NEW YORK (Reuters Health)—Children’s electronic health records (EHRs) are missing functions “essential” for managing children’s health, according to a multistakeholder work group that produced a “high-priority” list of EHR requirements.
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“Most doctors caring for children in hospitals or office practices now use EHRs, which benefit children and families by offering decision-support and other safety features that improve care quality and save lives,” Dr. Jonathan Wald of RTI International in Waltham, Massachusetts told Reuters Health.
“But not all EHRs (for children) offer the right functions,” he said by email.
“For example, sometimes a system is not designed to calculate safe pediatric medication doses based on a child’s weight and age, and that has to be done by hand instead,” he said.
“Or growth charts for children, especially the ones tailored to an individual, such as a child with developmental delay, are missing,” he added. “Or school and camp forms, which some EHRs generate easily, are not available, placing added burden on office staff.”
“Our project worked to identify high-priority functional requirements that all EHRs should have,” he explained. “We took a much longer list (500+) from (2013) and produced the top 47 based on a panel of nationally recognized pediatricians and experts.”
“Parents, doctors, EHR experts, and professional associations such as the American Academy of Pediatrics and the American Medical Informatics Association are in wide agreement about the importance of EHRs having the functionality that we identified,” he said.
The priority list, published online March 8 in Pediatrics, includes, for example, such items as:
– Link maternal and birth data to the child health record
– Record all vital signs and growth parameters precisely
– Provide unit conversions calculation and display during data entry
– Provide closest available standardized dose
– Include ability to document parental (guardian) notification or permission
– Allow unknown patient sex
– Order blood products in pediatric units
– Compute weight-based drug dosage
– Flag special health care needs
– Support appropriate newborn screening and followup
– Associate mother’s demographics with newborn
– Track incomplete preventive care opportunities
– Provide age-specific decision support
– Provide rounding for administrable doses
– Use biometric-specific norms for growth curves
– Provide alerts for out-of-range biometric data
“We hope that by focusing the energy of software vendors, EHR purchasers, policymakers and families on the same high-priority list, EHRs will be designed and used more safely and effectively in the care of children,” Dr. Wald concluded.
Dr. Stephen Downs, Director of Children’s Health Services Research at Indiana University School of Medicine and a research scientist at the Regenstrief Institute, both in Indianapolis, said, “I can’t agree more that the current design of most EHRs is not very pediatric friendly.”
“There are at least a couple of EHRs that cater specifically to pediatricians,” he said in an email to Reuters Health. “The vast majority don’t because there is not nearly as much money in pediatrics as in adult medicine.”
“Notable shortcomings are the lack of age-based norms for blood pressures or for dosing schedules where the amount of medication depends on the size – and occasionally age – of the child,” said Dr. Downs, who was not involved in developing the priority list but is familiar with the project.
“This has been a long-term effort,” he said. “The initial project produced a very complex set of standards that were really impractical to implement. The paper talks about a much simplified and high-priority set of requirements.”
“Personally, I think this is a very good subset,” Dr. Downs said. “If EHRs could implement all of them, that would be terrific.”
- Wald J, Haque S, Rizk S, et al. Enhancing Health IT Functionality for Children: The 2015 Children’s EHR Format. Pediatrics. 2018 March 8. http://pediatrics.aappublications.org/content/early/2018/03/06/peds.2016-3894.