Pediatric Data Standards SIG

1
Pediatric Data Standards SIG

• Functional Requirements Review

2
V10 Document Statements

• Each slide's title is the general area of
  functionality
• Bullets represent
• the current wording of the function statement
• the closest matching conformance criterion from
  the November 2005 EHR TC document
• whether the above two represent a "match," and
• an arbitrary ID number to reference an internal
  database
• Next steps
• Work groups/individuals review categories based
  on assignments and suggest edits Review
  suggested edits together through a series of
  webcasts to be scheduled soon

3
Four Sets of Conformance Criteria

• INCLUDED (74 CCs) Our CC are easily found in the
  DSTU INCLUDED.ppt
• NOT INCLUDED (47 CCs) Cant find anything like
  our CC in the DSTU NOT INCLUDED.ppt
• ALMOST INCLUDED (32 CCs) Something close to our
  CC is in the DSTU ALMOST INCLUDED.ppt
• GRAY AREA (19 CCs) The SIG needs to decide what
  it means, exactly GRAY AREA.ppt

4
32 Categories to Assign

• Age Representation
• Allergies (Miller, Omlor, Yu)
• Archiving
• Communications
• Consent
• Custody (Weigle)
• Decision Support (Akhtar, Del Beccaro, Warren)
• E-prescribing and Ordering (Yu, Del Beccaro)
• Epidemiology
• Family Linkage (Murray)
• Gender (Murray)
• Gestational Age (Murray)
• Growth (Sedman, Weigle)
• Guardianship
• Immunizations (Yu, Akhtar)
• Interface

• Lab Results (Rocca)
• Medical Home (Schneider, Sedman, Warren)
• Miscellaneous
• Norms
• Parental Data Entry (Schneider)
• Patient Identification (Miller, Underwood)
• Pedigree (Schneider)
• Preferences
• Prenatal
• Privacy
• Registries
• Reports
• Research (Miller)
• Telehealth (Akhtar, Rocca)
• Terminology (Underwood, Rocca)
• Vocabulary (Underwood, Rocca)
• Suggested New Category RHIO (Schneider)

5
V10 Document Statements

• Each slide's title is the general area of
  functionality
• Bullets represent
• the current wording of the function statement
• the closest matching conformance criterion from
  the November 2005 EHR TC document
• whether the above two represent a "match," and
• an arbitrary ID number to reference an internal
  database
• Possible next steps
• Work groups/individuals review and suggest edits
  Review suggested edits together through a series
  of webcasts

6
Age Representation

• Allow recording of post conceptional age and
  distinguish it from post-natal age
• Closest conformance criterion N/A DC.1.2
  (Manage patient demographics) comes closest (no
  CC contains this specific concept).
• NOT INCLUDED, noncontroversial
• Reference number 2

7
Age Representation

• Allow recording of the exact time of birth down
  to the minute
• Closest conformance criterion N/A DC.1.2
  (Manage patient demographics) comes closest (no
  CC contains this specific concept).
• NOT INCLUDED, noncontroversial
• Reference number 3

8
Age Representation

• Display age with the appropriate units, based on
  the child's age (for example, infants who are
  four days old should have their age displayed in
  days, as opposed two weeks or months)
• Closest conformance criterion N/A DC.1.2
  (Manage patient demographics) comes closest
  (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 4

9
Allergies

• Allergies could include items such as foods or
  environmental agents.
• Closest conformance criterion DC.1.3.2 1 (The
  system SHALL capture true allergy, intolerance,
  and adverse reaction to drug, dietary or
  environmental triggers as unique, discrete
  entries.).
• INCLUDED, noncontroversial
• Reference number 5

10
Allergies

• Allow the classification of reactions into
  allergic reactions, side effects, and
  intolerances
• Closest conformance criterion DC.1.3.2 1 (The
  system SHALL capture true allergy, intolerance,
  and adverse reaction to drug, dietary or
  environmental triggers as unique, discrete
  entries.).
• INCLUDED, noncontroversial
• Reference number 6

11
Allergies

• List food allergies and medication allergies
  separately
• Closest conformance criterion DC.1.3.2 1 (The
  system SHALL capture true allergy, intolerance,
  and adverse reaction to drug, dietary or
  environmental triggers as unique, discrete
  entries. Do we really want to ask for this? What
  do we really mean by separate?).
• Possibly included, controversial
• Reference number 7

12
Allergies

• The user determines what defines an allergy or
  adverse reaction
• Closest conformance criterion DC.1.3.2 4 (The
  system SHOULD provide the ability to capture the
  reaction type).
• INCLUDED, noncontroversial
• Reference number 8

13
Archiving

• Store data until the statutorily designated time
• Closest conformance criterion I.1.2.1 1 (The
  system SHALL provide for the storage and
  retrieval of health record data and clinical
  documents for legally proscribed (sic) time. ).
• INCLUDED, noncontroversial
• Reference number 9

14
Communications

• The user may indicate who they are sending
  results to and the system will track this
• Closest conformance criterion DC.1.10.1 8 (The
  system MAY route results to patients by methods
  such as phone, fax, electronically or in the form
  of a letter).
• INCLUDED, noncontroversial
• Reference number 10

15
Consent

• In cases where advanced directives are managed by
  the system, provide forms appropriate to both
  patients and guardians where the patient is below
  the legal age of consent
• Closest conformance criterion DC.1.11.2 (The
  system MAY be able to indicate that the patients
  personal representative (guardian/surrogate) has
  completed advanced directive(s) on their behalf.
  ).
• INCLUDED, noncontroversial
• Reference number 12

16
Consent

• Allow recording of both consent and assent to
  treatment
• Closest conformance criterion DC.1.11.3 7 (EHR
  systems SHOULD allow documentation of an assent
  as appropriate for patients legally unable to
  consent. ).
• INCLUDED, noncontroversial
• Reference number 11

17
Consent

• In cases where consent forms are managed by the
  system, allow adolescent patients to participate
  as if they were adults under appropriate
  conditions
• Closest conformance criterion DC.1.11.3 Manage
  consents and authorizations ((Does not explicitly
  mention this function)).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 13

18
Custody

• Identify a child who has been removed from a home
• Closest conformance criterion N/A ((This would
  simply be an item in the child's history, e.g.
  Social Hx)).
• VOCABULARY ISSUE
• Reference number 14

19
Custody

• Indicate when a child is in foster care
• Closest conformance criterion N/A ((This would
  simply be an item in the child's history, e.g.
  Social Hx)).
• VOCABULARY ISSUE
• Reference number 15

20
Custody

• Indicate when a child is under ongoing
  investigation for abuse or neglect
• Closest conformance criterion N/A ((This would
  simply be an item in the child's history, e.g.
  Social Hx)).
• VOCABULARY ISSUE
• Reference number 16

21
Custody

• Indicate when the child has been adopted
• Closest conformance criterion N/A ((This would
  simply be an item in the child's history, e.g.
  Social Hx)).
• VOCABULARY ISSUE
• Reference number 17

22
Custody

• Provide patient identification mechanisms that
  can withstand changes in family structure, such
  as loss of a child from the family in a custody
  decision
• Closest conformance criterion N/A ((I am pretty
  sure this needs some significant clarification)).
• NOT INCLUDED, noncontroversial
• Reference number 19

23
Custody

• Provide patient identification mechanisms that
  can withstand changes in family structure, such
  as removal of the child from the home
• Closest conformance criterion N/A ((I am pretty
  sure this needs some significant clarification)).
• NOT INCLUDED, noncontroversial
• Reference number 20

24
Custody

• Provide authentication procedures for adults who
  claim to be parents or guardians of a child, in
  cases where the child is under investigation four
  abuse and neglect
• Closest conformance criterion Needs more detail
  hard to put this one into a conformance criterion
  (Perhaps this one could be achieved merely by
  supporting some kind of alerting mechanism for
  kids whose custody is not straightforward).
• NOT INCLUDED, noncontroversial
• Reference number 18

25
Decision Support

• Incorporate age, weight, and disease criteria
  into alerts related to laboratory results
• Closest conformance criterion DC.1.10.1 11 (The
  system MAY trigger decision support algorithms
  from test results. ).
• INCLUDED, noncontroversial
• Reference number 31

26
Decision Support

• Integrate patient and family preferences into
  clinical decision support
• Closest conformance criterion DC.1.11.1 3 (The
  system SHOULD integrate patient and family
  preferedecision support systems).
• INCLUDED, noncontroversial
• Reference number 34

27
Decision Support

• Link care processes to the problem list
• Closest conformance criterion DC.1.5 9 (The
  system MAY associate encounters, orders,
  medications, notes with one or more problems.).
• INCLUDED, noncontroversial
• Reference number 35

28
Decision Support

• Link lab values to problem list
• Closest conformance criterion DC.1.5 9 (The
  system MAY associate encounters, orders,
  medications, notes with one or more problems.).
• INCLUDED, noncontroversial
• Reference number 37

29
Decision Support

• Link medical imaging to items all on the problem
  list
• Closest conformance criterion DC.1.5 9 (The
  system MAY associate encounters, orders,
  medications, notes with one or more problems.).
• INCLUDED, noncontroversial
• Reference number 38

30
Decision Support

• Link orders to problems in problem lists
• Closest conformance criterion DC.1.5 9 (The
  system MAY associate encounters, orders,
  medications, notes with one or more problems.).
• INCLUDED, noncontroversial
• Reference number 39

31
Decision Support

• Provide problem lists link to medical orders,
  lab, medical imaging, disease specific
  guidelines, or care processes including rationale
  for care.
• Closest conformance criterion DC.1.5 9 (The
  system MAY associate encounters, orders,
  medications, notes with one or more problems.).
• INCLUDED, noncontroversial
• Reference number 43

32
Decision Support

• Provide decision support for special
  immunizations such as palivizumab
• Closest conformance criterion DC.1.6.1 1 (The
  system SHALL support presentation of guidelines
  and protocols to clinicians).
• INCLUDED, noncontroversial
• Reference number 42

33
Decision Support

• Indicate in the case of decision support
  function whether the function applies to the
  pediatric population
• Closest conformance criterion DC.1.6.1 1, 3, 4,
  5 (assuming decision support guidelines)
  ((Comes close)).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 32

34
Decision Support

• Link disease specific guidelines to the problem
  list
• Closest conformance criterion DC.1.6.1 4 (The
  system SHALL present guidelines and protocols
  appropriate for the patients problem list. ).
• INCLUDED, noncontroversial
• Reference number 36

35
Decision Support

• Apply patient age to all decision support
  functions
• Closest conformance criterion DC.1.6.1 5 (The
  system SHALL support context-sensitive care
  plans, guidelines and protocols (function
  DC.2.2.1.2) ).
• INCLUDED if we make minor mods in a CC
• Reference number 25

36
Decision Support

• Facilitate selection of guidelines based on
  patient age
• Closest conformance criterion DC.1.6.1 5 (The
  system SHALL support context-sensitive care
  plans, guidelines and protocols (function
  DC.2.2.1.2) (provided "context" "age")).
• INCLUDED if we make minor mods in a CC
• Reference number 28

37
Decision Support

• Indicate the source of any applicable guidelines
  or decision support rules
• Closest conformance criterion DC.1.6.2 4 (The
  system SHOULD allow tracking of updates to care
  plans by authors, creation date, version
  history, references, local sources, non-local
  sources).
• INCLUDED, noncontroversial
• Reference number 33

38
Decision Support

• Allow for disease specific health maintenance
  schedules with accompanying decision support
• Closest conformance criterion DC.2.1.1 2 (The
  system SHALL enable access to standards and
  practices related to age, gender, normal growth
  and development and medical conditions this
  assumes that "assessments" refers to forms for
  data collection).
• INCLUDED, noncontroversial
• Reference number 23

39
Decision Support

• In cases where forms vary with age, select forms
  to be presented based on age.
• Closest conformance criterion DC.2.1.1 2 (The
  system SHALL enable access to standards and
  practices related to age, gender, normal growth
  and development and medical conditions this
  assumes that "assessments" refers to forms for
  data collection).
• INCLUDED, noncontroversial
• Reference number 29

40
Decision Support

• Modify displays based on age
• Closest conformance criterion DC.2.1.1 2 (The
  system SHALL enable access to standards and
  practices related to age, gender, normal growth
  and development and medical conditions this
  assumes that "assessments" refers to forms for
  data collection).
• INCLUDED, noncontroversial
• Reference number 40

41
Decision Support

• Modify displays based on gestational age at birth
• Closest conformance criterion DC.2.1.1 2 (The
  system SHALL enable access to standards and
  practices related to age, gender, normal growth
  and development and medical conditions this
  assumes that "assessments" refers to forms for
  data collection assumes gestational age could
  be treated as a "medical condition," which is
  reasonable).
• INCLUDED, noncontroversial
• Reference number 41

42
Decision Support

• Remind users of anticipatory guidance topics
  based on age
• Closest conformance criterion DC.2.2.1.2 1
  (assuming that "anticipatory guidance topics" can
  be considered a "care plan") (The system SHALL
  support access to resources for care plans that
  are context sensitive to patient specific data
  and assessment, and are appropriate to the age,
  gender, developmental stage and medical condition
  of the patient (DC 1.3.1, DC 1.4, DC 1.5, DC
  1.6)).
• INCLUDED, noncontroversial
• Reference number 44

43
Decision Support

• Remind users of anticipatory guidance topics
  based on risk factors
• Closest conformance criterion DC.2.2.1.2 1
  (assuming that "anticipatory guidance topics" can
  be considered a "care plan") (The system SHALL
  support access to resources for care plans that
  are context sensitive to patient specific data
  and assessment, and are appropriate to the age,
  gender, developmental stage and medical condition
  of the patient (DC 1.3.1, DC 1.4, DC 1.5, DC
  1.6)).
• INCLUDED, noncontroversial
• Reference number 45

44
Decision Support

• Remind users of anticipatory guidance topics
  based on topics previously discussed
• Closest conformance criterion DC.2.5.1 (sort of)
  (The system SHOULD present alerts for all patient
  specific preventive services to the provider (is
  anticipatory guidance a preventive service?)).
• INCLUDED, noncontroversial
• Reference number 46

45
Decision Support

• Alert clinicians to the need for developmental
  screening based on guidelines
• Closest conformance criterion DC.2.5.1 1 (The
  system SHOULD identify services for preventive
  care and wellness from patient demographics (eg.
  age, sex, region) ).
• INCLUDED, noncontroversial
• Reference number 21

46
Decision Support

• Alert clinicians to the need for hearing and
  vision screening per guidelines
• Closest conformance criterion DC.2.5.1 1 (The
  system SHOULD identify services for preventive
  care and wellness from patient demographics (eg.
  age, sex, region) ).
• INCLUDED, noncontroversial
• Reference number 22

47
Decision Support

• Based on the record of encounters, the patient's
  current age, and existing guidelines, calculate
  whether the patient is current on the health
  maintenance schedule
• Closest conformance criterion DC.2.6.3 (as long
  as failure to participate in well-care is
  considered a health risk, which pediatricians
  generally do) AND DC.2.5.1 (The system SHALL
  provide a means to identify those patients who
  have not received appropriate action in response
  to a health risk alert. (Care Plan Function
  Links) --gt How to modify this to deal with health
  maintenance? AND The system SHOULD present alerts
  for all patient specific preventive services to
  the provider. ).
• INCLUDED if we make minor mods in a CC
• Reference number 26

48
Decision Support

• Allow the deferral of alerts and reminders to a
  subsequent episode of care
• Closest conformance criterion N/A ((If a system
  decided that service X was needed today, and the
  user decided not to do it, then the system
  generally would decide that is needed tomorrow,
  too, right?)).
• NOT INCLUDED, noncontroversial
• Reference number 24

49
Decision Support

• Display deferred actions
• Closest conformance criterion N/A ((If a system
  decided that service X was needed today, and the
  user decided not to do it, then the system
  generally would decide that is needed tomorrow,
  too, right?)).
• NOT INCLUDED, noncontroversial
• Reference number 27

50
Decision Support

• In cases where gender is unknown, and in the case
  where certain decision support is gender
  specific, provide both male and female versions
  in cases where the gender is unknown
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 30

51
E-Prescribing Ordering

• Include body weight (or any other data used to
  decide dose, like gestational age or diagnosis)
  in the data sent with a prescription
• Closest conformance criterion (These data
  elements would be dictated by e-prescribing
  standards).
• NOT INCLUDED, noncontroversial
• Reference number 58

52
E-Prescribing Ordering

• Allow export of data to national drug databases
  designed to detect adverse drug events
• Closest conformance criterion COVERED IN
  "REGISTRIES PACKAGE" ((DC.1.3.3 Manage
  immunizations S.1.1 Registry notification
  S.3.1.2 Encounter-specific functionality S.3.3.6
  Health service reports at the conclusion of an
  episode of care I.1.3.1 Unique identity,
  registry, and directory services I.3.2
  Distributed registry access I.5.4 Interchange
  agreements I.6 Business rules management)).
• INCLUDED, noncontroversial
• Reference number 49

53
E-Prescribing Ordering

• Handle immunization separately from other
  medications
• Closest conformance criterion DC.1.3.3 (Manage
  immunizations).
• INCLUDED, noncontroversial
• Reference number 56

54
E-Prescribing Ordering

• Allow drug dose and based on compounded oral
  solutions, in the case where no oral solution is
  available in standard formularies
• Closest conformance criterion DC.1.8.1 (Order
  Medication).
• NOT INCLUDED, noncontroversial
• Reference number 47

55
E-Prescribing Ordering

• Allow drug dosing based on ideal body weight for
  a given medication
• Closest conformance criterion DC.1.8.1 (Order
  Medication).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 48

56
E-Prescribing Ordering

• In weight-based dosage functions, reflect maximum
  dose per day in the resulting prescription
• Closest conformance criterion DC.1.8.1 (Order
  Medication).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 57

57
E-Prescribing Ordering

• Link to FDA drug alerts
• Closest conformance criterion DC.1.8.1 (Order
  Medication).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 61

58
E-Prescribing Ordering

• Offer drug dosing decision support for those
  drugs with a recommended starting dose range
  (e.g., methylphenidate) and graduated dosage
  increments
• Closest conformance criterion DC.1.8.1 (Order
  Medication).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 63

59
E-Prescribing Ordering

• Support calculations for the preparation of
  intravenous infusions
• Closest conformance criterion DC.1.8.1 (Now that
  standard concetrations are the law of the land,
  we may need to give up on this one.).
• DELETE?
• Reference number 64

60
E-Prescribing Ordering

• Support standard concentrations for infusions
• Closest conformance criterion DC.1.8.1 (Hard to
  imagine an IV prescribing system that did not
  include data on the concentration of infusions
  is this a peditric issue?).
• DELETE?
• Reference number 65

61
E-Prescribing Ordering

• Allow recording of dose per meter squared of body
  surface area, so that the prescription can be
  replicated later at the same dose per
  meter-square
• Closest conformance criterion DC.1.8.1 14 (The
  system MAY support medication re-prescribing by
  allowing a prior prescription to be reordered
  without re-entering previous data (e.g.
  administration schedule, quantity). --gt Probably
  should be promoted to SHOULD and the dosage per
  kg should be available so one can replicate the
  prescription at the same dosage (i.e., at the new
  body surface area)).
• INCLUDED if we make minor mods in a CC
• Reference number 50

62
E-Prescribing Ordering

• Allow recording of the dose per kilogram in the
  record of a prescribed medication, so that the
  prescription can be replicated later at the same
  dose per kilogram
• Closest conformance criterion DC.1.8.1 14 (The
  system MAY support medication re-prescribing by
  allowing a prior prescription to be reordered
  without re-entering previous data (e.g.
  administration schedule, quantity). --gt Probably
  should be promoted to SHOULD and the dosage per
  kg should be available so one can replicate the
  prescription at the same dosage (i.e., at the new
  body weight)).
• INCLUDED if we make minor mods in a CC
• Reference number 53

63
E-Prescribing Ordering

• Link adverse drug reactions, including allergies,
  to the activity of ordering or modifying a
  prescription
• Closest conformance criterion DC.1.8.1 15 (The
  system SHOULD check and report allergies,
  drug-drug interactions, and other potential
  adverse reactions, when new medications are
  ordered. ).
• INCLUDED, noncontroversial
• Reference number 60

64
E-Prescribing Ordering

• Allow recording of exceptions to medication
  administration, such as refusal of medication,
  vomiting of the dose, or intravenous access not
  available
• Closest conformance criterion DC.1.8.2 (Manage
  medication administration).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 51

65
E-Prescribing Ordering

• Allow recording of over-the-counter medications,
  herbal remedies, and vitamin preparations in the
  medication list
• Closest conformance criterion DC.1.8.3 (The
  system SHALL provide a user interface to enter
  non-prescription medications including over the
  counter and complementary medications such as
  vitamins, herbs and supplements. ).
• INCLUDED, noncontroversial
• Reference number 52

66
E-Prescribing Ordering

• When allow ordering of blood products in units
  appropriate to pediatric care
• Closest conformance criterion DC.1.9.4 (Order
  blood products and other biologics).
• NOT INCLUDED, noncontroversial
• Reference number 68

67
E-Prescribing Ordering

• When a medication is discontinued, the user would
  have the ability to indicate if a medication was
  ineffective.
• Closest conformance criterion DC.2.3.1.1 8 (The
  system SHOULD allow checking of medications
  against a list of drugs noted to be ineffective
  for the patient in the past. ).
• INCLUDED, noncontroversial
• Reference number 67

68
E-Prescribing Ordering

• Allow the use of other data in dosing decision
  support, such as a lab value (e.g., urine
  specific gravity) of clinical characteristic
  (e.g., gestational age)
• Closest conformance criterion DC.2.3.1.2 2 (The
  system SHALL identify specific and appropriate
  drug dosages for each patient condition at the
  time of medication ordering. ).
• Possibly included, controversial
• Reference number 54

69
E-Prescribing Ordering

• Indicate when dosing decision support is based on
  evidence
• Closest conformance criterion DC.2.7.1 1 (Upon
  request, the system SHALL provide appropriate
  evidence-based documentation for clinical care
  recommendations. ).
• INCLUDED, noncontroversial
• Reference number 59

70
E-Prescribing Ordering

• Communicate with pediatric providers on
  medication use Weight/height/BSDA, conditions
  and any disease management information from
  pharmacy.
• Closest conformance criterion Makes no sense
  (These data elements would be dictated by
  e-prescribing standards).
• NOT INCLUDED, noncontroversial
• Reference number 55

71
E-Prescribing Ordering

• Make the patients age, weight, body surface area,
  and gestational age visible when viewing orders
  at every stage of the ordering process
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 62

72
E-Prescribing Ordering

• Transmit relevant body measurements (usually
  weight) with prescriptions
• Closest conformance criterion N/A (EHRs are
  going to do what the eRx messaging standards say
  to do if weight is a field, then they'll send
  it. If not, they won't.).
• NOT INCLUDED, noncontroversial
• Reference number 66

73
Education

• Provide patient education materials that are
  appropriate for patients in varying age ranges
• Closest conformance criterion DC.3.2.4 9 (The
  system MAY enable age-appropriate and/or
  reading-ability appropriate educational materials
  for the patient and/or patient representative ).
• INCLUDED, noncontroversial
• Reference number 69

74
Epidemiology

• identify patients by parent's employer in cases
  of epidemiologic surveillance involving an
  occupational exposure
• Closest conformance criterion D.3.5.4 1 (The
  system MAY support the identification of patients
  related by employer and work location for
  purposes of epidemiological exposure and public
  health analysis and reporting --gt Needs to
  include PARENT'S employer as well).
• INCLUDED if we make minor mods in a CC
• Reference number 73

75
Epidemiology

• Allow recording of the location of day care
  center, institutional food source, camps,
  schools, and so forth for the purposes of
  environmental monitoring
• Closest conformance criterion DC.2.6.2 1 (The
  system SHALL provide identification of the
  individual care providers or care managers within
  a cared for population --gt Only if schools,
  camps, and day care centers are classified as
  "providers or care managers").
• INCLUDED if we make minor mods in a CC
• Reference number 70

76
Epidemiology

• Facilitate notification of schools, camps, day
  care settings, and so forth of health risks that
  apply to populations of children within those
  institutions
• Closest conformance criterion DC.2.6.2 4 (The
  system MAY have the ability to disseminate a
  notification of a health risk to the identified
  individual care providers or care-managers
  through one or more alternative means --gt Only if
  schools, camps, and day care centers are
  classified as "providers or care managers").
• INCLUDED if we make minor mods in a CC
• Reference number 72

77
Epidemiology

• Facilitate epidemiologic studies by recording
  living situation
• Closest conformance criterion S.1.4.3 1 2
  (The system SHOULD provide a mechanism to
  identify the patients primary residence. The
  system MAY provide a mechanism to identify the
  patients secondary or alternate residence. ).
• INCLUDED, noncontroversial
• Reference number 71

78
Family Linkage

• Allow the recording of a relationship by living
  situation
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 77

79
Family Linkage

• Facilitate the scheduling of siblings to be seen
  as a group or in contiguous time slots
• Closest conformance criterion N/A (S.1.6
  Scheduling) (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 78

80
Family Linkage

• Allow linkages between siblings charts
• Closest conformance criterion S.3.5.1 1 (The
  system MAY support the identification of persons
  related by genealogy.).
• INCLUDED, noncontroversial
• Reference number 74

81
Family Linkage

• Allow linkages between the charts of parents and
  children
• Closest conformance criterion S.3.5.1 1 (The
  system MAY support the identification of persons
  related by genealogy.).
• INCLUDED, noncontroversial
• Reference number 75

82
Family Linkage

• Allow the creation of family groups of records
  within the system, for the purpose of moving
  between records within a family, subject to
  patient preferences, family preferences, and
  privacy regulations
• Closest conformance criterion S.3.5.1 1 (The
  system MAY support the identification of persons
  related by genealogy.).
• INCLUDED, noncontroversial
• Reference number 76

83
Family Linkage

• Link records in cases where there is a medical
  reason to do so, such as in cases of familial
  disease
• Closest conformance criterion S.3.5.1 1 (The
  system MAY support the identification of persons
  related by genealogy.).
• INCLUDED, noncontroversial
• Reference number 79

84
Gender

• Allow the assignment of an unknown gender
• Closest conformance criterion N/A (This may
  simply be a matter of allowing the value of
  "unknown" in the a gender field).
• VOCABULARY ISSUE
• Reference number 80

85
Gestational Age

• Allow recording of gestational age at the time of
  delivery as a permanent feature of the patient
  that can be accessed at all times during the care
  of the patient, in much the same way as a
  "problem"
• Closest conformance criterion N/A (This may
  simply be a matter of allowing gestational age to
  be an item on the problem list).
• VOCABULARY ISSUE
• Reference number 81

86
Growth

• Allow the recording of head circumference
• Closest conformance criterion DC.1.10.2 2 comes
  close (The system MAY capture other clinical
  measures as discrete elements such as peak
  expiratory flow rate, size of lesions, oxygen
  saturation, body mass index and severity of
  pain.).
• INCLUDED if we make minor mods in a CC
• Reference number 83

87
Growth

• Allow graphic display of growth data against a
  user-selectable set of normative curves
• Closest conformance criterion DC.1.4? (Growth
  charting is briefly mentioned in the text of
  DC.1.4 "Manage Assessments," but there are no
  specifics).
• NOT INCLUDED, noncontroversial
• Reference number 82

88
Growth

• Plot body mass index against normative curves
• Closest conformance criterion DC.1.4? (Growth
  charting is briefly mentioned in the text of
  DC.1.4 "Manage Assessments," but there are no
  specifics).
• NOT INCLUDED, noncontroversial
• Reference number 85

89
Growth

• Provide graphical growth chart and norms for
  children with varying conditions (e.g., Down
  syndrome and Turner syndrome)
• Closest conformance criterion DC.1.4? (Growth
  charting is briefly mentioned in the text of
  DC.1.4 "Manage Assessments," but there are no
  specifics).
• NOT INCLUDED, noncontroversial
• Reference number 87

90
Growth

• include the appropriate templates for growth data
  fields, which would be presented to the caregiver
  using CDC standards based on demographic data
  (i.e., length, weight, head circumference for lt
  36 months height weight, BMI for over 36
  months).
• Closest conformance criterion Makes no sense
  (Either the EHR allows the entering of head
  circumference or it does not. Either it
  calculates BMI or it does not. Whether these
  "fields" come up depend on the age-dependent
  templates the system implements (see Decision
  Support).).
• DELETE?
• Reference number 84

91
Growth

• Provide alerts about variances in the growth
  chart
• Closest conformance criterion Needs more detail
  hard to put this one into a conformance criterion
  (Growth charting is briefly mentioned in the text
  of DC.1.4 "Manage Assessments," but there are no
  specifics).
• NOT INCLUDED, noncontroversial
• Reference number 86

92
Growth

• Provide mechanism for monitoring of growth over
  time
• Closest conformance criterion Needs more detail
  hard to put this one into a conformance criterion
  (Growth charting is briefly mentioned in the text
  of DC.1.4 "Manage Assessments," but there are no
  specifics).
• NOT INCLUDED, noncontroversial
• Reference number 88

93
Guardianship

• Support the recording of multiple guardians and
  residences for given child whose parents are
  divorced or who have joint custody
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 90

94
Guardianship

• Allow reference to subsets of the demographic
  data of the patients guardian to serve for parts
  of the patients demographic data, to avoid
  re-entry of data and avoid data anomalies
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 91

95
Guardianship

• Allow recording of a guarantor, who may be
  different from the parent or guardian
• Closest conformance criterion S.3.5.2 1 (The
  system MAY support the identification of persons
  related by insurance plan. ).
• INCLUDED, noncontroversial
• Reference number 89

96
Immunizations

• Allow recording of immunizations including lot
  numbers and vaccine information statements
• Closest conformance criterion DC.1.3.3 1 2
  (The system SHALL record as discrete data
  elements data associated with any immunization
  given including date, type, lot number and
  manufacturer. The system SHOULD allow the
  association of standard codes with discrete data
  elements associated with an immunization.).
• INCLUDED, noncontroversial
• Reference number 93

97
Immunizations

• Allow reporting of immunization status of
  populations of children within the practice
• Closest conformance criterion DC.1.3.3 3 (This
  is not directly mentioned in the conformance
  criteria, but it would be a derivative of the
  process used to compute immunizations for
  individuals).
• NOT INCLUDED, noncontroversial
• Reference number 95

98
Immunizations

• Based on known immunization data, calculate
  immunization status (current versus delayed) and
  display in summary lists
• Closest conformance criterion DC.1.3.3 3 (The
  system SHALL determine any required immunizations
  during an encounter based on a current accepted
  schedule such as that from the Centers for
  Disease Control and Prevention. ).
• INCLUDED, noncontroversial
• Reference number 97

99
Immunizations

• Provide alerting and reminders for
  missedimmunizations
• Closest conformance criterion DC.1.3.3 3 (The
  system SHALL determine any required immunizations
  during an encounter based on a current accepted
  schedule such as that from the Centers for
  Disease Control and Prevention.).
• INCLUDED, noncontroversial
• Reference number 101

100
Immunizations

• Allow user level updating of immunization
  guidelines
• Closest conformance criterion DC.1.3.3 5 (The
  system SHALL allow for the updating of the
  immunization schedule --gt Does not include "user
  level is this important?).
• INCLUDED if we make minor mods in a CC
• Reference number 96

101
Immunizations

• Include mechanisms for immunization decision
  support that includes easy updating as
  recommendation change is included.
• Closest conformance criterion DC.1.3.3 5 (The
  system SHALL allow for the updating of the
  immunization schedule).
• INCLUDED, noncontroversial
• Reference number 100

102
Immunizations

• Allow flexible reporting of immunizations in a
  given practice to support required vaccine
  program reporting
• Closest conformance criterion DC.1.3.3 8 (The
  system SHOULD prepare a report of a patient's
  immunization history upon request for appropriate
  authorities such as schools or day-care centers.
  ).
• INCLUDED, noncontroversial
• Reference number 92

103
Immunizations

• Allow recording of parental consent to
  immunizations, according to applicable state law,
  as part of the point of care interface
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 94

104
Immunizations

• Compute immunization recommendations for a time
  other than the time of the current encounter (for
  example if a parent wants to know what
  immunizations are due at the next visit, the
  system would facilitate this analysis)
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 98

105
Immunizations

• Display immunizations by antigen
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 99

106
Interface

• Include age and DOB on every display, both
  printed and on the screen
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 102

107
Lab Results

• In the case of laboratories, allow recording of
  verification and communication to family members
• Closest conformance criterion DC.3.2.3 1, 3, 4
  (The system SHALL facilitate documentation of
  communications between providers and patients or
  their representatives. The system SHALL capture
  details of provider communications with patients
  or family (e.g. date, provider id, details of
  communication, result of communication requests).
  The system SHALL document communication
  originating with the patient or patient
  representative (e.g. date, entity, details of
  communication)).
• INCLUDED, noncontroversial
• Reference number 103

108
Medical Home

• Allow the designation of Advocate for the
  patient, who can append information to the chart
• Closest conformance criterion DC.1.1.4
  ((Mentions surrogate for patient in the
  description, but lists no conformance criteria)).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 104

109
Medical Home

• Allow the recording of a primary care physician
  for each patient
• Closest conformance criterion N/A (N/A - this
  has GOT to be an oversight).
• NOT INCLUDED, noncontroversial
• Reference number 105

110
Medical Home

• have the capability to identify multiple primary
  providers as well as multiple sub-specialists
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 106

111
Medical Home

• Indicate multiple primary care providers, in the
  case were a pediatrician and a family
  practitioner are assuming that role
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 108

112
Medical Home

• If the system provides a directory of providers,
  indicate which of those providers see pediatric
  patients, or who are pediatric specialists
• Closest conformance criterion S.1.3.1 5 (The
  system MAY provide a directory of clinical
  personnel external to the organization that are
  not users of the system to facilitate
  documentation communication and information
  exchange --gt Needs addition of data on peds
  specificity).
• INCLUDED if we make minor mods in a CC
• Reference number 107

113
Miscellaneous

• Links to a source where living wills are stored
• Closest conformance criterion DC.1.11.2 2 (The
  system SHOULD be able to indicate the type of
  advanced directives such as living will, durable
  power of attorney, or a "Do Not Resuscitate
  order".).
• INCLUDED, noncontroversial
• Reference number 110

114
Miscellaneous

• Coordinate bed identification between facilities,
  for transport from general hospital to children's
  hospital or to NICU.
• Closest conformance criterion S.1.4.2 1 (The
  system SHOULD identify and display/view the
  patients assigned location, unambiguously. ).
• INCLUDED, noncontroversial
• Reference number 109

115
Norms

• Provide age based norms for data when such norms
  exist
• Closest conformance criterion DC.1.10.1 ().
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 114

116
Norms

• The system should accept normal ranges supplied
  by the external reference laboratory. Ideally,
  lab values are linked to ""disease-specific
  state"" values.
• Closest conformance criterion DC.1.10.1
  (Receiving normal ranges and critical ranges from
  external sources is the default behavior for
  systems that accept lab values from external
  sources this is not explicitly mentioned in the
  functional model).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 116

117
Norms

• Indicate normal ranges for values for which there
  are mutliple normal ranges within each age range
  (example blood pressure, for whuch there are
  different normal values for each height range
  within each age range)
• Closest conformance criterion DC.1.10.2 ().
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 113

118
Norms

• Provide an indicator of abnormal vital signs in
  cases where the vital signs fall outside the
  range of normal for age
• Closest conformance criterion DC.1.10.2 ().
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 115

119
Norms

• Calculate and immeditely display, along with the
  original data, percentile values for any piece of
  data entered into the system for which a
  percentile distribution is known (height, weight,
  head circumference, body mass index, blood
  pressure)
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 111

120
Norms

• Indicate normal range for items (lab values and
  physical exam data) based on stage of sexual
  maturity
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 112

121
Parental Data Entry

• Incorporate documentation from external sources
• Closest conformance criterion DC.1.1.3 1, and
  DC.3.2.3 4 (The system SHALL allow external
  documents to be stored in the system, and The
  system SHALL document communication originating
  with the patient or patient representative (e.g.
  date, entity, details of communication) ).
• INCLUDED, noncontroversial
• Reference number 119

122
Parental Data Entry

• provide a Web-based interface for entering data
  by parents, patients, school nurses, pharmacy
  labs/medical devices technicians.
• Closest conformance criterion DC.1.1.4 3
  (specifying "web-based" is beyond the scope of
  this document this CC should handle the EHR end
  of this requirement) (The system SHALL capture,
  explicitly label the source of clinical data
  provided on behalf of the patient.).
• NOT INCLUDED, noncontroversial
• Reference number 121

123
Parental Data Entry

• Distinguish data provided by the clinician from
  data provided by the parent, guardian, teacher,
  translator, or family
• Closest conformance criterion DC.1.1.4 3 4
  (The system SHALL capture, explicitly label the
  source of clinical data provided on behalf of the
  patient. The system SHALL present
  patient-originated data for use by care
  providers.).
• INCLUDED, noncontroversial
• Reference number 118

124
Parental Data Entry

• Provide patients with a web-based tool to access
  their medical record information.
• Closest conformance criterion DC.3.2.3 5 (The
  system SHALL enable a secure web connection to
  support communications between providers and
  patients or their representatives ).
• INCLUDED if we make minor mods in a CC
• Reference number 122

125
Parental Data Entry

• Support entry of information by parents,
  patients, school nurses via the Web
• Closest conformance criterion DC.3.2.3 5 (The
  system SHALL enable a secure web connection to
  support communications between providers and
  patients or their representatives ).
• INCLUDED if we make minor mods in a CC
• Reference number 123

126
Parental Data Entry

• Allow designation of a given patient as competent
  to enter his or her own information at a point
  selected by the clinician
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 117

127
Parental Data Entry

• Permit oversight by parents of the patient
  entered information
• Closest conformance criterion N/A (May be to
  ill-defined in this form).
• NOT INCLUDED, noncontroversial
• Reference number 120

128
Patient Identification

• Allow the assignment of temporary identifiers in
  cases where a government issued identifier is not
  available.
• Closest conformance criterion DC.1.1.1 2 (The
  system SHALL provide the ability to uniquely
  identify a patient and tie the record to a single
  patient. ).
• INCLUDED, noncontroversial
• Reference number 129

129
Patient Identification

• Support administrative transactions before an
  official, government issued identifier is
  available
• Closest conformance criterion DC.1.1.1 2 (The
  system SHALL provide the ability to uniquely
  identify a patient and tie the record to a single
  patient. ).
• INCLUDED, noncontroversial
• Reference number 132

130
Patient Identification

• Allow cross-referencing of multiple identifiers
  that may identify the same patient
• Closest conformance criterion DC.1.1.1 6 (The
  system SHALL provide the ability to query and
  retrieve appropriate parts of a patient record
  using a primary identifier, secondary
  identifiers, or other information which are not
  identifiers, but could be used to help identify
  the patient. ).
• Possibly included, controversial
• Reference number 125

131
Patient Identification

• Allow changes in identifying data at the time of
  family changes due to adoption
• Closest conformance criterion DC.1.1.1 6 almost
  works (The system SHALL provide the ability to
  query and retrieve appropriate parts of a patient
  record using a primary identifier, secondary
  identifiers, or other information which are not
  identifiers, but could be used to help identify
  the patient. ).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 124

132
Patient Identification

• Allow entry of mothers identifying data as part
  of the patients identifying data
• Closest conformance criterion DC.1.1.1 6 almost
  works (Closest CC doesn't quite do it The system
  SHALL provide the ability to query and retrieve
  appropriate parts of a patient record using a
  primary identifier, secondary identifiers, or
  other information which are not identifiers, but
  could be used to help identify the patient. ).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 126

133
Patient Identification

• Allow name changes, and retain old names for the
  purpose of searching for patient records
• Closest conformance criterion DC.1.1.1 6 almost
  works (The system SHALL provide the ability to
  query and retrieve appropriate parts of a patient
  record using a primary identifier, secondary
  identifiers, or other information which are not
  identifiers, but could be used to help identify
  the patient. ).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 128

134
Patient Identification

• Allow entry of temporary ID numbers, which can be
  replaced with more formal identification number
  systems
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 127

135
Patient Identification

• To the extent afforded by existing national
  patient identifier systems, allow replacement of
  an identifier assigned in the pediatric period to
  a new, adult identifier at the age of majority
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 133

136
Patient Identification

• Allow the retention (and use as search criteria)
  the multiple names applied to a patient
• Closest conformance criterion S.1.4.1 ((Mentions
  changing names in the description, but there are
  no conf criteria mentioning how name changes
  would affect subsequent system operation)).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 130

137
Patient Identification

• Allow users to be able to find a patient in the
  system based on multiple search criteria
• Closest conformance criterion S.1.4.1 ((Mentions
  changing names in the description, but there are
  no conformance criteria mentioning how name
  changes would affect subsequent system
  operation)).
• NEEDS NEW CC IN THIS FUNCTION
• Reference number 131

138
Pedigree

• Allow construction of graphical patient pedigrees
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 134

139
Preferences

• Alert users to preferences based on religion,
  such as transfusions in Jehovah's Witness
  patients
• Closest conformance criterion DC.1.11.1 1 (The
  system SHALL capture, present, and store patient
  preferences such as language, religion and
  culture.).
• INCLUDED, noncontroversial
• Reference number 135

140
Preferences

• Allow parents to append information to the chart,
  per HIPAA guidelines
• Closest conformance criterion Redundant, since
  all products must comply with HIPAA (N/A).
• INCLUDED, noncontroversial
• Reference number 136

141
Prenatal

• Allow creation of a record of a patient before
  the patients birth
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 137

142
Prenatal

• Allow the retention of data related to prenatal
  procedures within the record of the patient
  postnatally
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 138

143
Privacy

• Label clinical information as requiring special
  privacy consideration, based on patient's age and
  applicable laws (this applies to so-called
  adolescent privacy)
• Closest conformance criterion DC.1.1.6 2 (The
  system SHALL restrict access to summarized
  information based on applicable rules for
  confidentiality of patient health information --gt
  assuming the rules can respond to age and
  sensitive diagnoses).
• INCLUDED if we make minor mods in a CC
• Reference number 144

144
Privacy

• In cases of care given to patients during
  adolescence, provide the ability to flag certain
  encounters, problems, diagnoses, and results as
  requiring special privacy handling
• Closest conformance criterion DC.1.1.6 2 and
  I.1.9 8 (The system SHALL restrict access to
  summarized information based on applicable rules
  for confidentiality of patient health information
  AND System MAY allow varying levels of
  confidentiality based on patient class and/or
  diagnosis).
• Possibly included, controversial
• Reference number 142

145
Privacy

• Allow user to mark sections or patients as
  confidential. This allows the practice to not
  print demographics, certain confidential
  sections, or other items
• Closest conformance criterion I.1.1.9 8 (if
  "age" is added to it) (System MAY allow varying
  levels of confidentiality based on patient class
  and/or diagnosis. --gt System SHOULD allow varying
  levels of confidentiality based on patient class,
  age, and/or diagnosis.).
• INCLUDED if we make minor mods in a CC
• Reference number 140

146
Privacy

• Protect the genetic identity of the child, when
  desired, when assisted reproductive technology is
  used
• Closest conformance criterion I.1.9 1 (The
  system SHOULD enforce the applicable
  jurisdictional and organizational patient privacy
  rules).
• Possibly included, controversial
• Reference number 145

147
Privacy

• Allow labeling of data for special privacy
  considerations
• Closest conformance criterion I.1.9 8 (System
  MAY allow varying levels of confidentiality based
  on patient class and/or diagnosis. ).
• INCLUDED, noncontroversial
• Reference number 139

148
Privacy

• In cases of care given to patients during
  adolescence, offer reminders based on diagnoses
  of the need for special privacy handling
• Closest conformance criterion N/A (N/A).
• NOT INCLUDED, noncontroversial
• Reference number 141

149
Privacy

• Include donor management support Functions in an
  EMR related to organ and tissue donation may need
  to accommodate information about the gamete or
  zygote donated that resulted in pregnancy that
  gave rise to the patient, within applicable
  privacy laws.
• Closest conformance criterion S.1.2 Donor
  Management Support but does not include ART ().
• NOT INCLUDED, noncontroversial
• Reference number 143

150
Registries

• Allow linkage to registries maintained in the
  public sector
• Closest conformance criterion COVERED IN
  "REGISTRIES PACKAGE" ((DC.1.3.3 Manage
  immunizations S.1.1 Registry notification
  S.3.1.2 Encounter-specific functionality S.3.3.6
  Health service reports at the conclusion of an
  episode of care I.1.3.1 Unique identity,
  registry, and directory services I.3.2
  Distributed registry access I.5.4 Interchange
  agreements I.6 Business rules management)).
• INCLUDED, noncontroversial
• Reference number 146

151
Registries

• Exchange data with newborn metabolic screening
  registries
• Closest conformance criterion COVERED IN
  "REGISTRIES PACKAGE" ((DC.1.3.3 Manage
  immunizations S.1.1 Registry notification
  S.3.1.2 Encounter-specific functionality S.3.3.6
  Health service reports at the conclusion of an
  episode of care I.1.3.1 Unique identity,
  registry, and directory services I.3.2
  Distributed registry access I.5.4 Interchange
  agreements I.6 Business rules management)).
• INCLUDED, noncontroversial
• Reference number 147

152
Registries

• Exchange data with other public health registries
  of relevance to children
• Closest conformance criterion COVERED IN
  "REGISTRIES PACKAGE" ((DC.1.3.3 Manage
  immunizations S.1.1 Registry notification
  S.3.1.2 Encounter-specific functionality S.3.3.6
  Health service reports at the conclusion of an
  episode of care I.1.3.1 Unique identity,
  registry, and directory services I.3.2
  Distributed registry access I.5.4 Interchange
  agreements I.6 Business rules management)).
• INCLUDED, noncontroversial
• Reference number 148

153
Registries

• Exchange immunization data with immunization
  registries
• Closest conformance criterion COVERED IN
  "REGISTRIES PACKAGE" ((DC.1.3.3 Manage
  immunizations S.1.1 Registry notification
  S.3.1.2 Encounter-specific functionality S.3.3.6
  Health service reports at the conclusion of an
  episode of care I.1.3.1 Unique identity,
  registry, and directory services I.3.2
  Distributed registry access I.5.4 Interchange
  agreements I.6 Business rules management)).
• INCLUDED, noncontroversial
• Reference number 149

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