worldvista-pedi

[Nancy A. <nan...@ms...>]

I am happy to say we have made some real progress on the pedi project, and a
tiny bit on the OBGYN project.

First, I got responses from several Hardhats/WorldVistA volunteers that were
willing to jump in and help - Mark Amundson, Wayne Brandes, Molly Cheah,
Paul Fu, Roy Gaber, James Gray, Gary Monger, Steve Owen, Thurman Pedigo,
Kevin Toppenberg, Cameron Schlehuber, and John Leo Zimmer (and  if I missed
you, please send me a nasty email and remind me). Others, that are friends
of Hardhat/WV folks that have been helping out are Theresa Cullen of the IHS
and Scott Hamstra of the IHS, plus Henry Huggins and other IHS folks that
have been drawn in along the way, and Emory Fry from the Navy.

I spent a whole lot of time sending out email all over everywhere looking
for some non-Hardhats that would be willing to help with the Pedi project or
VistA-Office project.  I was particularly interested in getting an
organization like the AAFP or the AAP interested as they might have  a
number of docs who were interested in electronic medical records and would
be willing to take a look at what we produced to tell us what was and was
not good about it.

Well, after a whole lot of disappointment, we really hit one out of the park
when I got a response from Andy Spooner.  Andy is the John Dustin Buckman
Professor, Associate Professor, and Director Division of General Pediatrics,
Department of Pediatrics, University of Tennessee College of Medicine.  He
is also chairman of the American Association of Pediatrics Steering
Committee on Clinical Information Technology, and if that were not enough,
he is the Cochairman of the HL7 Pediatric Special Interest Group on
Pediatric Data Standards. He has seen VistA in action, and has students and
residents who have used VistA and like it and he thought adding Pedi was a
great idea.  In addition, one of the goals of the HL7 Pediatric SIG was to
figure out how to provide developers the information they needed to make a
good pediatric record. My email came at a good time because, since we
represent a non-profit all volunteer, open source group, he felt we were a
good choice for them to work with to be sure they are on the right track in
giving developers the information they need. Wayne Brandes ended up joining
the SIG, and I didn't join (just didn't seem right being an internist), but
I was invited to attend their meeting in Atlanta in person, or via
telephone, to let their group know about us. I also was directed to the
documents that were the drafts of what they were working on , that were
already packed with information that we need for our project. They are
available on the web.

Last Wednesday I attended all of their meeting that I could - i.e., anything
were there was a phone hookup for conferencing.  They were VERY helpful and
it is only going to get better. They are currently working on a text
description of what a pediatric record needs to have that an adult record
does not have, and when they are done with that, they intend to make
storyboards of what they envision the look and feel of an ideal pediatric
EMR would be like. I can't imagine anything better for us to use, except if
it were available yesterday.

While I was on the phone waiting for one of the meeting to start, I struck
up a conversation with Trent Rosenbloom who is a physician/informaticist
from Vanderbilt University Medical Center. He has been working on their
pediatric medical records and offered to help us any way he can.  Steve
Lawless, another physician and Chief Knowledge Office (don't you love that
title) for a huge pediatric group called Nemours in Wilmington, Delaware was
also trapped waiting with me on the phone at a different time, and he too,
offered to help if he could. He found the story of what were were doing with
VistA very interesting and wished that their system were open source. Cheri
Throop, RN, MHSA, RHIT, CPHQ is the Administrative Co-chair for the SIG and
is truly outstanding at her job.  She works for the Child Health Corporation
of America in Kansas City, MO. David Claussen, another physician, is the
other Cochairman and also has been very helpful, hosting a conference call
that Theresa Cullen, Emory Fry, Scott Hamstra and me all attended.  He is
also heavily involved and coauthor of one of the most widely quoted papers
on patient safety and quality of care from the Institute of Medicine.

With considerable luck, the vexing problem of pediatric immunizations may be
considerably less of a problem than we thought it would be.  It appears the
CDC was well aware of the complexity and actually had written what I guess
could be described as a specification for the algorithm that would be
necessary for immunizations and posted it on the CDC web site.  As I
understand it at this point, that algorithm has been written as part of a
HHS project to support state immunization registries, and is available to
the registries.  I contacted Theresa Cullen and Mike Ginsburg (the
VistA-Office Project Manager) and emailed the CDC to see if we can find out
more about it.  Mike seems to think that the program is in the public
domain.  The IHS uses an excellent program, but unfortunately, it has to be
licensed, but the fees for the IHS re quite reasonable.

Meanwhile, Cameron Schlehuber, who had agreed to tell us what to do for the
database side of things, surprised me. A few weeks back, I had sent him the
links to the CDC information on pediatric growth charts and tables to give
him an idea of what we needed to deal with that portion of the record. I
should have figured when he said something about it being "something that
would be fun to program" that he would be up to something. At 2:30 AM
Saturday I received and email with a KID file attached that puts all the
data into VistA from those CDC tables and has a MenuMan option that calls a
program, PEDGC, that calculates the percentile for about a half dozen
combinations of sex with weight and age, length and age, head circumference
and age, weight for stature, and BMI for age. Turns out he took a day to
load standard growth charts and code the formulae for percentile
calculations.  Cameron also told me he will be coordinating the use of the
PED namespace (and all others) for the VistA Office EHR with the developers
under contract as well as others making contributions for that project.

On the downside of the Pedi Project is that I have heard that the IHS
pediatric software that we were hoping to incorporate may be proprietary so
that we will not be able to use it. Other downside elements are that much if
not all of the development data that we need to do that portion of the
record ( things like when the child talks and walks and smiles, etc.) is
proprietary and will probably have to be put in as "plugins" that practices
can add if they are willing to obtain licenses. Growth data for special
groups such as children with Down's syndrome is also proprietary.  I am
trying to get permission to use the information free of charge in the
development process and I am still hoping we will be able to find some data
that is free to use.

As for the OBGYN project, that is going to be harder, I think.  There does
not seem to be much, if any, activity in the national organizations for
OBGYN in informatics, but Emory Fry and someone I met from New York seem to
have OBGYN contacts who are interested.  I am also pursuing some software
from a tribal hospital that is no longer a federal hospital with the IHS who
I hope will be willing to share it.

This email is being posted to Hardhats, but please feel free to join the
mailing list for the Pedi Project, even if all you want to do is keep tabs
on what is going on. If you would like to help, by all means, jump in and
please make contact either by emailing me or posting to the Pedi Project
mailing list - wor...@li...