Neonatal Care Report
Clinical Document Architecture (CDA)
Release 2 ∙ Version 3
Copyright 2009, Children’s Hospitals Neonatal Database – All Rights Reserved
In affiliation with Child Health Corporation of America
Neonatal Care Report
Children’s Hospitals Neonatal Consortium (CHNC)
Background & Rationale
 collaborative of 24 children’s hospital Neonatal ICUs
 multidisciplinary initiative, started in 2006
 limited knowledge about best practices & outcomes for the
unique population of infants in tertiary NICUs:
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complex & uncommon neonatal diseases


preterm infants with co-morbidities/complications
ill term infants requiring emergent intervention
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e.g., ECMO, surgery, dialysis
congenital anomalies
genetic & metabolic syndromes
typically referred for surgical and other subspecialty care
Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America
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Neonatal Care Report
CHNC Mission
Aims of the Initiative:

To evaluate & optimize the tertiary neonatal intensive care
provided at children’s hospitals
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

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determine variations in care
evaluate efficacy of current practices
promote safety & facilitate research efforts
spearhead benchmarking & quality improvement initiatives
 ultimately improve clinical outcomes
Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America
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Neonatal Care Report
Development of Database - CHND
CHNC Partnership with Child Health Corporation of America (CHCA)


In 2008, CHNC partnered with CHCA, a business alliance of 43
leading children’s hospitals
Developed a comprehensive clinical database:
Children’s Hospitals Neonatal Database (CHND)
Establishment of a Core Data Set


In 2009, CHNC/CHCA completes specifications for a core data
set of about 700 defined data fields
Data collection
primarily manual abstraction from current
systems of clinical documentation (costly)
Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America
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Neonatal Care Report
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Children’s Hospitals Neonatal Database Participants
Atlanta
Birmingham
Boston
Chicago
Columbus
Cincinnati
Dallas
Detroit
Denver
Fort Worth
Houston
Kansas City
Little Rock
Los Angeles
Memphis
(Le Bonheur)
*13 additional CHCA hospitals and 8 non CHCA sites considering
future participation.
Oakland
Philadelphia
Pittsburgh
St. Louis
San Diego
Salt Lake City
St. Petersburg
Washington, DC
Wilmington, DE
Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America
Neonatal Care Report (NCR)
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Messaging a Subset of Data
Employing HL7 standards to facilitate electronic extraction
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HL7 Clinical Document Architecture (CDA) Release 2
Selection of Subset of Data Elements for the NCR
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unambiguous data fields, well established standards
present in majority of centers (varied stages of EHR development)
Demographic data
•
Name, MRN, Maternal Zip
Birth Data
•
•
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Birth weight
Gestational Age
Apgar scores (1, 5, prolonged)
Admission/Discharge Information
•
•
Dates
Measurements (weights, head circ.)
Acuity Scoring
•
•
severity of illness assessment
derived from existing mortality models:
•
•
Predominantly laboratory and physiologic data
Scored at several intervals
• Pediatric Risk of Mortality: PRISM-III
• Pediatric Index of Mortality: PIM-II
• Clinical Risk Index for Babies: CRIB-II
• Score for Neonatal Acute Physiology: SNAPPE II
•
1st 12 hours, Day 3, Day 7 of admission
Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America
Neonatal Care Report
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Working Group Contributors
Co-Chair/Co-Editor:
Robert H. Dolin, MD
Semantically Yours, LLC
bobdolin@gmail.com
Co-Chair/Co-Editor:
Liora Alschuler
Alschuler Associates, LLC
liora@alschulerassociates.com
Co-Chair:
Calvin Beebe
Mayo Clinic
cbeebe@mayo.edu
Co-Chair:
Keith W. Boone
GE Healthcare
keith.boone@ge.com
Primary Editor:
Gay Giannone, MSN RN
Alschuler Associates, LLC
gay@alschulerassociates.com
Co-Editor:
Joy Kuhl, MBA, CPF
Principal | Optimal Accords, LLC
joy@optimalaccords.com
Co-Editor:
Michael A. Padula, MD
Neonatologist, Clinical Informaticist
The Children's Hospital of Philadelphia
padula@email.chop.edu
Co-Editor:
Feliciano Yu, M.D.
Information Technology Division
Pediatrics Professor
University of Alabama at Birmingham
School of Medicine
fyu@peds.uab.edu
Co-Editor: David J. Durand, MD
Director, Division of Neonatology
Children's Hospital and Research Center Oakland
ddurand@mail.cho.org
Co-Editor: Karna Murthy, MD
Neonatologist, Children's Memorial Hospital
Assistant Professor of Pediatrics
Northwestern University
k-murthy@northwestern.edu
Co-Editor: Jacqueline Kueser
Vice President, Strategy/R&D
Children’s Hospitals Corporation of America
jacqueline.kueser@chca.com
Co-Editor: Kirk Elrod
CHCA IT Liaison/Business Analyst
Children’s Hospitals Corporation of America
kirk.elrod@chca.com
Current Working Group also includes:
Kate Conrad,
Bobby George,
Andy Spooner
David Muraco,
Diane Ward
Celeste Milton,
Jean Millar
Ann Watt
Shaun Shakib
Sandy Stuart
Brett Marquard
Jingdong (JD) Li
Anneke Goossen William Goossen
Teresa Finitzo
Copyright 2009, Children’s Hospitals Neonatal Database - All Rights Reserved - In affiliation with Child Health Corporation of America