GQ1. Description of EHRs

GQ 1A: Are there functionalities that have been identified in the literature and feature more prominently than others as potentially important to achieve for improving children's health?

• Family relationships, patient engagement, age of majority.
• Determine family relationship through subject to subject relationship. Insurance status, etc.
• Tracking last well-child visit
• PPI transition policy, EHR support checklist (Got Transition)

GQ2. Description of the context in which EHRs are implemented

GQ 2A: What is the potential value of pediatric-specific functionalities in the context of care transition, specifically from newborn care to pediatric primary care, from pediatric primary care to pediatric specialist care, and from pediatric primary care to adolescent care?

• Add transition from adolescences to adult to the list of transitions
• Pediatric-specific time unites, weight units, weight-based dosing, developmental milestones, growth data, family appropriate education, use of pediatric scales
• Private physician wish list (e.g., immunization logic) is not new or specific to EHR functionality
• Core functionality is difficult
• Lack of standards for clinical circumstance (e.g. there are only two growth charts, but pediatricians want more)

GQ 2B: Are certain pediatric-specific functionalities beneficial for a pediatrician to conduct her work including sick and well-child visits? If so, does this vary by health care setting (e.g. primary care office, specialty care office, school health, and alternative care settings) or by type of visit (e.g., preventive vs. acute care)?

• Language translation
• Food safety, domestic violence,
• Data tied to non-clinical data
• Social service case-management data
• Bright Futures Guidance- not there or not computable. CDSS only 20% compatible (publication by Steve Downs)
• Conformance criteria

GQ2C: What are the challenges to implementing specific functionalities? Are some harder than others to implement by a) vendors; and/or b) pediatric providers?

• Functions align with MU or PCMH and is certification driven
• CQM is vague and broken

(http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH/DuringEarnItPCMH/PCMH2014ISSDataSources.aspx)

GQ3. Description of the existing evidence

GQ 3A: Is there any evidence that using an EHR adapted for the specific needs of pediatric providers compared with using a “regular” EHR or not using an EHR at all produces a) better quality, including safety and cost outcomes for patients; and/or b) improved workflow or job satisfaction for providers?

• Health information chapter
• Electronic Pediatric Research in Office Settings ePros (http://www2.aap.org/pros/epros/eprosa&m.htm)

GQ 3B: Which pediatric-specific functionalities influence a) patient outcomes (including safety; quality; cost; equity; standardization of care; and/or efficiency); b) the ability of a pediatric provider to conduct work within the EHR; c) improvement of workflow and provider satisfaction; and/or d) involvement of patients and families (including their education and shared decision making)?

• Data of usefulness is mostly unpublished

GQ4. Dissemination and future developments

GQ 4A: How does testability and usability of core functionalities promote or impede dissemination and future development of pediatric EHRs?

• Testing for usability can be difficult
• Real-time contextual support
• Provide specific guidelines, concrete and computable information for translation by vendors
• Decrease burden of reports, order, and care plans.