​Partnership for Policy Implementation

When non-specific language is used in a statement, HIT developers are left to interpret the meaning, which leads to differences in implementation. For example, the use of the word “infant” (what’s the age range for an infant?) or the phrase “low maternal education” are ambiguities that are difficult to encode within a system. The PPI works to disambiguate non-clear language and to substitute specific, common, and well-defined pediatric language. ​

Given that domain experts are most commonly authors of policy statements, clinical reports, technical reports, and clinical guidelines, PPI helps to identify when these documents are written with definitions or concepts that non-experts might find to be unclear. For example, when providers are asked to perform developmental surveillance at every visit, a full explicit definition of the meaning of surveillance should be included. ​

When provider action is prescribed, it needs to both be explicit and detail all potential possibilities. By clearly and completely defining the logic, HIT developers can build alerts, reminders, and decision support tools to facilitate task completion by clinicians. ​

The PPI recognizes that statements for standards-of-practice have the potential to define exactly how actions and behaviors should be performed. For example, the standard for developmental screening can be clarified to state whether it can be conducted with a standardized instrument before a visit, or whether it should be completed by the provider in the office. By providing this specific information, functional standards for EHR software can be established and disseminated to developers for incorporation into workflows. ​

Through the use of tools like clinical algorithms, the PPI aims to help create policies and guidelines that communicate how clinicians should behave. The goal is to make recommendations action-oriented so that clinicians and technology developers have a better understanding of how to fulfill the intent of the statement.

The PPI seeks to prescribe documentation and rational for specific clinical actions. By clearly defining the level of evidence supporting each course of action, the provider is given the tools by which to use professional judgment to make a decision at the point of care. ​

Once clear, more concise statements are created, they have to be “matched” to the various vocabulary, logical, and functional HIT standards (eg, LOINC, SNOMED, RxNorm, etc). This process will ultimately lead to a common pediatric language for information-management systems. These public domain products allow HIT systems to be integrated and interoperable with each other. These efforts also assure that the national HIT framework supports the medical home approach to pediatric care, enabling the provision of coordinated, comprehensive care to all children and their families.