Facilitator Develops Project

PlanApproval

Obtained from ASIG to

Develop AISContent Defined Through Conference

Calls

Listserve Established and Call Notifications

Sent

Steps to creating an attachment

Gather source documentsBaseline content from external sourceCreating content from scratch

Committee approves development of attachmentOutreach workgroup formed

FacilitatorScribeMembers

Steps to creating an attachment…

Contacts compiledInvitation letter sent to stakeholdersProject Plan createdAdministrative Actions

List serve establishedCalls set up Notifications sent

Content defined via conference calls with workgroup

Content gathered and collected using RAQBuildApplication

Steps to creating an attachment…

Final content approved by workgroupASIG committee approves development of AIS

AIS createdLOINCS and OIDS obtainedExamples developedFinal AIS document approved for ballotDocument goes through HL7 ballot process

Q & A

Copyright © 2004-2005 Health Level Seven. All Rights Reserved.

The copyright owner grants permission to user to copy this material for its own internal use. This does not permit any commercial resale of all or any part of the material.

CDAR1AIS0007R010

Additional Information Specification 0007: Children's Preventive Health Services

(CPHS) Attachment

Release 1.0 Based on HL7 CDA Standard Release 1.0,

with supporting LOINC® Tables

August 2005

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Table of Contents

1 INTRODUCTION ...............................................................................................................................................1 1.1 LOINC CODES AND STRUCTURE .....................................................................................................................1 1.2 REVISION HISTORY ..........................................................................................................................................3 1.3 PRIVACY CONCERNS IN EXAMPLES..................................................................................................................3 1.4 HL7 ATTACHMENT-CDA DOCUMENT VARIANTS............................................................................................3 1.5 REQUEST FOR INFORMATION VERSUS REQUEST FOR SERVICE .........................................................................3

2 LOINC CODES ...................................................................................................................................................4 2.1 SUPPORTING DOCUMENTATION .......................................................................................................................4 2.2 SCOPE MODIFICATION CODES..........................................................................................................................4 2.3 SPECIAL CONSIDERATIONS ..............................................................................................................................4 2.4 ATTACHMENT DATA COMPONENTS .................................................................................................................4

2.4.1 Children's Preventive Health Services Attachment ...............................................................................5 3 CHILDREN'S PREVENTIVE HEALTH SERVICES ATTACHMENT VALUE TABLES.......................7

3.1 CHILDREN'S PREVENTIVE HEALTH SERVICES SERVICE VALUE TABLE ............................................................7 4 CODING EXAMPLES......................................................................................................................................28

4.1 SCENARIO ......................................................................................................................................................28 4.1.1 Coded Children's Preventive Health Services Attachment, Human-Decision Variant ........................29 4.1.2 Coded Children's Preventive Health Services Attachment, Computer-Decision Variant....................36

5 RESPONSE CODE SETS AND OID REFERENCES...................................................................................47 5.1 HL70136: HL7 YES-NO INDICATOR..............................................................................................................47 5.2 HL79020: HL7 SCREEN TYPE INDICATOR .....................................................................................................47 5.3 HL79021: HL7 SCREENING LEVEL................................................................................................................47 5.4 HL79022: HL7 CONDITION/DISEASE INDICATOR..........................................................................................48 5.5 HL79023: HL7 YES/NO/REFERRED INDICATOR ............................................................................................48 5.6 HL79025: HL7 SCREEN ASSESSMENT RESULTS INDICATOR .........................................................................48 5.7 HL79026: HL7 FOLLOW-UP INDICATOR .......................................................................................................49 5.8 HL79027: HL7 DIAGNOSIS STATE................................................................................................................49 5.9 HL79029: HL7 SCREEN TEST STATUS..........................................................................................................49 5.10 HL79030: HL7 REFERRAL NETWORK LOCATION INDICATOR..................................................................49 5.11 HL79031: HL7 IMMUNIZATION STATUS CODE ........................................................................................49 5.12 HL79032: HL7 PATIENT ANTICIPATORY GUIDANCE TYPE ......................................................................50 5.13 HL79033: HL7 PROGRAM PARTICIPATION NAME....................................................................................50 5.14 HL79034: HL7 PATIENT ESCORT RELATIONSHIP TO PATIENT .................................................................50 5.15 HL79035: HL7 REFERRAL STATE LOCATION INDICATOR........................................................................51 5.16 HL79036: HL7 REFERRAL CATCHMENT LOCATION INDICATOR..............................................................51 5.17 HL79037: HL7 DENTAL ASSESSMENT RESULTS......................................................................................51 5.18 I9C : ICD-9-CM .......................................................................................................................................51 5.19 HPC: HEALTHCARE COMMON PROCEDURAL CODING SYSTEM (HCPCS).................................................52 5.20 ISO+: EXTENDED ISO UNITS CODES .........................................................................................................52 5.21 ANS+: EXTENDED ANSI UNITS CODES .....................................................................................................52 5.22 NPI: NATIONAL PROVIDER IDENTIFIER.....................................................................................................52 5.23 PTX: HEALTH CARE PROVIDER TAXONOMY ............................................................................................52 5.24 VACCINE MANUFACTURERS (MVX).........................................................................................................52 5.25 MISCELLANEOUS OID REFERENCES..........................................................................................................53

5.25.1 Unique Instance Identifier ...................................................................................................................53 5.25.2 person_name.type_cd ..........................................................................................................................53 5.25.3 Example OID.......................................................................................................................................53

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Index of Tables and Figures Table 1.1 Relationship of LOINC Codes, X12N Transactions, and HL7 CDA Documents. ........................................2 Table 2.1 LOINC code for a complete Children's Preventive Health Services attachment data set..............................4 Table 2.4.1 Data Components for Children's Preventive Health Services Attachment .................................................5 Table 3.1 Children's Preventive Health Services Value Table ......................................................................................7 Figure 4.1 Children's Preventive Health Services Data...............................................................................................28 Example 4.1.1 Children's Preventive Health Services Attachment, Human-Decision Variant ...................................29 Figure 1. Portion of Rendered Human-Decision Variant ............................................................................................33 Example 4.1.2 Children's Preventive Health Services Attachment, Computer-Decision Variant ...............................36 Table 5.1 HL7 Yes-No Indicator.................................................................................................................................47 Table 5.2 HL7 Screen Type Indicator .........................................................................................................................47 Table 5.3 HL7 Screening Level...................................................................................................................................47 Table 5.4 HL7 Condition/Disease ..............................................................................................................................48 Table 5.5 HL7 Yes/No/Referred Indicator ..................................................................................................................48 Table 5.6 HL7 Screen Assessment Results Indicator ..................................................................................................48 Table 5.7 HL7 Follow-up Indicator.............................................................................................................................49 Table 5.8 HL7 Diagnosis State....................................................................................................................................49 Table 5.9 HL7 Screen Test Status ...............................................................................................................................49 Table 5.10 HL7 Referral Network Location Indicator ................................................................................................49 Table 5.11 HL7 Immunization Status Code ................................................................................................................49 Table 5.12 HL7 Patient Anticipatory Guidance Type .................................................................................................50 Table 5.13 HL7 Program Participation Name .............................................................................................................50 Table 5.14 HL7 Patient Escort Relationship to Patient ...............................................................................................50 Table 5.15 HL7 Referral State Location Indicator ......................................................................................................51 Table 5.16 HL7 Referral Catchment Location Indicator .............................................................................................51 Table 5.17 HL7 Dental Assessment Results................................................................................................................51

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1 Introduction This publication provides the LOINC®1 code values specific to a Children's Preventive Health Services attachment for the following applications.

• Those codes that define the attachment or attachment components used in transactions such as those defined by the ASC X12N 277 Health Care Claim Request for Additional Information and the ASC X12N 275 Additional Information to Support a Health Care Claim or Encounter Implementation Guides which are products of the insurance subcommittee, X12N, of Accredited Standards Committee X12.2,3

• All of the codes may be used in HL7 Clinical Document Architecture (CDA) documents designed for inclusion in the BIN segment of the 275 transaction as described in the HL7 Additional Information Specification Implementation Guide4

The format of this document and the methods used to arrive at its contents are prescribed in the HL7 Additional Information Specification Implementation Guide, CDAR1AIS0000R021.

The Children’s Preventive Health Services attachment is used to convey information about service encounters involving preventative health measures for children, such as screening assessments and tests and their subsequent results and findings, immunization information, guidance and education given, and follow-up care needed.

Section 2 of this document defines the LOINC codes used to request Children's Preventive Health Services attachments, and the LOINC codes of each component in an attachment.

Section 3 further describes each component of the Children's Preventive Health Services attachment, the cardinality of the components and their answer parts, and the description, data types, codes, and units of each answer part.

Section 4 presents coding examples, with a narrative scenario, an XML example, and a display image of each example attachment using a popular browser.

Section 5 further describes the code sets used in the response to each answer part of the attachment.

Note: All LOINC codes and descriptions are copyrighted by the Regenstrief Institute, with all rights reserved. See http://www.LOINC.org.

1.1 LOINC Codes and Structure

LOINC codes are used for several purposes:

1 LOINC® is a registered trademark of Regenstrief Institute and the LOINC Committee. The LOINC database and LOINC Users’ Guide are copyright 1998-2005 Regenstrief Institute and the LOINC Committee and the LOINC database codes and names are available at no cost from http://www.LOINC.org. Regenstrief Institute, 1050 Wishard Blvd., Indianapolis, IN 46202 Email: [email protected] 2Information on this and other X12N/HIPAA-related implementation guides is available from the Washington Publishing Company, PMB 161, 5284 Randolph Rd., Rockville, MD 20852-2116. Phone: 800-972-4334. or http://www.wpc-edi.com/ 3 Within this Health Level Seven document, references to the transaction defined by these X12N implementation guides will be abbreviated by calling them 275 and 277. 4 Health Level Seven, Inc. 3300 Washtenaw Ave., Suite 227, Ann Arbor, MI 48104-4250. (http://www.hl7.org)

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• In the X12N 277 transaction set, LOINC codes identify the attachment or attachment components being requested to support a claim or encounter.

• In the HL7 CDA document, LOINC codes are used to identify the attachment, the attachment components, and their answer parts. This is returned in the X12N 275 transaction set.

• LOINC modifier codes may be used in the 277 transaction to further define the specificity of a request.

Table 1.1 Relationship of LOINC Codes, X12N Transactions, and HL7 CDA Documents.

X12N 277 X12N 275 HL7 CDA

Purpose of Attachment

Request for additional information to support a health care claim

Additional information to support a health care claim or encounter

Provide controlled content for X12N 275 BIN segment

LOINC Modifier

Codes

Used in the STC segment to limit the scope or time frame of a request for information. e.g., Send information for

up to 90 days before the related encounter

Reiterated in the STC segment

Not used in the CDA document

LOINC Attachment Identifier

Used in the STC segment to request an attachment in its entirety, e.g., Send the Children’s

Preventive Health Services Attachment

Reiterated in the STC segment

Used in the <document_type_cd> element of the header

LOINC Attachment Component

Used in the STC segment to request a specific attachment component or part of a clinical report, .e.g., Send the screen

assessments for this visit

Reiterated in the STC segment

Used in the computer-decision CDA variant in the <caption_cd> element of a <section> to identify the attachment component being provided, e.g., This is the screen assessment

LOINC Attachment Component Answer Part

Not used in the 277

Not used in the 275 except within the

CDA instance document in the BIN segment.

Used in the computer-decision CDA variant in the <caption_cd> element of a <paragraph>, an <item> element within a <list> or a <td> element within a <table> to identify the answer part of an attachment component being provided, e.g., This is the screen assessment results

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1.2 Revision History

Date Purpose November 2004 Discussion Draft

March 2005 Initial Release August 2005 Second Informative Ballot Release

1.3 Privacy Concerns in Examples The names of natural persons that appear in the examples of this book are intentionally fictional. Any resemblance to actual natural persons, living or deceased is purely coincidental.

1.4 HL7 Attachment-CDA Document Variants As described in the HL7 Additional Information Specification Implementation Guide, there are two variants of a CDA document when used as an attachment.

The human-decision variant is used solely for information that will be rendered for a person to look at, in order to make a decision. HL7 provides a non-normative style sheet for this purpose. There are two further alternatives within the human-decision variant.

• non_xml body: The information can be sent with a CDA header structured in XML, along with a "non_xml body" that references scanned images of documents that contain the submitted information

• xml body: the information can be sent as free text in XML elements that organize the material into sections, paragraphs, tables and lists as described in the HL7 Additional Information Specification Implementation Guide.

The computer-decision variant has the same content as the human-decision variant, but additional coded and structured information is included so that a computer could provide decision support based on the document. Attachments in the computer-decision variant can be rendered for human decisions using the same style sheet that HL7 provides for rendering documents formatted according to the human-decision variant.

1.5 Request for Information versus Request for Service

This attachment specification for Children's Preventive Health Services defines a “send-me-what-you-have” concept. It asks for a set of Children's Preventive Health Services attachment components gathered during the Children's Preventive Health Services encounter process. It is not asking for any additional data capture efforts. For example, if the request for data is to send the History and Physical assessment information and it was not captured at the time of care, it is not asking the provider to obtain additional information if they don’t already have this information.

In any attachment component answer part it may sometimes be impossible to send a required answer and necessary to send, instead, a reason why the information is not available. In the human decision variant the sender shall supplement the natural language explanation of why the information is not available with local markup. In the computer-decision variant the sender shall

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include local markup to describe the reason that the information is not available as described in the Data Types section of the HL7 Additional Information Specification Implementation Guide.

2 LOINC Codes

2.1 Supporting Documentation

Table 2.1 defines the LOINC code used to request a complete attachment data set for Children's Preventive Health Services. The use of this code in the 277 STC segment represents an explicit request for the complete set of data components relevant to the children's preventive health services attachment.

The provider shall return all data components for which data is available.

The provider may choose to return images of pages that constitute the requested information by using the <non_xml> element of the CDA as described in the HL7 Additional Information Specification Implementation Guide.

Table 2.1 LOINC code for a complete Children's Preventive Health Services attachment data set

LOINC code Attachment Name 39294-4 Children’s Preventive Health Services Attachment

2.2 Scope Modification Codes The HL7 publication LOINC Modifier Codes (for use with ASC X12N Implementation Guides when Requesting Additional Information) provides code values for further defining the specificity of a request for additional information. Both time window and item selection modifier codes are defined. This publication is available from HL7, and is in the download package with the AIS documents.

2.3 Special Considerations There are no special consideration for this Additional Information Specification; therefore, this section is intentionally left blank.

2.4 Attachment Data Components Individual LOINC codes are defined for each component of the Children's Preventive Health Services attachment. These LOINC codes are listed in table 2.4.1.

The LOINC codes in Table 2.1 represent requests for a complete Children's Preventive Health Services attachment. However, the requester also has the option of focusing on a specific component of the attachment through the use of the LOINC codes defined in the following table. In this case the provider will respond with information, where available, specific to the requested data components.

These LOINC codes may be used in ASC X12N 277 as defined in the associated Implementation Guide and will be mirrored in the corresponding ASC X12N 275 response. In addition, these LOINC codes are used in the <caption_cd> element of the computer-decision variant of HL7

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Additional Information Specification Implementation Guide. The questions that these LOINC codes represent are the result of a significant industry outreach project and represent the complete set of Children's Preventive Health Services attachment components.

2.4.1 Children's Preventive Health Services Attachment

Table 2.4.1 Data Components for Children's Preventive Health Services Attachment LOINC Code Description 39294-4 CHILDREN'S PREVENTIVE HEALTH SERVICES ATTACHMENT

39157-3 SCREEN TYPE INDICATOR 39158-1 PERIODICITY INDICATOR 39159-9 SCREENING LEVEL 39160-7 RE-CHECK VISIT 39255-5 DATE OF THE PREVIOUS SCREEN 39161-5 NEXT SCREEN DATE 39155-7 FAMILY HISTORY OR CONDITION/DISEASE INDICATOR 39162-3 CHRONIC ILLNESS INDICATOR 39256-3 SCREEN ASSESSMENT, HISTORY AND PHYSICAL (COMPOSITE) 39166-4 SCREEN ASSESSMENT, BEHAVIORAL/MENTAL HEALTH (COMPOSITE) 39257-1 SCREEN ASSESSMENT, CARDIAC (COMPOSITE) 39173-0 SCREEN ASSESSMENT, DENTAL (COMPOSITE) 39177-1 SCREEN ASSESSMENT, ENDOCRINE (COMPOSITE) 39258-9 SCREEN ASSESSMENT, ENT (COMPOSITE) 39181-3 SCREEN ASSESSMENT, GENITO/URINARY (COMPOSITE) 39185-4 SCREEN ASSESSMENT, GROWTH AND DEVELOPMENT INCLUDING SPEECH

(COMPOSITE) 39189-6 SCREEN ASSESSMENT, HEARING (COMPOSITE) 39193-8 SCREEN ASSESSMENT, LEAD (EXPOSURE TO) (COMPOSITE) 39262-1 SCREEN ASSESSMENT, NEUROLOGIC (COMPOSITE) 39200-1 SCREEN ASSESSMENT, NUTRITION (COMPOSITE) 39204-3 SCREEN ASSESSMENT, ORTHOPEDIC (COMPOSITE) 39208-4 SCREEN ASSESSMENT, TUBERCULOSIS (EXPOSURE TO) (COMPOSITE) 39212-6 SCREEN ASSESSMENT, VISION (COMPOSITE) 39216-7 SCREEN ASSESSMENT, OTHER (COMPOSITE) 39221-7 DIAGNOSIS RECOMMENDATIONS (COMPOSITE) 39224-1 SCREEN TEST, CHLAMYDIA STATUS/RESULTS 39225-8 SCREEN TEST, GONORRHEA STATUS/RESULTS 39226-6 SCREEN TEST, HEMOGLOBIN STATUS/RESULTS (COMPOSITE) 39227-4 SCREEN TEST, HEMATOCRIT STATUS/RESULTS (COMPOSITE) 39228-2 SCREEN TEST, LEAD STATUS/RESULTS (COMPOSITE) 39229-0 SCREEN TEST, LIPOPROTEIN ANALYSIS STATUS/RESULTS (COMPOSITE) 39230-8 SCREEN TEST, SICKLE CELL INDICATOR STATUS/RESULTS 39263-9 SCREEN TEST, TUBERCULIN STATUS/RESULTS 39264-7 SCREEN TEST, URINALYSIS, DIP STICK STATUS/RESULTS 39265-4 SCREEN TEST, URINALYSIS, COMPLETE STATUS/RESULTS 39231-6 SCREEN TEST, VDRL/RPR/ART STATUS/RESULTS 39232-4 SCREEN TEST, OTHER (COMPOSITE) 39266-2 FOLLOW-UP (REFERRED TO) PROVIDER SPECIALIST (COMPOSITE) 39273-8 FOLLOW-UP (REFERRED) PROGRAM (COMPOSITE) 39235-7 IMMUNIZATION DATA (COMPOSITE) 3141-9 WEIGHT 3137-7 HEIGHT/LENGTH

39156-5 BODY MASS INDEX MEASUREMENT 35094-2 BLOOD PRESSURE (COMPOSITE) 9843-4 INFANT HEAD CIRCUMFERENCE 8339-4 BIRTH WEIGHT

39238-1 PATIENT ANTICIPATORY GUIDANCE INDICATOR 39239-9 PATIENT ANTICIPATORY GUIDANCE OR HEALTH EDUCATION TYPE 39240-7 PATIENT TOBACCO USE INDICATOR 39241-5 PATIENT TOBACCO USE COUNSEL INDICATOR

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LOINC Code Description 39242-3 PATIENT TOBACCO PREVENTION REFERRAL INDICATOR 39243-1 PATIENT SECOND HAND SMOKE EXPOSURE INDICATOR 39278-7 CAREGIVER/FAMILY MEMBER TOBACCO USE INDICATOR 39279-5 CAREGIVER/FAMILY MEMBER TOBACCO PREVENTION REFERRAL INDICATOR 39244-9 PATIENT DRUG/ALCOHOL USE INDICATOR 39245-6 PATIENT DRUG/ALCOHOL ABUSE COUNSELING INDICATOR 39246-4 RISK ASSESSMENT INDICATOR 39247-2 PRENATAL ASSESSMENT INDICATOR 39248-0 PRENATAL INTERVIEW WITH INFANTS PCP INDICATOR 39249-8 PROGRAM PARTICIPATION (COMPOSITE) 39280-3 RESPONSIBLE PARTY (COMPOSITE) 39284-5 PATIENT ESCORT (COMPOSITE) 39252-2 FOSTER CARE INDICATOR 39288-6 PRE-PAID HEALTH PLAN INDICATOR 39253-0 PRIMARY CARE PRACTITIONER (PCP) INDICATOR 39254-8 PRIMARY CARE PRACTITIONER (PCP) PERFORM SCREEN INDICATOR 18711-2 PRIMARY CARE PRACTITIONER (PCP) NAME

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3 Children's Preventive Health Services Attachment Value Tables Each of the tables in this section further describes the LOINC components listed in the above corresponding table, along with the expected answer part(s) for each question, including the data type, cardinality, and codes/units for each answer. For a complete list of the data types used in this AIS the their XML constuct, please refer to the Additional Information Specification Implemention Guide. The minimum attachment data set equates to the required components; those identified in the value table, below, with cardinality (Card) of

{1,1} (component is required and has one and only one occurrence) or {1,n} (component is required and has one or more occurrences).

Those data components with a cardinality of {0,1} (if available has one and only one occurrence) or {0,n} (if available may have one or more occurrences) shall be sent if available.

3.1 Children's Preventive Health Services Service Value Table

Table 3.1 Children's Preventive Health Services Value Table LOINC code

Component Answer Value Data

Type Card Response Code

/ Numeric Units 39157-3 SCREEN TYPE INDICATOR

Defines whether the screen was an Initial or Periodic Screen.

1,1

39157-3 IN Initial PE Periodic IT Interperiodic

CE 1,1 HL79020

39158-1 PERIODICITY INDICATOR Defines if this screen was conducted according to the periodicity schedule for the age of the individual.

1,1

39158-1 N No Y Yes

CE 1,1 HL70136

39159-9 SCREENING LEVEL Defines if this screen was a Partial or Total Screen.

0,1

39159-9 PAR Partial TOT Total

CE 1,1 HL79021

39160-7 RE-CHECK VISIT Defines if this screen is a re-check.

0,1

39160-7 N No Y Yes

CE 1,1 HL70136

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39255-5 DATE OF THE PREVIOUS SCREEN Identifies the date of the previous screen assessment in CCYY-MM-DD format.

0,1

39255-5

DT 1,1

39161-5 NEXT SCREEN DATE The date when the patient is due for their next screen assessment in CCYY-MM-DD format.

0,1

39161-5

DT 1,1

39155-7 FAMILY HISTORY OR CONDITION/DISEASE INDICATOR Indicates if there is a family history of a hereditary or familial condition and/or disease.

1,1

39155-7 YA Yes, 1 Condition YB Yes, 2-3 Conditions YC Yes, More Than 3 Conditions N No

CE 1,1 HL79022

39162-3 CHRONIC ILLNESS INDICATOR Identifies if the patient has clinical manifestations or has been diagnosed as having a chronic disease such as asthma or diabetes.

0,1

39162-3 Y Yes N No R Referred (Patient has been referred to a PCP, Specialist or Program for treatment.)

CE 1,1 HL79023

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39256-3 SCREEN ASSESSMENT, HISTORY AND PHYSICAL (COMPOSITE) Defines the results and follow-up information about the history and physical assessment performed.

0,1

39163-1 SCREEN ASSESSMENT, HISTORY AND PHYSICAL RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39164-9 SCREEN ASSESSMENT, HISTORY AND PHYSICAL FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

39165-6 SCREEN ASSESSMENT, HISTORY AND PHYSICAL DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39166-4 SCREEN ASSESSMENT, BEHAVIORAL/MENTAL HEALTH (COMPOSITE) Defines the results and follow-up information about the behavioral/mental health assessment performed.

0,1

39167-2 SCREEN ASSESSMENT, BEHAVIORAL/MENTAL HEALTH RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39168-0 SCREEN ASSESSMENT, BEHAVIORAL/MENTAL HEALTH FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

39169-8 SCREEN ASSESSMENT, BEHAVIORAL/MENTAL HEALTH DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39257-1 SCREEN ASSESSMENT, CARDIAC (COMPOSITE) Defines the results and follow-up information about the cardiac assessment performed.

0,1

39170-6 SCREEN ASSESSMENT, CARDIAC RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39171-4 SCREEN ASSESSMENT, CARDIAC FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

39172-2 SCREEN ASSESSMENT, CARDIAC DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39173-0 SCREEN ASSESSMENT, DENTAL (COMPOSITE)Defines the results and follow-up information about the dental assessment performed.

0,1

39174-8 SCREEN ASSESSMENT, DENTAL RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79037

39175-5 SCREEN ASSESSMENT, DENTAL FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

39176-3 SCREEN ASSESSMENT, DENTAL DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39177-1 SCREEN ASSESSMENT, ENDOCRINE (COMPOSITE) Defines the results and follow-up information about the endocrine assessment performed.

0,1

39178-9 SCREEN ASSESSMENT, ENDOCRINE RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39179-7 SCREEN ASSESSMENT, ENDOCRINE FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

39180-5 SCREEN ASSESSMENT, ENDOCRINE DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39258-9 SCREEN ASSESSMENT, ENT (COMPOSITE) Defines the results and follow-up information about the ENT assessment performed.

0,1

39259-7 SCREEN ASSESSMENT, ENT RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39260-5 SCREEN ASSESSMENT, ENT FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

39261-3 SCREEN ASSESSMENT, ENT DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39181-3 SCREEN ASSESSMENT, GENITO/URINARY (COMPOSITE) Defines the results and follow-up information about the genitor/urinary assessment performed.

0,1

39182-1 SCREEN ASSESSMENT, GENITO/URINARY RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39183-9 SCREEN ASSESSMENT, GENITO/URINARY FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

39184-7 SCREEN ASSESSMENT, GENITO/URINARY DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39185-4 SCREEN ASSESSMENT, GROWTH AND DEVELOPMENT (INCLUDING SPEECH) (COMPOSITE) Defines the results and follow-up information about the growth and development (including speech) assessment performed.

0,1

39186-2 SCREEN ASSESSMENT, GROWTH AND DEVELOPMENT (INCLUDING SPEECH) RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39187-0 SCREEN ASSESSMENT, GROWTH AND DEVELOPMENT (INCLUDING SPEECH) FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39188-8 SCREEN ASSESSMENT, GROWTH AND DEVELOPMENT (INCLUDING SPEECH) DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39189-6 SCREEN ASSESSMENT, HEARING (COMPOSITE) Defines the results and follow-up information about the hearing assessment performed.

0,1

39190-4 SCREEN ASSESSMENT, HEARING RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39191-2 SCREEN ASSESSMENT, HEARING FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

39192-0 SCREEN ASSESSMENT, HEARING DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39193-8 SCREEN ASSESSMENT, LEAD (EXPOSURE TO) (COMPOSITE) Defines the results and follow-up information about the lead (exposure to) assessment performed.

0,1

39194-6 SCREEN ASSESSMENT, LEAD (EXPOSURE TO) RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39195-3 SCREEN ASSESSMENT, LEAD (EXPOSURE TO) FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39196-1 SCREEN ASSESSMENT, LEAD (EXPOSURE TO) DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39262-1 SCREEN ASSESSMENT, NEUROLOGIC (COMPOSITE) Defines the results and follow-up information about the neurologic assessment performed.

0,1

39197-9 SCREEN ASSESSMENT, NEUROLOGIC RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39198-7 SCREEN ASSESSMENT, NEUROLOGIC FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

39199-5 SCREEN ASSESSMENT, NEUROLOGIC DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39200-1 SCREEN ASSESSMENT, NUTRITION (COMPOSITE) Defines the results and follow-up information about the nutrition assessment performed.

0,1

39201-9 SCREEN ASSESSMENT, NUTRITION RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39202-7 SCREEN ASSESSMENT, NUTRITION FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39203-5 SCREEN ASSESSMENT, NUTRITION DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39204-3 SCREEN ASSESSMENT, ORTHOPEDIC (COMPOSITE) Defines the results and follow-up information about the orthopedic assessment performed.

0,1

39205-0 SCREEN ASSESSMENT, ORTHOPEDIC RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39206-8 SCREEN ASSESSMENT, ORTHOPEDIC FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

39207-6 SCREEN ASSESSMENT, ORTHOPEDIC DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39208-4 SCREEN ASSESSMENT, TUBERCULOSIS (EXPOSURE TO) (COMPOSITE) Defines the results and follow-up information about the tuberculosis (exposure to) assessment performed.

0,1

39209-2 SCREEN ASSESSMENT, TUBERCULOSIS (EXPOSURE TO) RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39210-0 SCREEN ASSESSMENT, TUBERCULOSIS (EXPOSURE TO) FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39211-8 SCREEN ASSESSMENT, TUBERCULOSIS (EXPOSURE TO) DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39212-6 SCREEN ASSESSMENT, VISION (COMPOSITE) Defines the results and follow-up information about the vision assessment performed.

0,1

39213-4 SCREEN ASSESSMENT, VISION RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39214-2 SCREEN ASSESSMENT, VISION FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

39215-9 SCREEN ASSESSMENT, VISION DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39216-7 SCREEN ASSESSMENT, OTHER (COMPOSITE) Defines the results and follow-up information about the “other” assessment performed.

0,n

39217-5 SCREEN ASSESSMENT, OTHER SCREEN ASSESSMENT NAME Defines the name of the Screen Assessment performed when not otherwise specified in this AIS.

TX 1,1

39218-3 SCREEN ASSESSMENT, OTHER RESULTS INDICATOR Identifies general outcomes about the results of the screen assessment performed. See section 5 for the list of valid codes.

CE 1,1 HL79025

39219-1 SCREEN ASSESSMENT, OTHER FOLLOW-UP INDICATOR Identifies follow-up recommendations for this screen. See section 5 for the list of valid codes.

CE 0,1 HL79026

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39220-9 SCREEN ASSESSMENT, OTHER DIAGNOSIS STATE Defines it the primary diagnosis associated with the claim for this screen was newly or prevsiouly discovered. ND Newly Discovered PD Previously Discovered

CE 0,1 HL79027

39221-7 DIAGNOSIS RECOMMENDATIONS (COMPOSITE) Explanation of the recommendations for a given diagnosis.

0,n

39222-5 DIAGNOSIS RECOMMENDATION, ICD9-CM

CE 1,1 ICD9-CM

39223-3 DIAGNOSIS RECOMMENDATION, DESCRIPTION (NARRATIVE) Provide a narrative description of the diagnosis recommendation.

TX 1,1

39224-1 SCREEN TEST, CHLAMYDIA STATUS/RESULTS Defines the status and results for the screen test performed.

0,1

39224-1 POS Ordered – Positive NEG Ordered - Negative NRE Ordered – No results NOR Not Ordered

CE 1,1 HL79029

39225-8 SCREEN TEST, GONORRHEA STATUS/RESULTS Defines the status and results for the screen test performed.

0,1

39225-8 POS Ordered – Positive NEG Ordered - Negative NRE Ordered – No results NOR Not Ordered

CE 1,1 HL79029

39226-6 SCREEN TEST, HEMOGLOBIN STATUS/RESULTS (COMPOSITE) Defines the status and results for the screen test performed.

0,1

718-7 SCREEN TEST, HEMOGLOBIN RESULTS Defines the results in grams/deciliters for the screen test performed.

NM 1,1 iso+

41987-9 SCREEN TEST, HEMOGLOBIN STATUS Defines the status for the screen test performed. POS Ordered – Positive NEG Ordered - Negative NRE Ordered – No results NOR Not Ordered

CE 1,1 HL79029

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39227-4 SCREEN TEST, HEMATOCRIT STATUS/RESULTS (COMPOSITE) Defines the status and results for the screen test performed.

0,1

20570-8 SCREEN TEST, HEMATOCRIT RESULTS Defines the results in percent for the screen test performed.

NM 1,1 iso+

41986-1 SCREEN TEST, HEMATOCRIT STATUS Defines the status for the screen test performed. POS Ordered – Positive NEG Ordered - Negative NRE Ordered – No results NOR Not Ordered

CE 1,1 HL79029

39228-2 SCREEN TEST, LEAD STATUS/RESULTS (COMPOSITE) Defines the status and results for the screen test performed.

0,1

5671-3 SCREEN TEST, LEAD RESULTS Defines the results in micrograms/deciliters for the screen test performed.

NM 1,1 iso+

41985-3 SCREEN TEST, LEAD STATUS Defines the status for the screen test performed. POS Ordered – Positive NEG Ordered - Negative NRE Ordered – No results NOR Not Ordered

CE 1,1 HL79029

39229-0 SCREEN TEST, LIPOPROTEIN ANALYSIS STATUS/RESULTS (COMPOSITE) Defines the status and results for the screen test performed.

0,1

2093-3 SCREEN TEST, LIPOPROTEIN ANALYSIS – TOTAL CHOLESTEROL RESULTS Defines the results in milligrams/deciliters for the screen test performed.

NM 1,1 iso+

2571-8 SCREEN TEST, LIPOPROTEIN ANALYSIS – TRIGLYCERIDE RESULTS Defines the results in milligrams/deciliters for the screen test performed.

NM 1,1 iso+

2085-9 SCREEN TEST, LIPOPROTEIN ANALYSIS – HDL RESULTS Defines the results in milligrams/deciliters for the screen test performed.

NM 1,1 iso+

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

2089-1 SCREEN TEST, LIPOPROTEIN ANALYSIS – LDL RESULTS Defines the results in milligrams/deciliters for the screen test performed.

NM 1,1 iso+

41984-6 SCREEN TEST, LIPOPROTEIN ANALYSIS STATUS Defines the status for the screen test performed. POS Ordered – Positive NEG Ordered - Negative NRE Ordered – No results NOR Not Ordered

CE 1,1 HL79029

39230-8 SCREEN TEST, SICKLE CELL INDICATOR STATUS/RESULTS Defines the status and results for the screen test performed.

0,1

39230-8 POS Ordered – Positive NEG Ordered - Negative NRE Ordered – No results NOR Not Ordered

CE 1,1 HL79029

39263-9 SCREEN TEST, TUBERCULIN STATUS/RESULTS Defines the status and results for the screen test performed.

0,1

39263-9 POS Ordered – Positive NEG Ordered - Negative NRE Ordered – No results NOR Not Ordered

CE 1,1 HL79029

39264-7 SCREEN TEST, URINALYSIS - DIP STICK STATUS/RESULTS Defines the status and results for the screen test performed.

0,1

39264-7 POS Ordered – Positive NEG Ordered - Negative NRE Ordered – No results NOR Not Ordered

CE 1,1 HL79029

39265-4 SCREEN TEST, URINALYSIS - COMPLETE STATUS/RESULTS Defines the status and results for the screen test performed.

0,1

39265-4 POS Ordered – Positive NEG Ordered - Negative NRE Ordered – No results NOR Not Ordered

CE 1,1 HL79029

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39231-6 SCREEN TEST, VDRL/RPR/ART STATUS/RESULTS Defines the status and results for the screen test performed.

0,1

39231-6 POS Ordered – Positive NEG Ordered - Negative NRE Ordered – No results NOR Not Ordered

CE 1,1 HL79029

39232-4 SCREEN TEST, OTHER (COMPOSITE) Defines the status and results for the “other” screen test(s) performed when not otherwise specified in this AIS.

0,n

39233-2 SCREEN TEST, OTHER NAME

TX 1,1

39234-0 SCREEN TEST, OTHER STATUS/RESULTS POS Ordered – Positive NEG Ordered - Negative NRE Ordered – No results NOR Not Ordered

CE 1,1 HL79029

39266-2 FOLLOW-UP (REFERRED TO) PROVIDER SPECIALIST (COMPOSITE) Identifies information about the referred to Provider or Specialist that is to perform follow-up services, if known.

0,n

39267-0 FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST, REASON (NARRATIVE) Identifies information about the referred to Provider or Specialist that is to perform follow-up services, if known.

TX 1,1

39268-8 FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST, NAME Identifies the name of the follow-up Provider/Specialist this patient was referred to.

PN 1,1

39269-6 FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST, PROVIDER TYPE Identifies the provider type of the follow-up Provider/Specialist this patient was referred to.

CE 0,1 PTX

39270-4 FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST, ADDRESS Identifies the address of the follow-up Provider/Specialist this patient was referred to.

XAD 0,1

39271-2 FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST, PHONE Identifies the phone number of the follow-up Provider/Specialist this patient was referred to, if known.

TX 0,1

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39289-4 FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST, APPOINTMENT DATE State the scheduled date of the referral appointment, if known.

DT 0,1

39272-0 FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST, NETWORK LOCATION INDICATOR This defines whether the referral was to a Provider/Specialist in or out-of-network.. INN In-Network OON Out-of-Network

CE 0,1 HL79030

41989-5 FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST, STATE LOCATION INDICATOR This defines whether the referral was to a Provider/Specialist in or out-of-state. INS In-State OOS Out-of-State

CE 0,1 HL79035

41988-7 FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST, CATCHMENT LOCATION INDICATOR This defines whether the referral was to a Provider/Specialist in or out of the catchment area. If the patient is referred to a provider within the Prime Service Area of the Military Treatment Facility, this is considered In Catchment. If the patient is referred to a civilian provider who is not within a specified radius of the Prime beneficiaries Military Treatment Facility this is considered Out of Catchment. INC In-Catchment OOC Out-of-Catchment

CE 0,1 HL79036

39273-8

FOLLOW-UP (REFERRED TO) PROGRAM (COMPOSITE) Identifies information about the specific program if the patient was referred to an outside program.

0,n

39274-6 FOLLOW-UP (REFERRED TO) PROGRAM, REASON (NARRATIVE) Explanation of the reason for the referral to the program.

TX 1,1

39275-3 FOLLOW-UP (REFERRED TO) PROGRAM, NAME Identifies the name of the follow-up program this patient was referred to.

TX 1.1

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39276-1 FOLLOW-UP (REFERRED TO) PROGRAM, ADDRESS Identifies the address of the follow-up program this patient was referred to, if known.

XAD 0,1

39277-9 FOLLOW-UP (REFERRED TO) PROGRAM, PHONE Identifies the phone number of the follow-up program this patient was referred to, if known.

TX 0,1

39290-2 FOLLOW-UP (REFERRED TO) PROGRAM, APPOINTMENT DATE State the scheduled date of the referral appointment, if known.

DT 0,1

39235-7 IMMUNIZATION DATA (COMPOSITE) Identifies information about immunizations given to the patient.

0,n

39236-5 IMMUNIZATION DATA, CODE Identifies the immunization code (Level 1 HCPCS) scheduled for the patient.

CE 1,1 HPC

39237-3 IMMUNIZATION DATA, STATUS CODE Identifies the status of the immunization scheduled for the patient in relationship to the periodicity schedule. See section 5 for the list of valid codes.

CE 1,1 HL79031

30973-2 IMMUNIZATION DATA, DOSE NUMBER Identifies the dose number in the series of doses given for the specified immunization. Required if the immunization was given. (Immunization Status = NU or SN) Must be reported in iso+ units of iu (international units).

NM 0,1 iso+

30957-5 IMMUNIZATION DATA, MANUFACTURER Identifies the name of the manufacturer. Required if the immunization was given. (Immunization Status = NU or SN)

CE 0,1 HL70227

30959-1 IMMUNIZATION DATA, LOT NUMBER Identifies the lot number of the immunization given. Required if the immunization was given. (Immunization Status = NU or SN)

TX 0,1

3141-9 WEIGHT Identifies the measured body weight of the patient. Weight will be reported in either iso+ units of kg (kilograms) or ans+ units of lb (pounds).

1,1

3141-9

NM 1,1 iso+ (kg) ans+ (lb)

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

3137-7 HEIGHT /LENGTH Identifies the patient's height. Height will be reported in iso+ units of either cm (centimeters) or in (inches).

1,1

3137-7

NM 1,1 iso+

39156-5 BODY MASS INDEX MEASUREMENT Identifies the patient's calculated Body Mass Index Measurement. Must be reported in iso+ units of iu (international units).

1,1

39156-5

NM 1,1 iso+

35094-2 BLOOD PRESSURE (COMPOSITE) Identifies the patient's blood pressure.

0,1

8480-6 BLOOD PRESSURE, SYSTOLIC Must be reported in iso+ units of mm/HG.

NM 1,1 iso+

8462-4 BLOOD PRESSURE, DIASTOLIC Must be reported in iso+ units of mm/HG.

NM 1,1 iso+

9843-4 INFANT HEAD CIRCUMFERENCE Identifies the head circumference of the patient if the patient is an infant. Head Circumference will be reported in iso+ units of either cm (centimeters) or in (inches).

0,1

9843-4

NM 1,1 iso+

8339-4 BIRTH WEIGHT Identifies the patient's birth weight. Birth weight will be reported as either iso+ units of kg (kilograms) or ans+ units of lb (pounds).

0,1

8339-4

NM 1,1 iso+ (kg) ans+ (lb)

39238-1 PATIENT ANTICIPATORY GUIDANCE INDICATOR Identifies if Anticipatory Guidance or health education was given.

1,1

39238-1 N No Y Yes

CE 1,1 HL70136

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39239-9 PATIENT ANTICIPATORY GUIDANCE OR HEALTH EDUCATION TYPE Identifies the type of guidance or health education given to the patient or caregiver/family member of the patient.

0,n

39239-9 See section 5 for the list of valid codes.

CE 1,1 HL79032

39240-7 PATIENT TOBACCO USE INDICATOR Identifies if the patient uses tobacco.

0,1

39240-7 N No Y Yes

CE 1,1 HL70136

39241-5 PATIENT TOBACCO USE COUNSEL INDICATOR Identifies if the patient has been counseled about the use of tobacco.

0,1

39241-5 N No Y Yes

CE 1,1 HL70136

39242-3 PATIENT TOBACCO PREVENTION REFERRAL INDICATOR Identifies if the patient has been counseled about or referred to a tobacco prevention/cessation class.

0,1

39242-3 N No Y Yes

CE 1,1 HL70136

39243-1 PATIENT SECOND HAND SMOKE EXPOSURE INDICATOR Identifies if the patient is consistently exposed to second hand smoke.

0,1

39243-1 N No Y Yes

CE 1,1 HL70136

39278-7 CAREGIVER/FAMILY MEMBER TOBACCO USE INDICATOR Identifies if the caregiver/family member has been counseled about tobacco use.

0,1

39278-7 N No Y Yes

CE 1,1 HL70136

39279-5 CAREGIVER/FAMILY MEMBER TOBACCO PREVENTION REFERRAL INDICATOR Identifies if the caregiver/family member has been counseled about or referred to a tobacco prevention/cessation class.

0,1

39279-5 N No Y Yes

CE 1,1 HL70136

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39244-9 PATIENT DRUG/ALCOHOL USE INDICATOR Indicates if the patient uses alcohol or drugs.

0,1

39244-9 N No Y Yes

CE 1,1 HL79006

39245-6 PATIENT DRUG/ALCOHOL ABUSE COUNSELING INDICATOR Indicates if the patient is receiving counseling or treatment for alcohol and/or drug abuse. If the answer is R-Referred, it indicates that the patient has been referred to a PCP or program for treatment or counseling.

0,1

39245-6 Y Yes N No R Referred (Patient has been referred to a PCP, Specialist or Program for treatment.)

CE 1,1 HL79023

39246-4 RISK ASSESSMENT INDICATOR Indicates if this service included a family home visitation for risk assessment and risk reduction.

0,1

39246-4 N No Y Yes

CE 1,1 HL70136

39247-2 PRENATAL ASSESSMENT INDICATOR Identifies if a prenatal assessment was performed on this minor patient.

0,1

39247-2 N No Y Yes

CE 1,1 HL70136

39248-0 PRENATAL INTERVIEW WITH INFANTS PCP INDICATOR Indicates if this episode of care provided an opportunity for the expectant parents to interview or initiate a continuing relationship with the pediatrician, PCP, or clinic for the infant’s health care.

0,1

39248-0 N No Y Yes

CE 1,1 HL70136

39249-8 PROGRAM PARTICIPATION (COMPOSITE) Identifies the various programs the patient participates in.

0,n

39250-6 PROGRAM PARTICIPATION, NAME See section 5 for the list of valid codes.

CE 1,1 HL79033

39251-4 PROGRAM PARTICIPATION, OTHER PROGRAM PARTICIPATION NAME If 'OTH' is selected in Program Participation Name, the name of the program must be specified in this field.

TX 0,1

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39280-3 RESPONSIBLE PARTY (COMPOSITE) Identifies information about the person responsible for the patient.

0,1

39281-1 RESPONSIBLE PARTY, NAME The name of the patient’s parent or legal guardian if the patient is a minor.

PN 1,1

39282-9 RESPONSIBLE PARTY, HOME PHONE NUMBER The primary home phone number of the patient's parent or legal guardian if the patient is a minor. This could be either a cell or land line.

TX 0,1

39283-7 RESPONSIBLE PARTY, WORK PHONE NUMBER The work number of the patient’s parent or legal guardian if the patient is a minor.

TX 0,1

39284-5 PATIENT ESCORT (COMPOSITE) Identifies information about the person accompanying the patient to the appointment.

0,1

39285-2 PATIENT ESCORT, NAME The name of the individual who accompanied the patient to the appointment.

PN 1,1

39286-0 PATIENT ESCORT, RELATIONSHIP TO PATIENT Identifies the relationship of the accompanying person to the patient. See section 5 for the list of valid codes.

CE 0,1 HL79034

39287-8 PATIENT ESCORT, OTHER ESCORT RELATIONSHIP If 'OTH' is selected for Relationship to Patient, then the relationship must be defined in this field.

TX 0,1

39252-2 FOSTER CARE INDICATOR Defines if the patient is in foster care.

0,1

39252-2 N No Y Yes

CE 1,1 HL70136

39288-6 PRE-PAID HEALTH PLAN INDICATOR Identifies if the patient is enrolled in a pre-paid health plan at the time this encounter occurred.

0,1

39288-6 N No Y Yes

CE 1,1 HL70136

39253-0 PRIMARY CARE PRACTITIONER (PCP) INDICATOR Defines if the Primary Care Practitioner (PCP) provides routine care for the patient.

0,1

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LOINC code Component Answer

Value Data Type

Card Response Code/ Numeric Units

39253-0 N No Y Yes

CE 1,1 HL70136

39254-8 PRIMARY CARE PRACTITIONER (PCP) PERFORM SCREEN INDICATOR Identifies if the person performing the screen or assessment is the patient's Primary Care Practitioner (PCP).

0,1

39254-8 N No Y Yes

CE 1,1 HL70136

18711-2 PATIENT PRIMARY CARE PRACTITIONER (PCP) NAME If the PCP is not performing the screen/assessment, identifies the name of the patient's PCP.

0,1

18711-2

PN 1,1

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4 Coding Examples

4.1 Scenario The following message encodes a Children's Preventive Health Services attachment for patient Jane J. Jay.

Dr. John Smith who has an National Provider ID of 9854687254 and a Proprietary Provider ID of chd215434a (proprietary and NPI are both being reported during the transition period to use of the NPI) performed the assessment on January 5, 2005.

The claim associated with this CDA document is identified by the value CP153598 in data element TRN02-Attachment Control Number of Loop 2000A-Payer/Provider Control Number.

The patient, Jane J. Jay received an intial examination with history and physicam, vision, and hearing screens. The vision screen was referred to another physician for follow-up care due to abnormal results. The patient was given her MMR immunization and anticipatory guidance.

The following is a table of all services provided and information collected at the time of the encounter.

Figure 4.1 Children's Preventive Health Services Data

SCREEN TYPE INDICATOR Initial (IN) PERIODICITY INDICATOR Yes (Y) DATE OF THE PREVIOUS SCREEN 2004-11-22 FAMILY HISTORY OR CONDITION/

DISEASE INDICATOR No (N) SCREEN ASSESSMENT

(NAME) History and Physical (HNP) (RESULTS INDICATOR) Normal (NOR) SCREEN ASSESSMENT

(NAME) Vision (VIS) (RESULTS INDICATOR) Abnormal, Under Care (ABU) (FOLLOW-UP INDICATOR) Referred (REF) SCREEN ASSESSMENT

(NAME) Hearing (HEA) (RESULTS INDICATOR) Normal (NOR) FOLLOW-UP (REFERRED TO)

PROVIDER SPECIALIST (REASON) Abnormal vision results (NAME) John J. Knight, MD (PROVIDER TYPE) 207W00000X (ADDRESS) 1200 Vision Drive Carefree, CA 95678 IMMUNIZATION DATA (CODE) Measles, mumps and rubella (90707) (STATUS CODE) Now Up to Date for Age (NU) (DOSE NUMBER) 2 (MANUFACTURER) Merck and Co., Inc (MSD) (LOT NUMBER) AB12345 PATIENT WEIGHT 98 lbs PATIENT HEIGHT/LENGTH 56 in. PATIENT BODY MASS INDEX

MEASUREMENT 22 PATIENTANTICIPATORY GUIDANCE INDICATOR Yes (Y)

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PATIENT ANTICIPATORY GUIDANCE TYPE(S) Alcohol/Drug/Inhalants (DRG) Developmental/Behavioral (DEV) Sexual Activity/Family Planning (SFP) PATIENT TOBACCO USE INDICATOR Yes (Y) PATIENT TOBACCO USE COUNSEL IND Yes (Y) PATIENT TOBACCO PREVENTION

REFERRAL IND No (N) RISK ASSESSMENT INDICATOR No (N)

4.1.1 Coded Children's Preventive Health Services Attachment, Human-Decision Variant

The right column of the example below contains the single HL7 document in the human-decision variant that conveys this report in its entirety. The left column provides help in relating the example to the scenario and to the Value Table.

Example 4.1.1 Children's Preventive Health Services Attachment, Human-Decision Variant

Header <levelone xmlns="urn:hl7-org:v3/cda" xmlns:v3dt="urn:hl7-org:v3/v3dt" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3/cda levelone_1.0.attachments.xsd"> <clinical_document_header> <id EX="a123" RT="2.16.840.1.113883.3.933"/> <document_type_cd V="39294-4" DN="Children's Preventive Health Services Attachment"/> <origination_dttm V="2005-01-05"/>

Provider Identification includes both NPI and Proprietary Provider ID

<provider> <provider.type_cd V="PRF"/> <person> <id EX="9854687254" RT="2.16.840.1.113883.3.105"/> <id EX="chd215434a" RT="2.16.840.1.113883.6.106"/> <person_name> <nm> <v3dt:GIV V="John"/> <v3dt:MID V="E."/> <v3dt:FAM V="Smith"/> <v3dt:SFX V="MD"/> </nm> <person_name.type_cd V="L" S="2.16.840.1.113883.5.200"/> </person_name> </person> </provider>

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Patient Identification

<patient> <patient.type_cd V="PATSBJ"/> <person> <id EX="5962314675" RT="2.16.840.1.113883.19.7.4"/> <person_name> <nm> <v3dt:GIV V="Jane"/> <v3dt:FAM V="Jay"/> <v3dt:MID V="J."/> </nm> <person_name.type_cd V="L" S="2.16.840.1.113883.12.200"/> </person_name> </person> <is_known_by> <id EX="5962314675" RT="2.16.840.1.1138863.19.7.4"/> <is_known_to> <id EX="9854687254" RT="2.16.840.1.113883.19.7.2"/> </is_known_to> </is_known_by> </patient>

Attachment Control Number

<local_header descriptor="Att_ACN"> <local_attr name="attachment_control_number" value="CP153598"/> </local_header> </clinical_document_header>

Screen Type Indicator: Initial

<body> <section> <caption>SCREEN TYPE INDICATOR</caption> <paragraph> <content>Initial</content> </paragraph> </section>

Periodicity Indicator: Yes

<section> <caption>PERIODICITY INDICATOR</caption> <paragraph> <content>Yes</content> </paragraph> </section>

Date of Previous Screen: 11/22/2004

<section> <caption>DATE OF PREVIOUS SCREEN</caption> <paragraph> <content>22 November 2004</content> </paragraph> </section>

Family History Indicator: No

<section> <caption>FAMILY HISTORY OR CONDITION/DISEASE INDICATOR</caption> <paragraph> <content>No</content> </paragraph> </section>

Screen Assessment Name and Results Indicator: History and Physical, Normal

<section> <caption>SCREEN ASSESSMENT, HISTORY AND PHYSICAL</caption> <paragraph> <caption>SCREEN ASSESSMENT RESULTS INDICATOR</caption> <content>Normal</content> </paragraph> </section>

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Screen Assessment Name, Results Indicator, and Follow-up Indicator: Vision, Abnormal, Under Care, Referred

<section> <caption>SCREEN ASSESSMENT, VISION</caption> <paragraph> <caption>SCREEN ASSESSMENT RESULTS INDICATOR</caption> <content>Abnormal, Under Care</content> </paragraph> <paragraph> <caption>SCREEN ASSESSMENT FOLLOW-UP INDICATOR</caption> <content>Referred</content> </paragraph> </section>

Screen Assessment Name and Results Indicator: Hearing, Normal

<section> <caption>SCREEN ASSESSMENT, HEARING</caption> <paragraph> <caption>SCREEN ASSESSMENT RESULTS INDICATOR</caption> <content>Normal</content> </paragraph> </section>

Follow-Up (Referred to) Provider/Specialist Reason, Name, Provider Type, Address: Abnormal vision results, John J. Knight, MD, 207W00000X Opthalmologist, 1200 Vision Drive, Carefree, CA 95678

<section> <caption>FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST</caption> <paragraph> <caption>FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST REASON</caption> <content>Abnormal vision results</content> </paragraph> <paragraph> <caption>FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST NAME</caption> <content>John J. Knight, MD</content> </paragraph> <paragraph> <caption>FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST PROVIDER TYPE</caption> <content>207W00000X Opthalmologist</content> </paragraph> <paragraph> <caption>FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST ADDRESS</caption> <content> 1200 Vision Drive<local_markup descriptor="br"/> Carefree, CA 95678<local_markup descriptor="br"/> </content> </paragraph> </section>

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Immunization Data, Code, Status Code, Dose Number, Manufacturer, Lot Number: 90707, Now up to date for age, 2, Merck and Co, Inc, AB12345

<section> <caption>IMMUNIZATION DATA</caption> <paragraph> <caption>IMMUNIZATION CODE</caption> <content>Measles, mumps and rubella (90707)</content> </paragraph> <paragraph> <caption>IMMUNIZATION STATUS CODE</caption> <content>Now up to date for age</content> </paragraph> <paragraph> <caption>IMMUNIZATION DOSE NUMBER</caption> <content>2</content> </paragraph> <paragraph> <caption>IMMUNIZATION MANUFACTURER</caption> <content>Merck and Co., Inc. (MSD)</content> </paragraph> <paragraph> <caption>IMMUNIZATION LOT NUMBER</caption> <content>AB12345</content> </paragraph> </section>

Weight: 98 lbs. <section> <caption>WEIGHT</caption> <paragraph> <content>98 lbs.</content> </paragraph> </section>

Height/Length: 4 feet 8 inches

<section> <caption>HEIGHT/LENGTH</caption> <paragraph> <content>56 inches</content> </paragraph> </section>

Body Mass Index Measurement: 22

<section> <caption>BODY MASS INDEX MEASUREMENT</caption> <paragraph> <content>22</content> </paragraph> </section>

Patient Anticipatory Guidance Indicator: Yes

<section> <caption>PATIENT ANTICIPATORY GUIDANCE INDICATOR</caption> <paragraph> <content>Yes</content> </paragraph> </section>

Patient Anticipatory Guidance Type: Alcohol/Drug/Inhalant, Developmental/Behavioral, Sexual Activity/Family Planning

<section> <caption>PATIENT ANTICIPATORY GUIDANCE TYPE</caption> <paragraph> <content>Alcohol/Drug/Inhalants</content> </paragraph> </section> <section> <caption>PATIENT ANTICIPATORY GUIDANCE TYPE</caption> <paragraph> <content> Developmental/Behavioral</content> </paragraph> </section> <section> <caption>PATIENT ANTICIPATORY GUIDANCE TYPE</caption> <paragraph> <content>Sexual Activity/Family Planning</content> </paragraph> </section>

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Patient Tobacco Use Indicator: Yes

<section> <caption>PATIENT TOBACCO USE INDICATOR</caption> <paragraph> <content>Yes</content> </paragraph> </section>

Patient Tobacco Use Counsel Indicator: Yes

<section> <caption>PATIENT TOBACCO USE COUNSEL INDICATOR</caption> <paragraph> <content>Yes</content> </paragraph> </section>

Patient Tobacco Prevention Referral Indicator: No

<section> <caption>PATIENT TOBACCO USE PREVENTION REFERRAL INDICATOR</caption> <paragraph> <content>No</content> </paragraph> </section>

Risk Assessment: No

<section> <caption>RISK ASSESSMENT INDICATOR</caption> <paragraph> <content>No</content> </paragraph> </section> </body> </levelone>

Figure 1 shows a portion of the human-decision variant as rendered by a popular browser.

Figure 1. Portion of Rendered Human-Decision Variant

Children's Preventive Health Services Attachment

Provider: John E. Smith, MD

Patient: Jane J. Jay Patient ID: 5962314675

Attachment Control Number: CP153598

SCREEN TYPE INDICATOR

Initial

PERIODICITY INDICATOR

Yes

DATE OF PREVIOUS SCREEN

22 November 2004

FAMILY HISTORY OR CONDITION/DISEASE INDICATOR

No

SCREEN ASSESSMENT, HISTORY AND PHYSICAL

SCREEN ASSESSMENT, HISTORY AND PHYSICAL RESULTS INDICATOR. Normal

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SCREEN ASSESSMENT, VISION

SCREEN ASSESSMENT, VISION RESULTS INDICATOR. Abnormal, Under Care

SCREEN ASSESSMENT, VISION FOLLOW-UP INDICATOR. Referred

SCREEN ASSESSMENT, HEARING

SCREEN ASSESSMENT, HEARING RESULTS INDICATOR. Normal

FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST

FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST REASON. Abnormal vision results

FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST NAME. John J. Knight, MD

FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST PROVIDER TYPE. 207W00000X Opthalmologist

FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST ADDRESS. 1200 Vision Drive Carefree, CA 95678

IMMUNIZATION DATA

IMMUNIZATION CODE. Measles, mumps and rubella (90707)

IMMUNIZATION STATUS CODE. Now up to date for age

IMMUNIZATION DOSE NUMBER. 2

IMMUNIZATION MANUFACTURER. Merck and Co., Inc. (MSD)

IMMUNIZATION LOT NUMBER. AB12345

WEIGHT

98 lbs.

HEIGHT

56 inches

BODY MASS INDEX MEASUREMENT

22

PATIENT ANTICIPATORY GUIDANCE INDICATOR

Yes

PATIENT ANTICIPATORY GUIDANCE TYPE

Alcohol/Drug/Inhalants

PATIENT ANTICIPATORY GUIDANCE TYPE

Developmental/Behavioral

PATIENT ANTICIPATORY GUIDANCE TYPE

Sexual Activity/Family Planning

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PATIENT TOBACCO USE INDICATOR

Yes

PATIENT TOBACCO USE COUNSEL INDICATOR

Yes

PATIENT TOBACCO USE PREVENTION REFERRAL INDICATOR

No

RISK ASSESSMENT INDICATOR

No

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4.1.2 Coded Children's Preventive Health Services Attachment, Computer-Decision Variant

The right column of the example below contains the single HL7 Additional Information CDA document in the computer-decision variant that conveys this report in its entirety. The left column provides help in relating the example to the scenario and to the Value Table.

Example 4.1.2 Children's Preventive Health Services Attachment, Computer-Decision Variant

Header <levelone xmlns="urn:hl7-org:v3/cda" xmlns:v3dt="urn:hl7-org:v3/v3dt" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3/cda levelone_1.0.attachments.xsd"> <clinical_document_header> <id EX="a123" RT="2.16.840.1.113883.3.933"/> <document_type_cd V="39294-4" DN="Children's Preventive Health Services Attachment"/> <origination_dttm V="2005-01-05"/>

Provider Identification includes both NPI and Proprietary Provider ID

<provider> <provider.type_cd V="PRF"/> <person> <id EX="9854687254" RT="2.16.840.1.113883.3.105"/> <id EX="chd215434a" RT="2.16.840.1.113883.6.106"/> <person_name> <nm> <v3dt:GIV V="John"/> <v3dt:MID V="E."/> <v3dt:FAM V="Smith"/> <v3dt:SFX V="MD"/> </nm> <person_name.type_cd V="L" S="2.16.840.1.113883.5.200"/> </person_name> </person> </provider>

Patient Identification

<patient> <patient.type_cd V="PATSBJ"/> <person> <id EX="5962314675" RT="2.16.840.1.113883.19.7.4"/> <person_name> <nm> <v3dt:GIV V="Jane"/> <v3dt:FAM V="Jay"/> <v3dt:MID V="J."/> </nm> <person_name.type_cd V="L" S="2.16.840.1.113883.12.200"/> </person_name> </person> <is_known_by> <id EX="5962314675" RT="2.16.840.1.1138863.19.7.4"/> <is_known_to> <id EX="9854687254" RT="2.16.840.1.113883.19.7.2"/> </is_known_to> </is_known_by> </patient>

Attachment Control Number

<local_header descriptor="Att_ACN"> <local_attr name="attachment_control_number" value="CP153598"/> </local_header> </clinical_document_header>

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Screen Type Indicator: Initial

<body> <section> <caption>SCREEN TYPE INDICATOR <caption_cd V="39157-3"/> </caption> <paragraph> <content>Initial <coded_entry> <coded_entry.value V="IN" S="2.16.840.1.113883.12.9020" SN="HL79020"/> </coded_entry> </content> </paragraph> </section>

Periodicity Indicator: Yes

<section> <caption>PERIODICITY INDICATOR <caption_cd V="39158-1"/> </caption> <paragraph> <content>Yes <coded_entry> <coded_entry.value V="Y" S="2.16.840.1.113883.12.136" SN="HL70136"/> </coded_entry> </content> </paragraph> </section>

Date of Previous Screen: 11/22/2004

<section> <caption>DATE OF PREVIOUS SCREEN <caption_cd V="39255-5"/> </caption> <paragraph> <content>22 November 2004 <local_markup descriptor="dt_DT" ignore="all">2004-11-22</local_markup> </content> </paragraph> </section>

Family History Indicator: No

<section> <caption>FAMILY HISTORY OR CONDITION/DISEASE INDICATOR <caption_cd V="39155-7"/> </caption> <paragraph> <content>No <coded_entry> <coded_entry.value V="N" S="2.16.840.1.113883.12.9022" SN="HL79022"/> </coded_entry> </content> </paragraph> </section>

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Screen Assessment Name and Results Indicator: History and Physical, Normal

<section> <caption>SCREEN ASSESSMENT, HISTORY AND PHYSICAL <caption_cd V="39256-3"/> </caption> <paragraph> <caption>SCREEN ASSESSMENT, HISTORY AND PHYSICAL RESULTS INDICATOR <caption_cd V="39163-1"/> </caption> <content>Normal <coded_entry> <coded_entry.value V="NOR" S="2.16.840.1.113883.12.9025" SN="HL79025"/> </coded_entry> </content> </paragraph> </section>

Screen Assessment Name, Results Indicator, and Follow-up Indicator: Vision, Abnormal, Under Care, Referred

<section> <caption>SCREEN ASSESSMENT, VISION <caption_cd V="39212-6"/> </caption> <paragraph> <caption>SCREEN ASSESSMENT, VISION RESULTS INDICATOR <caption_cd V="39213-4"/> </caption> <content>Abnormal, Under Care <coded_entry> <coded_entry.value V="ABU" S="2.16.840.1.113883.12.9025" SN="HL79025"/> </coded_entry> </content> </paragraph> <paragraph> <caption>SCREEN ASSESSMENT, VISION FOLLOW-UP INDICATOR <caption_cd V="39214-2"/> </caption> <content>Referred <coded_entry> <coded_entry.value V="REF" S="2.16.840.1.113883.12.9026" SN="HL79026"/> </coded_entry> </content> </paragraph> </section>

Screen Assessment Name and Results Indicator: Hearing, Normal

<section> <caption>SCREEN ASSESSMENT, HEARING <caption_cd V="39189-6"/> </caption> <paragraph> <caption>SCREEN ASSESSMENT, HEARING RESULTS INDICATOR <caption_cd V="39190-4"/> </caption> <content>Normal <coded_entry> <coded_entry.value V="NOR" S="2.16.840.1.113883.12.9025" SN="HL79025"/> </coded_entry> </content> </paragraph> </section>

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Follow-Up (Referred to) Provider/Specialist Reason, Name, Provider Type, Address: Abnormal vision results, John J. Knight, OD, PTX here, 1200 Vision Drive, Carefree, CA 95678

<section> <caption>FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST <caption_cd V="39266-2"/> </caption> <paragraph> <caption>FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST REASON <caption_cd V="39267-0"/> </caption> <content>Vision results abnormal </content> </paragraph> <paragraph> <caption>FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST NAME <caption_cd V="39268-8"/> </caption> <content>John J. Knight, MD <local_markup descriptor="dt_PN"> <local_markup descriptor="dt_PN_GIV" ignore="all"> JOHN</local_markup> <local_markup descriptor="dt_PN_MID" ignore="all">J </local_markup> <local_markup descriptor="dt_PN_FAM" ignore="all"> KNIGHT</local_markup> <local_markup descriptor="dt_PN_SFX" ignore="all">MD </local_markup> </local_markup> </content> </paragraph> <paragraph> <caption>FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST PROVIDER TYPE <caption_cd V="39269-6"/> </caption> <content>207W00000X Opthalmologist <coded_entry> <coded_entry.value V="207W00000X " S="2.16.840.1.113883.6.101" SN="USProvTxnmy"/> </coded_entry> </content> </paragraph> <paragraph> <caption>FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST ADDRESS <caption_cd V="39270-4"/> </caption> <content> 1200 Vision Drive<local_markup descriptor="br"/> Carefree, CA 95678<local_markup descriptor="br"/> <local_markup descriptor="dt_AD"> <local_attr name="dt_AD_LIT" value="1200 Vision Drive"/> <local_attr name="dt_AD_CTY" value="Carefree"/> <local_attr name="dt_AD_STA" value="CA"/> <local_attr name="dt_AD_ZIP" value="95678"/> </local_markup> </content> </paragraph> </section>

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Immunization Data, Code, Status Code, Dose Number, Manufacturer, Lot Number: 90707, Now up to date for age, 2, Merck and Co, Inc, AB12345

<section> <caption>IMMUNIZATION DATA <caption_cd V="39235-7"/> </caption> <paragraph> <caption>IMMUNIZATION DATA, CODE <caption_cd V="39236-5"/> </caption> <content>Measles, mumps and rubella vaccine or Measles, mumps and rubella vaccine (90707) <coded_entry> <coded_entry.value V="90707 " S="2.16.840.1.113883.6.14" SN="HPC"/> </coded_entry> </content> </paragraph> <paragraph> <caption>IMMUNIZATION DATA, STATUS CODE <caption_cd V="39237-3"/> </caption> <content>Now up to date for age <coded_entry> <coded_entry.value V="NU" S="2.16.840.1.113883.12.9031" SN="HL79031"/> </coded_entry> </content> </paragraph> <paragraph> <caption>IMMUNIZATION DATE, DOSE NUMBER <caption_cd V="30973-2"/> </caption> <content>2 <local_markup descriptor="dt_nm" ignore="all">2 <coded_entry> <coded_entry.value V="iu" S="2.16.840.1.113883.5.141"/> </coded_entry> </local_markup> </content> </paragraph> <paragraph> <caption>IMMUNIZATION DATA, MANUFACTURER <caption_cd V="30957-5"/> </caption> <content>Merck and Co., Inc. (MSD) <coded_entry> <coded_entry.value V="MSD" S="2.16.840.1.113883.6.60" SN="MVX"/> </coded_entry> </content> </paragraph> <paragraph> <caption>IMMUNIZATION DATA, LOT NUMBER <caption_cd V="30959-1"/> </caption> <content>AB12345 </content> </paragraph> </section>

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Weight: 98 lbs. <section> <caption>WEIGHT <caption_cd V="3141-9"/> </caption> <paragraph> <content>98 lbs. <local_markup descriptor="dt_nm" ignore="all">98 <coded_entry> <coded_entry.value V="lb" S="2.16.840.1.113883.5.141"/> </coded_entry> </local_markup> </content> </paragraph> </section>

Height/Length: 4 feet 8 inches

<section> <caption>HEIGHT/LENGTH <caption_cd V="3137-7"/> </caption> <paragraph> <content>56 in. <local_markup descriptor="dt_nm" ignore="all">56 <coded_entry> <coded_entry.value V="in" S="2.16.840.1.113883.5.141"/> </coded_entry> </local_markup> </content> </paragraph> </section>

Body Mass Index Measurement: 22

<section> <caption>BODY MASS INDEX MEASUREMENT <caption_cd V="39156-5"/> </caption> <paragraph> <content>22 <local_markup descriptor="dt_nm" ignore="all">22 <coded_entry> <coded_entry.value V="iu" S="2.16.840.1.113883.5.141"/> </coded_entry> </local_markup> </content> </paragraph> </section>

Patient Anticipatory Guidance Indicator: Yes

<section> <caption>PATIENT ANTICIPATORY GUIDANCE INDICATOR <caption_cd V="39238-1"/> </caption> <paragraph> <content>Yes <coded_entry> <coded_entry.value V="Y" S="2.16.840.1.113883.12.136" SN="HL70136"/> </coded_entry> </content> </paragraph> </section>

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Patient Anticipatory Guidance Type: Alcohol/Drug/Inhalant, Developmental/Behavioral, Sexual Activity/Family Planning

<section> <caption>PATIENT ANTICIPATORY GUIDANCE TYPE <caption_cd V="39239-9"/> </caption> <paragraph> <content>Alcohol/Drug/Inhalants <coded_entry> <coded_entry.value V="DRG" S="2.16.840.1.113883.12.9032" SN="HL79032"/> </coded_entry> </content> </paragraph> </section> <section> <caption>PATIENT ANTICIPATORY GUIDANCE TYPE <caption_cd V="39239-9"/> </caption> <paragraph> <content>Developmental/Behavioral <coded_entry> <coded_entry.value V="DEV" S="2.16.840.1.113883.12.9032" SN="HL79032"/> </coded_entry> </content> </paragraph> </section> <section> <caption>PATIENT ANTICIPATORY GUIDANCE TYPE <caption_cd V="39239-9"/> </caption> <paragraph> <content>Sexual Activity/Family Planning <coded_entry> <coded_entry.value V="SFP" S="2.16.840.1.113883.12.9032" SN="HL79032"/> </coded_entry> </content> </paragraph> </section>

Patient Tobacco Use Indicator: Yes

<section> <caption>PATIENT TOBACCO USE INDICATOR <caption_cd V="39240-7"/> </caption> <paragraph> <content>Yes <coded_entry> <coded_entry.value V="Y" S="2.16.840.1.113883.12.136" SN="HL70136"/> </coded_entry> </content> </paragraph> </section>

Patient Tobacco Use Counsel Indicator: Yes

<section> <caption>PATIENT TOBACCO USE COUNSEL INDICATOR <caption_cd V="39241-5"/> </caption> <paragraph> <content>Yes <coded_entry> <coded_entry.value V="Y" S="2.16.840.1.113883.12.136" SN="HL70136"/> </coded_entry> </content> </paragraph> </section>

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Patient Tobacco Prevention Referral Indicator: No

<section> <caption>PATIENT TOBACCO USE PREVENTION REFERRAL INDICATOR <caption_cd V="39242-3"/> </caption> <paragraph> <content>No <coded_entry> <coded_entry.value V="N" S="2.16.840.1.113883.12.136" SN="HL70136"/> </coded_entry> </content> </paragraph> </section>

Risk Assessment: No

<section> <caption>RISK ASSESSMENT INDICATOR <caption_cd V="39246-4"/> </caption> <paragraph> <content>No <coded_entry> <coded_entry.value V="N" S="2.16.840.1.113883.12.136" SN="HL70136"/> </coded_entry> </content> </paragraph> </section> </body> </levelone>

Figure 2 shows a portion of the computer-decision variant as rendered by a popular browser. It includes the medications rendered as a table.

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Figure 2. Rendered Portion of Compuer-Decision Variant.

Children's Preventive Health Services Attachment

Provider: John E. Smith, MD

Patient: Jane J. Jay Patient ID: 5962314675

Attachment Control Number: CP153598

SCREEN TYPE INDICATOR

Initial

PERIODICITY INDICATOR

Yes

DATE OF PREVIOUS SCREEN

22 November 2004

FAMILY HISTORY OR CONDITION/DISEASE INDICATOR

No

SCREEN ASSESSMENT, HISTORY AND PHYSICAL

SCREEN ASSESSMENT, HISTORY AND PHYSICAL RESULTS INDICATOR. Normal

SCREEN ASSESSMENT, VISION

SCREEN ASSESSMENT, VISION RESULTS INDICATOR. Abnormal, Under Care

SCREEN ASSESSMENT, VISION FOLLOW-UP INDICATOR. Referred

SCREEN ASSESSMENT, HEARING

SCREEN ASSESSMENT, HEARING RESULTS INDICATOR. Normal

FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST

FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST REASON. Abnormal vision results

FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST NAME. John J. Knight, MD

FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST PROVIDER TYPE. 207W00000X Opthalmologist

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FOLLOW-UP (REFERRED TO) PROVIDER/SPECIALIST ADDRESS. 1200 Vision Drive Carefree, CA 95678

IMMUNIZATION DATA

IMMUNIZATION CODE. Measles, mumps and rubella (90707)

IMMUNIZATION STATUS CODE. Now up to date for age

IMMUNIZATION DOSE NUMBER. 2

IMMUNIZATION MANUFACTURER. Merck and Co., Inc. (MSD)

IMMUNIZATION LOT NUMBER. AB12345

WEIGHT

98 lbs.

HEIGHT

56 inches

BODY MASS INDEX MEASUREMENT

22

PATIENT ANTICIPATORY GUIDANCE INDICATOR

Yes

PATIENT ANTICIPATORY GUIDANCE TYPE

Alcohol/Drug/Inhalants

PATIENT ANTICIPATORY GUIDANCE TYPE

Developmental/Behavioral

PATIENT ANTICIPATORY GUIDANCE TYPE

Sexual Activity/Family Planning

PATIENT TOBACCO USE INDICATOR

Yes

PATIENT TOBACCO USE COUNSEL INDICATOR

Yes

PATIENT TOBACCO USE PREVENTION REFERRAL INDICATOR

No

RISK ASSESSMENT INDICATOR

No

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5 Response Code Sets and OID References This section describes response codes that may be used in the computer-decision variant when the value table indicates a coded with exception (CE) data type or to represent units when the attachment component is of the numeric (NM) data type. The entry in the value table that refers to these code sets is used in the subsection titles. In addition, this section contains references to OIDS used in the header of the CDA for both variants and the body of the CDA for the computer-decision variant.

The values for some code sets appear directly in this document. In other cases, the section cites another document as the source.

5.1 HL70136: HL7 Yes-No Indicator The OID for this table is 2.16.840.1.113883.12.136.

Table 5.1 HL7 Yes-No Indicator Code Description Additional Comments

N No Y Yes

5.2 HL79020: HL7 Screen Type Indicator The OID for this table is 2.16.840.1.113883.12.9020.

Table 5.2 HL7 Screen Type Indicator Code Description Additional Comments

IN Initial PE Periodic IT Interperiodic

5.3 HL79021: HL7 Screening Level The OID for this table is 2.16.840.1.113883.12.9021.

Table 5.3 HL7 Screening Level Code Description Additional Comments PAR Partial TOT Total

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5.4 HL79022: HL7 Condition/Disease Indicator The OID for this table is 2.16.840.1.113883.12.9022.

Table 5.4 HL7 Condition/Disease Code Description Additional Comments YA Yes, 1 Condition YB Yes, 2-3 Conditions YC Yes, More than 3 Conditions N No

5.5 HL79023: HL7 Yes/No/Referred Indicator The OID for this table is 2.16.840.1.113883.12.9023.

Table 5.5 HL7 Yes/No/Referred Indicator Code Description Additional Comments

Y Yes N No R Referred Patient has been referred to a

PCP, Specialist or Program for treatment.

5.6 HL79025: HL7 Screen Assessment Results Indicator The OID for this table is 2.16.840.1.113883.12.9025.

Table 5.6 HL7 Screen Assessment Results Indicator Code Description Additional Comments NOR Normal NNU Normal, Not Under Care ABN Abnormal, Treatment Required ABU Abnormal, Under Care NDO Not Done RPE Results Pending RCN Refused, Contraindicated or Not Needed

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5.7 HL79026: HL7 Follow-up Indicator The OID for this table is 2.16.840.1.113883.12.9026.

Table 5.7 HL7 Follow-up Indicator Code Description Additional Comments QUR Questionable Result, Re-check Scheduled DXT Diagnosis Made and Treatment Started DXP Diagnosis Pending/Return Visit Scheduled REF Referred RER Referral Refused

5.8 HL79027: HL7 Diagnosis State The OID for this table is 2.16.840.1.113883.12.9027.

Table 5.8 HL7 Diagnosis State Code Description Additional Comments ND Newly Discovered PD Previously Discovered

5.9 HL79029: HL7 Screen Test Status The OID for this table is 2.16.840.1.113883.12.9029.

Table 5.9 HL7 Screen Test Status Code Description Additional Comments POS Ordered - Positive NEG Odered - Negative NRE Ordered – No Results NOR Not Ordered

5.10 HL79030: HL7 Referral Network Location Indicator The OID for this table is 2.16.840.1.113883.12.9030.

Table 5.10 HL7 Referral Network Location Indicator Code Description Additional Comments INN In-Network OON Out-of-Network

5.11 HL79031: HL7 Immunization Status Code The OID for this table is 2.16.840.1.113883.12.9031.

Table 5.11 HL7 Immunization Status Code Code Description Additional Comments NU Now Up to Date for Age SN Still Not Up to Date for Age PR Parental Refusal MC Medically Contraindicated VN Vaccine Not Available

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5.12 HL79032: HL7 Patient Anticipatory Guidance Type The OID for this table is 2.16.840.1.113883.12.9032.

Table 5.12 HL7 Patient Anticipatory Guidance Type Code Description Additional Comments CHB Childbirth CMD Communicable Disease CRI Crisis Intervention DEV Developmental/Behavioral DRG Drug/Alcohol/Inhalants FAM Family Involvement INC Infant Care NUT Nutrition Activity ORA Oral Health PAR Parenting SFI Safety/Injury Prevention SFP Sexual Activity/Family Planning SIL Signs of Illness SOC Social/Peer Skills

5.13 HL79033: HL7 Program Participation Name The OID for this table is 2.16.840.1.113883.12.9033.

Table 5.13 HL7 Program Participation Name Code Description Additional Comments CSN Children with Special Needs This value can be used for the

federal CSN program or state programs that handle Children with Special Needs

EIP Early Intervention Program ECH Extended Care Health Option (ECHO) HDS Head Start WIC Women Infants and Children OTH Other If used, then Other Program

Participation Name must be completed

5.14 HL79034: HL7 Patient Escort Relationship to Patient The OID for this table is 2.16.840.1.113883.12.9034.

Table 5.14 HL7 Patient Escort Relationship to Patient Code Description Additional Comments PAR Parent REL Relative FRI Friend SOC Social Worker HCW Health Care Worker OTH Other If used, then Other

Relationship to Patient must be completed

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5.15 HL79035: HL7 Referral State Location Indicator The OID for this table is 2.16.840.1.113883.12.9035.

Table 5.15 HL7 Referral State Location Indicator Code Description Additional Comments INS In-State OOS Out-of-State

5.16 HL79036: HL7 Referral Catchment Location Indicator The OID for this table is 2.16.840.1.113883.12.9036.

Table 5.16 HL7 Referral Catchment Location Indicator Code Description Additional Comments INC In-Catchment OOC Out-of-Catchment

5.17 HL79037: HL7 Dental Assessment Results The OID for this table is 2.16.840.1.113883.12.9037

Table 5.17 HL7 Dental Assessment Results Code Description Additional Comments

C1 No Visible Dental Problem No problem visualized. Child has not seen a dentist in the last 12 months, and should be referred for routine care.

C2 Mild Dental Problems Small carious lesions or gingivitis, the patient is asymptomatic. The condition is not urgent, yet requires a dental referral.

C3 Severe Dental Problems Large carious lesions, chronic abscess, or extensive gingivitis, or a history of pain. The need for dental care is urgent. Refer for treatment as soon as possible.

C4 Emergency Dental Treatment Required Acute injury, oral infection, or other painful condition. An immediate dental referral is indicated.

5.18 I9C : ICD-9-CM International Classification of Diseases, Clinical Modification. The OID for this table is 2.16.840.1.113883.6.2

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5.19 HPC: Healthcare Common Procedural Coding System (HCPCS) Procedure coding from the Centers for Medicare and Medicaid Services (CMS) (Level 2 and 3) and the American Medical Association (AMA) (Level 1). For more information about level 1 codes (CPT-4) contact the AMA at P.O. Box 10946, Chicago IL 60610. For more information about level 2 and 3 codes contact CMS at 7500 Security Blvd., Baltimore, MD 21244.

The OID for this table is 2.16.840.1.113883.6.14.

5.20 iso+: Extended ISO Units Codes ISO 2955-1983 and extensions as defined in HL7 Version 2.4 Figure 7-9. Due to its length the table is included in the HL7 Additional Information Specification Implementation Guide rather than in this Additional Information Specification.

The OID for this table is 2.16.840.1.113883.5.141 (UnitOfMeasure).

5.21 ans+: Extended ANSI Units Codes Extended ANSI Unit Codes as in HL7 Version 2.4 Figure 7-9. Due to its length the table is included in the HL7 Additional Information Specification Implementation Guide rather than in this Additional Information Specification.

The OID for this table is 2.16.840.1.113883.5.141 (UnitOfMeasure).

5.22 NPI: National Provider Identifier On January 23, 2004, the Secretary of HHS published a final rule (Federal Register volume 69, page 3434) which establishes the standard for a unique health identifier for health care providers for use in the health care system, and announces the adoption of the National Provider Identifier (NPI) as that standard. It also establishes the implementation specifications for obtaining and using the standard unique health identifier for health care providers.

For more information contact the US Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), 7500 Security Blvd., Baltimore, MD 21244

The DHHS Administrative Simplification web site is http://www.cms.hhs.gov/hipaa/hipaa2/. Information about the NPI may be found in the Identifier Standards section.

The OID for this identifier is 2.16.840.1.113883.4.6

5.23 PTX: Health Care Provider Taxonomy The National Uniform Claim Committee (NUCC) maintains the Health Care Provider Taxonomy. The code set is available through Washington Publishing. See: http://www.wpc-edi.com/codes/

The OID for this table is 2.16.840.1.113883.6.101.

5.24 Vaccine Manufacturers (MVX) This is a list of vaccine manufacturers (MVX) maintained by the Centers for Disease Control (CDC). The current MVX list may be found at http://www.cdc.gov/nip/registry/hl7/hl7-mvx.htm.

The OID for this code set is 2.16.840.1.113883.6.60.

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5.25 Miscellaneous OID References This section contains a list of OID references used in the construct of the CDA header and body not otherwise noted in the above code set and table references.

5.25.1 Unique Instance Identifier The OID 2.16.840.1.113883.3.933 is used to identify the “unique instance ID” for this document.

5.25.2 person_name.type_cd

OID 2.16.840.1.113883.12.200 is an object identifier for the person_name.type_cd component.

5.25.3 Example OID

In some instances in the example, OID 2.16.840.1.113883.19.7.xxx was used where xxx represents an author assigned number. This is used for demonstration purposes only. The actual OID for that concept will be included in the final published version of the document.

-End of document--

Quarter 3

National Child Health Data Standards (NCHDS)

NATIONAL CHILD HEALTH DATA STANDARDS PROJECT

Commissioned Papers

1. Biondich, P., & Downs, S., (2006). State of IT standards.

2. MacTaggart, P., & Bagley, B., (2006). Policy and system strategies to quickly implement new HIT related standards, including the role of Medicaid, SCHIP and public financing.

3. Spooner, S.A., & Classen, D., (2006). The role that advancing HIT

standards could play in improving quality and safety of care for children.

4. Hinman, A., & Davidson, A., (2006). Linking various HIT systems

together in child health, including public health, schools, emergency medical systems and social services.

5. Rosenbaum, S. (2006). Legal Aspects.

6. Halamka, J. (2006). Standards, policies and linkage.

Quarter 3

Storyboard Review Storyboard Subgroup

Feliciano Yu, Project Chairperson Noam Artz Noorullah Akhtar Terese Finitzo Steve Lawless Anna Orlova Rob Savage Ron Van Duyne David Classen, Co-Chair Andy Spooner, Co-Chair Kate Collins, Coordinator

Storyboards Storyboards and and

ActivtyActivty DiagramsDiagrams

Dan Russler, M.D.Dan Russler, M.D.July 19, 2005July 19, 2005

Tutorial ObjectivesTutorial Objectives

Develop a strategy for building a Develop a strategy for building a communication bridge between domain experts communication bridge between domain experts and engineersand engineersDefine the borders between problemDefine the borders between problem--space and space and solution space analysissolution space analysisIntroduce HL7 StoryboardsIntroduce HL7 StoryboardsIntroduce Unified Modeling Language (UML) Introduce Unified Modeling Language (UML) Activity DiagramsActivity Diagrams

Tools for Requirements AnalysisTools for Requirements Analysis

Basic Modeling EnvironmentBasic Modeling EnvironmentPenPenPaperPaper

Intermediate Modeling EnvironmentIntermediate Modeling EnvironmentMicrosoft WordMicrosoft WordMicrosoft VisioMicrosoft VisioMicrosoft ExcelMicrosoft Excel

HighHigh--end Modeling Environmentend Modeling EnvironmentRational RoseRational Rose

The Communication PyramidThe Communication Pyramid

`Free-text Documents

Structured Documents

ad hoc Drawings

Non-standard Graphics

Discussions

Standardized Process Analysis (UML)Pro

blem

Proble

mSpa

ceSpa

ceSolution

Solution

SpaceSpace

Imple

mentat

ion-In

depe

nden

t

Implem

entation-Specific

Leve

l of A

bstr

actio

n

Communication Models

ProblemProblem--Space ArtifactsSpace Artifacts

Storyboard Text*Storyboard Text*

UML Storyboard Activity Diagram*UML Storyboard Activity Diagram*

Domain GlossaryDomain Glossary

UML Domain Analysis ModelUML Domain Analysis Model

Static Model CrossStatic Model Cross--Reference (to HL7 RIM)Reference (to HL7 RIM)

HL7 Reference Information ModelHL7 Reference Information ModelWhere does it fit into the process?Where does it fit into the process?

Storyboards

HL7 RIM

Problem-Space Analysis Process (a la HDF)

Message Artifacts

Proble

m

Proble

mSpa

ceSpa

ceSolution

Solution

SpaceSpace

Leve

l of A

bstr

actio

n

Why Storyboards?Why Storyboards?

Domain experts can usually write narrative, freeDomain experts can usually write narrative, free--form descriptions of how the domain worksform descriptions of how the domain worksAn inexpensive method for gathering An inexpensive method for gathering requirements that documents the business requirements that documents the business processprocessAble to describe a series of actions/interactions Able to describe a series of actions/interactions between one or many persons and/or systemsbetween one or many persons and/or systemsFocuses on the problem spaceFocuses on the problem space

Sample StoryboardSample Storyboard

Precondition: Precondition: Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christinein the clinic.Storyboard: Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews ChristineSusan reviews Christine’’s chart s chart including the problem list, allergies, chemotherapy protocol, including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan. She schedules orders, results and the patient education plan. She schedules Christine for education on the disease and on the side effects oChristine for education on the disease and on the side effects of f chemotherapy.chemotherapy.PostconditionPostcondition: : Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Why Activity Diagrams?Why Activity Diagrams?

Clarifies the roles of people and systems in the storyboardClarifies the names of the activitiesClarifies the sequence of activitiesClarifies the decision pointsIdentifies opportunities for messages

Clarifies the data communicated at each pointClarifies the trigger events for specific processes

Sample Activity DiagramSample Activity DiagramSchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Schedules Appt

Person, procedure, reason : Request

Why Glossaries?

Domain experts don’t agree on the meaning of termsDomain vocabularies and mappings often poorly understood, e.g. ICD, CPT, SNOMED Engineers don’t understand domain termsMulti-word terms not defined in dictionariesTerm meanings needed for later steps in analysis process

Sample GlossarySample GlossarySource Term Term Source Storyboard Sentence Nominalized

VerbGeneral Dictionary Definition

Domain Dictionary Definition

Inferred Question

SNOMED CT

Lexical Match

Meaning Match

Christine Storyboard: Single-word Term

Christine, age 46, was recently diagnosed with stage II breast cancer.

not applicable Not Applicable What was the name?

diagnosed Storyboard: Single-word Term

Christine, age 46, was recently diagnosed with stage II breast cancer.

diagnosis The act or process of determining the nature and cause of a disease or injury through examination of the patient

The act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data

What was the diagnosis?

Establish-ed diagnosis 14657009

breast cancer Storyboard: Multi-word Term

Christine, age 46, was recently diagnosed with stage II breast cancer.

none none What was the diagnosis?

254837009 Malignant tumour of breast

RN Activity Diagram: Role A graduate trained nurse who has passed a state registration examination and has been licensed to practice nursing

A nurse who has graduated from an accredited school of nursing and licensed to practice by a state authority

224535009 Registered nurse

reviews chart Activity Diagram: Action State

chart review Review: An inspection or examination for purposes of evaluation

Chart: A recording, in tabular form, of clinical data relating to a case

Review of 55210009 medical

records review, 312853008

requests education appointment

Activity Diagram: Action State

education appointment request

Patient education 311401005

request Activity Diagram: Flow Class

Why Domain Analysis Models?Why Domain Analysis Models?(A UML Class Model or Static Model or Information Model)(A UML Class Model or Static Model or Information Model)

Each domain has evolved an independent Each domain has evolved an independent ““world viewworld view””

Domain experts can only validate what is familiar to Domain experts can only validate what is familiar to them them Domains tend to see themselves as unique Domains tend to see themselves as unique Domain Domain ““world viewworld view”” is filled with jargonis filled with jargon

Domain Domain ““world viewworld view”” (Information Model)(Information Model)Best way to teach people about a domainBest way to teach people about a domainBest view of the requirements for a domainBest view of the requirements for a domain

Sample Domain Analysis ModelSample Domain Analysis Model

+timing-code-vocabulary-vtext-stext

Action

-code-vocabulary-vtext-stext

Site

-hasSite

-code-vocabulary-vtext-stext

Route

-hasRoute

-code-vocabulary-vtext-stext

Means

-code-vocabulary-vtext-stext

Object of Action

-hasMeans

-actsOn

-name-role-code-vocabulary-vtext

Recipient of Care-hasRecipientOfCare

OtherObjects

-degree-potentiality-acuity-timing

Judgement

-timing-focusType

Focus

-code-vocabulary-vtext-stext

Subject of information

-hasSubjectOfInformation

-hasSite

-name-role-code-vocabulary-vtext

Provider Role

-Result

Finding

Diagnosis

Supply

-hasSupply*

focusType Value Set =

• Patient Functioning• Environment• ICF and other similar concepts in other vocabularies

Finding includes theconcepts of Goal andOutcome dependingon relationship timingand other actions

Subject is coded forindividual, family,or other physical entity

-code-vocabulary-vtext-stext

-hasFocus

-hasJudgement

Why CrossWhy Cross--Reference to the RIM?Reference to the RIM?

Domain analysis models support Domain analysis models support communication within a domaincommunication within a domainCommunications between domains requires an Communications between domains requires an abstract, domainabstract, domain--independent model such as the independent model such as the HL7 RIMHL7 RIMCrossCross--reference tables build the mappings from reference tables build the mappings from the narrow world of the individual domain to the narrow world of the individual domain to the crossthe cross--domain interoperability supported by domain interoperability supported by the HL7 RIMthe HL7 RIM

Static Model CrossStatic Model Cross--ReferenceReference

Domain Analysis Model HL7 Reference Model Cross-Reference Specification

Model Element Element Type

Model Element Element Type

Mapping Strength

Mapping Rule

Participant Class Entity

Entity.ClassCode

Participation

Role

Role.ClassCode

Act

Observation

Class

Attribute

Class

Class

Attribute

Class

Class

Restriction (<)

Participant is equivalent to an Entity with a Entity.ClassCode = “Person” or “organization” that is the player of a Role with a Role.ClassCode equal to “patient” or “provider” that is associated with a Participation related to an Observation Act.

Participant.Name Attribute Entity.name

Role.name

Attribute

Attribute

Equivalent (=)

Entity.name is a repeating attribute. It may be necessary to identify a specific name use or to use Role.name instead.

ProblemProblem--Space ArtifactsSpace Artifacts

Storyboard TextStoryboard Text

UML Storyboard Activity DiagramUML Storyboard Activity Diagram

Domain GlossaryDomain Glossary

UML Domain Analysis ModelUML Domain Analysis Model

Static Model CrossStatic Model Cross--Reference (to HL7 RIM)Reference (to HL7 RIM)

HL7 Reference Information ModelHL7 Reference Information ModelWhere does it fit into the process?Where does it fit into the process?

Storyboards

HL7 RIM

Problem-Space Analysis Process (a la HDF)

Message Artifacts

Proble

m

Proble

mSpa

ceSpa

ceSolution

Solution

SpaceSpace

Leve

l of A

bstr

actio

n

LetLet’’s Take a Breathers Take a BreatherAny Questions?Any Questions?

StoryboardStoryboardSkillSkill--buildingbuilding

Sample StoryboardSample Storyboard

Precondition: Precondition: Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christinein the clinic.Storyboard: Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews ChristineSusan reviews Christine’’s chart s chart including the problem list, allergies, chemotherapy protocol, including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan. She schedules orders, results and the patient education plan. She schedules Christine for education on the disease and on the side effects oChristine for education on the disease and on the side effects of f chemotherapy.chemotherapy.PostconditionPostcondition: : Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

SourcesSources

Interviews with domain experts!!!!Interviews with domain experts!!!!Watching people workWatching people workCase studiesCase studiesIn healthcare, chart reviewsIn healthcare, chart reviewsLiterature reviewsLiterature reviews

How do you write a Storyboard?How do you write a Storyboard?Determine and Narrow the TopicDetermine and Narrow the Topic

Identify the PreconditionIdentify the PreconditionSettingSettingRoles of the participants/actorsRoles of the participants/actorsName the charactersName the characters

Sequence of EventsSequence of EventsWrite the storyWrite the storySimple sentences: subject, verb, object and linearSimple sentences: subject, verb, object and linearDescribe interactions with systems (if part of story)Describe interactions with systems (if part of story)

Check the flow of the storyCheck the flow of the storySend out for review and validation by domain expertsSend out for review and validation by domain expertsIterative process with other problemIterative process with other problem--space artifactsspace artifacts

Declare Declare PostconditionPostcondition

AdvantagesAdvantages

Facilitates validation with domain expertsFacilitates validation with domain expertsLack of formal structureLack of formal structureDomain experts can easily read, write and editDomain experts can easily read, write and editKnowledge transferKnowledge transfer

Storyboard ExerciseStoryboard Exercise

Precondition: Precondition: Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christinein the clinic.Storyboard: Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews ChristineSusan reviews Christine’’s chart s chart including the problem list, allergies, chemotherapy protocol, including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan. She schedules orders, results and the patient education plan. She schedules Christine for education on the disease and on the side effects oChristine for education on the disease and on the side effects of f chemotherapy.chemotherapy.PostconditionPostcondition: : Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Storyboard Exercise #2Storyboard Exercise #2

Precondition: IPrecondition: I’’m need to log into em need to log into e--mail mail from the hotelfrom the hotel……..

Storyboard:Storyboard:

PostconditionPostcondition::

UML Activity DiagramsUML Activity DiagramsSkillSkill--buildingbuilding

Activity Diagram Activity Diagram Dynamic ViewDynamic View

Activity Diagram

Visualizing the activities and flow of a healthcare business process

Activity Diagram Activity Diagram 9 Components9 Components

1. Swim Lane• Partitions activities according to the responsible

party or entity associated with the activity2. Activity State

• Action (single step in a process or procedure)3. Transition

• Way to sequentially link actions4. Data Object

• Activities operate on and by objects that serve as inputs or output to a specific activity

• Become datagrams transmitted in messages

Iteration #1 StoryboardIteration #1 Storyboard

Precondition: Precondition: Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christinein the clinic.Storyboard: Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews ChristineSusan reviews Christine’’s chart s chart including the problem list, allergies, chemotherapy protocol, including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan. She schedules orders, results and the patient education plan. She schedules Christine for education on the disease and on the side effects oChristine for education on the disease and on the side effects of f chemotherapy.chemotherapy.PostconditionPostcondition: : Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

11stst Iteration Activity DiagramIteration Activity DiagramSchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Schedules Appt

Person, procedure, reason : Request

11stst Iteration Activity DiagramIteration Activity DiagramSchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Schedules Appt

Person, procedure, reason : Request

?

Activity Diagram Activity Diagram 9 Components9 Components

Decision PointPoint where decision is make and flow is directed based on that decision

GuardWay to control the flow once a transition has startedEvaluates a true/false once associated with a specific transition or decision point

22ndnd Iteration Activity DiagramIteration Activity DiagramSchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Schedules Appt

[Needs extensive education]

Patient education

[Doesn't need much education]

Person, procedure, reason : Request

Waits for chemotherapy

Iteration #2 StoryboardIteration #2 StoryboardPrecondition: Precondition: Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christinein the clinic.Storyboard: Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews ChristineSusan reviews Christine’’s chart s chart including the problem list, allergies, chemotherapy protocol, including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan orders, results and the patient education plan and decides she and decides she needs additional educationneeds additional education. She schedules Christine for education . She schedules Christine for education on the disease and on the side effects of chemotherapy.on the disease and on the side effects of chemotherapy.

Alt Flow: Alt Flow: Susan educates patient immediately >>P.C. Susan educates patient immediately >>P.C. Christine waits for chemotherapyChristine waits for chemotherapy

PostconditionPostcondition: : Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

22ndnd Iteration Activity DiagramIteration Activity DiagramSchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Schedules Appt

[Needs extensive education]

Patient education

[Doesn't need much education]

Person, procedure, reason : Request

Waits for chemotherapy

22ndnd Iteration Activity DiagramIteration Activity DiagramSchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Schedules Appt

[Needs extensive education]

Patient education

[Doesn't need much education]

Person, procedure, reason : Request

Waits for chemotherapy ?

33rdrd Iteration Activity DiagramIteration Activity DiagramSchedulingRNPatient

Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christine in the clinic.

Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Expresses Concern Reviews Chart

Requests education appt

Responds with Appt

Accepts ApptCommunicates Appt Information

[Needs extensive education]

Patient education

[Doesn't need much education]

Person, procedure, reason : Request

Procedure, time : Appt

Waits for chemotherapy

Procedure, time, directions : Appt

Iteration #3 StoryboardIteration #3 StoryboardPrecondition: Precondition: Christine, age 46, was recently diagnosed with stage II breast cancer. She is scheduled to receive her first round of chemotherapy in a few days. Susan, an RN, is seeing Christinein the clinic.Storyboard: Storyboard: Christine expresses concern about the nausea & vomiting in chemotherapy. Susan reviews ChristineSusan reviews Christine’’s chart s chart including the problem list, allergies, chemotherapy protocol, including the problem list, allergies, chemotherapy protocol, orders, results and the patient education plan and decides she orders, results and the patient education plan and decides she needs additional education. She schedules needs additional education. She schedules requests an requests an appointment for appointment for Christine for education on the disease and on the Christine for education on the disease and on the side effects of chemotherapy. side effects of chemotherapy. Scheduling responds with an Scheduling responds with an appointment, and Susan gives Christine directions and other appointment, and Susan gives Christine directions and other appointment information.appointment information.

Alt Flow: Alt Flow: Susan educates patient immediately >>P.C. Susan educates patient immediately >>P.C. Christine waits for chemotherapy Christine waits for chemotherapy

PostconditionPostcondition: : Christine is scheduled to receive education on side effects related to the chemotherapy and education on the disease.

Activity Diagram TakeActivity Diagram Take--HomeHome

“The process of storyboard refinement and activity diagram definition is iterative”

Activity Diagram Activity Diagram 9 Components9 Components

ForkAllows activities to spawn into two or more threads

JoinAllows synchronization of the forks to arrive at a common point

Signal Receipt / Signal Send (not illustrated)Specific information associated with a transition

Parallel Flow ControlParallel Flow ControlLabCardiologistObstetrician

Perform Lab

Schedule Patient

Request Service

Evaluate Patient

Consult Order Form

Lab Form--CBC & Protime

Routine Ob Care

Payor Authorization

Evaluate Patient

Protime Goal

Ob Care with Calculation Goal VarianceProtime Result

[Protime In Range][Protime High][Protime Low]

Set Protime Goal

Activity Diagram ExerciseActivity Diagram ExerciseWhat are the What are the swimlaneswimlane titles for your etitles for your e--mail mail storyboard?storyboard?

Atkin's EHR SystemSmith's EHR System Dr Atkins (Specialist)Dr Smith (GP)

Builds Care Provision Summary

Receive Request

Receives Promise

[PaperConsultation]

Receive Reject

[reject request]

Care Provision : Request

Care Provision : Promise

C P i i U d t R t

Promises Care

[Accept Request]

Initiates Consultation

Dr. Smith is a general practitioner who has been seeing a patient regularly forsome time and utilizing his standard care plans for the condition. The patient’s condition is worsening, and Dr. Smith wishes to obtain the opinion of a specialist, Dr. Atkins.

Identifies Reason, etc & Sends Compiles Message

Reviews Request

Compiles Reject Message Composes RejectionReceives Reject

Care Provision : Reject

Compile Promise MessageNotes Promise

Sends More Information Compiles Update Message Receives Update

Tries another specialist

ThatThat’’s All, s All, YY’’AllAllAnd Thanks!And Thanks!

Any Remaining Questions?Any Remaining Questions?

Immunization Registry Storyboard iteration #3 Precondition: Billy Newpatient is 4 years old. He has been seen at other clinics in the state. However, he is a new patient at Dr. Shotz’s clinic. He is there for a pre-school physical. Dr. Shotz's clinic EMR is able to interface with state/local immunization registry. The state/local immunization registry conforms to CDC Minimal Functional Standards for Immunization Registries. The clinic EMR conforms to HL-7 EHR-S Functional Model. Storyboard: Billy has previously been seen at other clinics in the same state. The caretaker does not have his immunization record. In preparing his new patient chart for Dr. Shotz to review, the nurse initiates the clinic EMR to query the state immunization registry. The immunization registry finds and sends data to clinic EMR. The clinic EMR populates Billy’s patient chart with that data. The clinic EMR generates immunization recommendations using a decision support engine. AltFlow 1: The state registry uses a decision support engine and sends recommendations along with Billy’s immunization data. AltFlow 2: The state registry does not have Billy’s record. Registry sends “Record not found” message to clinic EMR. Dr. Shotz reviews the chart and notes (amongst other data) Billy’s immunization record (or its absence thereof) and recommendations. After taking history from the caretaker and performing physical exam, she orders immunizations. The nurse administers the shots and documents them in the clinic’s EMR. The clinic EMR sends the message about the new immunizations to the state registry which updates its record. The nurse also prints an updated paper record of Billy’s immunizations. Alt Flow: Dr. Shots determines that Billy does not require or decides to withhold immunizations at this stage. No updates are made to the immunization history in the patient record. No data is sent to the registry. Post-condition: The state registry has successfully sent Billy’s immunization history. The state registry has successfully recorded Billy’s new immunizations. The clinic EMR has an updated immunization record. The patient has an updated immunization record.

Quarter 4

Joint Session with Patient Care TC, Patient Safety SIG, Patient Health and

Emergency Response (PHER) SIG

Patient Care TC Co-Chairs William Goosen David Rowed, VAMC Clinic Dan Russler, McKesson Provider Technologies

Patient Safety SIG Co-Chairs

Clive Flashman, Head of NRLS & Information Systems Lisa Stevens, Food and Drug Administration

PHER SIG Co-Chairs

Rita Altamore, Washington State Department of Health Jim Case, American Association of Veterinary Lab Diagnosticians Daniel Pollock, Centers for Disease Control and Prevention