Pe DS SIG
June 7, 2007
Following are recommendations and/or questions provided by HL7 Child Health Functional
Profile Work Group volunteers during a review of the EHR-S Functional Model. The comments
were not especially germane to child health, and so it is recommended to hold these for
consideration by the EHR Technical Committee during the next revision of the EHR-S FM in
2008. These could be reviewed in more detail over the coming months and clarified in a letter
to the EHR TC from the PeDSSIG.
Current Conformance Criteria
DC1.1.3.1.2: IF lab results are received
through an electronic interface, THEN the
system SHALL receive and store the data
elements into the patient record.
Comments
CJ: Consider adding, "in a discrete fashion." KL: The
reference ranges associated with the lab values shall
be received and stored.
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DC1.1.3.1.3: IF lab results are received
through an electronic interface, THEN the
system SHALL display them upon
request.
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DC1.1.3.1.7: The system SHOULD
provide the ability to receive, store and
display clinical result images (such as
radiologic images) received from an
external source.
DC1.1.3.1.9: The system SHOULD
provide the ability to receive, store and
present medication details from an
external source.
DC1.1.3.1.10: The system SHOULD
provide the ability to receive, store and
present structured text-based reports
received from an external source.
DC1.1.3.1.11: The system SHOULD
provide the ability to receive, store and
present standards-based structured,
codified data received from an external
source
Section DC1.3.3
MD: Should we have a statement/standard that states
the external data should have a way to denote that it
was obtained externally? KL: The reference ranges
associated with the lab values shall be displayed upon
request.
MD: Should we have a statement/standard that states
the external data/images should have a way to denote
that it was obtained externally?
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DC1.4.1.10. The system MAY present
allergies, intolerances and adverse
reactions that have been deactivated.
Section DC1.4.2
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Section DC1.6.1
MD: Should we have a statement/standard that states
the external data/images should have a way to denote
that it was obtained externally?
MD: Should we have a statement/standard that states
the external data/images should have a way to denote
that it was obtained externally?
MD: Should we have a statement/standard that states
the external data/images should have a way to denote
that it was obtained externally?
Suggest new: IF no one is available, THEN the system
SHALL provide the ability to document lack of assent or
consent in the emergency treatment of minors. Could
take off “minors” as this is a universal need.
RB: The system SHALL present allergies, intolerances
and adverse reactions that have been deactivated and
display the user and date it was deactivated.
Suggest new: MD: A. 13. The system SHOULD
provide the ability to transmit the current medication list
to designated external providers (e.g. active medication
list to primary care or next provider required for med
recon)
Suggest New: CB: A. The system SHALL provide for
the periodic review and update of site specific
guidelines and protocols.
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Pe DS SIG
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DC1.6.1.1
The system SHALL provide
the ability to present current guidelines
and protocols to clinicians who are
creating plans for treatment and care.
DC1.6.2. 1.
The system SHALL
provide the ability to capture patientspecific plans of care and treatment.
Section DC1.7.1
Section DC1.7.1
Section DC1.7.1
Section DC1.7.1
Section DC1.7.1
Section DC1.7.1
Section DC1.7.1
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DC.1.7.2.4 3.
The system SHALL
provide the ability to capture
administrative details (such as insurance
information, consents and authorizations
for disclosure) as necessary for the
referral.
Section DC1.7.3
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Section DC1.8.1
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DC1.8.2 3.
The system SHALL
perform checking for potential adverse or
allergic reactions for all immunizations
when they are about to be given.
CJ: I think this is unclear. Would a link to an outside
web page be sufficient? Must it be based on the pt's
current problems? If this remains SHALL, I think it
should be clarified.
Capture or create? Too vague
Suggest New: The system SHOULD have the ability to
designate which orders require co-signature by role but
can immediately be activated pending signature
(e.g.verbal orders).
Suggest New: The system SHOULD allow a provider to
designate at the time of order entry (independent of
role) that the order requires co-signature prior to
activation (e.g. chemotherapy orders may require two
MD signatures).
Suggest New: The system SHOULD capture the date,
time and provider entering the order on behalf of
another provider.
Suggest New: The system SHOULD have the ability to
designate which orders require co-signature by role
prior to order activation (e.g. medical student orders).
Suggest New: When ordering medications for use
outside of the hospital the system MAY generate a list
of the medications and/or treatments prescribed in a
format that is linguistically appropriate for the patient
and/or patient’s family.
Suggest New: The system MAY have the ability to
prescribe “drip” medications and generate titration
sheets.
Suggest New: The system MAY have the ability to
prescribe “drip” medications and generate titration
sheets.
MD: add in the examples the ability to designate
consult versus transfer of care (CMS requirement in
orders for consults vs referrals)
Suggest New: MD: A. The system should apply the
same decision support and standards to orders entered
via order sets as it would to orders entered individually
Suggest New: MD: A. The system shall have the ability
to reschedule individual doses and to record the reason
for the reschedule
ASZ: M. "The system shall perform checking for
potential adverse events or allergic reactions when the
immunization is ordered."
The system does not know when an immunization is
"about to be given" unless you are doing bar coding
administration. Not many clinics have this technology.
Checking upon documentation is too late. Ordering is
probably the best time. Bar coding should be a
"future".
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Pe DS SIG
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DC1.8.2 7.
The system SHOULD
provide the ability to associate standard
codes with discrete data elements
associated with an immunization.
Section DC1.8.5
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Section DC1.8.5
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Section DC1.9
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DC2.1.1.5: The system SHOULD provide
prompts based on practice standards to
recommend additional assessment
functions.
Section DC2.2.1
Section DC2.2.2.6
Section DC2.4.1
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DC2.4.4.2.1: The system SHALL present
recommendations for potential referrals
based on diagnosis(es).
S.3.1: The system SHALL conform to
function IN.1.1 (Entity Authentication).
Which codes?
Suggest New: The system MAY provide the ability to
pull data from other places in the record into a note.
Suggest New: The system SHOULD provide the ability
to view edits to documentation and the identity of the
user making the changes.
Suggest New: The system should provide the ability to
generate instructions in more than one language
Could this be clarified further? Not sure what this
means.
Shouldn’t both of these be “SHALL”
Shouldn’t this be “SHALL”
Suggest New: The system SHOULD provide for review
of order set clinical content on a periodic basis to
maintain the integrity of clinical content.
Please clarify
The system SHALL conform to IN.1.1 (Entity
Authentication) and SHOULD specifically conform to
IN.1.1.1.11 (propagation of administrative records on
applicable related registered patients
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