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Core Functionality in Pediatric Electronic Health Records
Technical Briefs, No. 20
Investigators: Kevin R Dufendach, MD, Jacob A Eichenberger, MD, Melissa L McPheeters, PhD, MPH, Michael W Temple, MD, Haresh L Bhatia, MS, Mhd Wael Alrifai, MD, Shannon A Potter, MLIS, Stuart T Weinberg, MD, Kevin B Johnson, MD, MS, and Christoph U Lehmann, MD.
Author Information and AffiliationsStructured Abstract
Background:
Clinicians, informaticians, policy makers, and professional organizations such as the American Academy of Pediatrics have described the need for electronic health record (EHR) systems and information technology tools that better support pediatric health care through the availability of pediatric functionalities. The Children's EHR Format created almost 700 requirements pertaining to pediatric functionality. While the report included multiple desired functions, the large number of requirements as well as the lack of prioritization may have had a paralyzing effect on most vendors, who, confronted with Meaningful Use requirements, did not leverage the format to improve their products.
Purpose:
A Technical Brief is a report of an emerging intervention for which there are limited published data and too few completed research studies to support definitive conclusions. The goals of the Technical Brief are to provide an objective description of the state of the science, identify a potential framework for assessing the applications and implications of the intervention, summarize ongoing research, and present research gaps. We developed a technical brief on the state of practice and the current literature around core functionalities for pediatric electronic health records to describe current practice and to provide a framework for future research.
Methods:
We had conversations with Key Informants representing clinicians, policy experts, and researchers. We searched online sources for information about currently available programs and resources. We conducted a literature search to identify currently available research on the effectiveness of individual functionalities.
Findings:
There is expert consensus in the literature that EHRs used in the care of children require specific functionalities to support the work of child health care providers and assure the delivery of quality care to pediatric patients. These functionalities relate to a child's evolving physiology and maturity and associated conditions. Key areas include vaccination, child development, physiologic medication dosing, pediatric disease management, pediatric norms, and the relationship between pediatric patients and their caregivers, including adolescent privacy. Empirical evidence for health outcomes associated with the introduction of a pediatric EHR or for implementation of systems such as clinical decision support is largely limited to pre-post studies on a subset of important functionalities. Key Informants indicated that if these functionalities are implemented well, the EHR will also better support the care of all patients.
Summary and implications:
While many of the key functionalities identified in this brief are not purely pediatric, their key role in the care of children in contrast to their minimal role for adults could mean they can get omitted in an EHR designed primarily for adult care. Incentives for developing pediatric functionalities for EHRs are currently driven by (1) meaningful use requirements and the patient-centered medical home; (2) a desire to support and maintain patient safety; and (3) the increasing presence of pediatric-specific clinical quality measures. Introducing a new pediatric functionality to an EHR should, therefore, be done thoughtfully and ideally is done in consideration of utility, testability, and usability principles. Understanding the importance of computability and specificity of guidelines as well as motivations for development of pediatric-specific functionalities provides further insight into how dissemination and development will be driven in the future.
Contents
- Preface
- Acknowledgments
- Key Informants
- Peer Reviewers
- Background
- Methods
- Findings
- Summary and Implications
- Next Steps
- References
- Appendix A Literature Search Strategies
- Appendix B Key Informant Interviews
- Appendix C Summary of Key Informant Input
- Appendix D Screening Forms
- Appendix E Summary of Consensus Statements
- Appendix F Ongoing Studies
- Appendix G Reasons for Exclusion
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2012-00009-I, Prepared by: Vanderbilt University Evidence-based Practice Center, Nashville, TN
Suggested citation:
Dufendach KR, Eichenberger JA, McPheeters ML, Temple MW, Bhatia HL, Alrifai MW, Potter SA, Weinberg ST, Johnson KB, Lehmann CU. Core Functionality in Pediatric Electronic Health Records. Technical Brief No. 20. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2012-00009-I.) AHRQ Publication No. 15-EHC014-EF. Rockville, MD: Agency for Healthcare Research and Quality; April 2015. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Vanderbilt University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00009-I).
The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers–patients and providers, health system leaders, and policymakers, among others–make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, reimbursement or coverage policies, may not be stated or implied.
None of the investigators have any affiliation or financial involvement that conflicts with the material presented in this report.
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.ahrq.gov
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