EHRs for Pediatric Care

Electronic Health Records for Pediatricians: A Shopper's Guide

Getting the most out of your EHR

Pediatric patients have unique needs for effective and safe care. Whether you are in a position to choose the EHR you use, or your employer has chosen a tool, clinicians caring for children should prioritize the following questions and functionalities when implementing an EHR or other health IT tools.

What to look for in an EHR for Pediatric Care?

Health IT Certification can be a useful indicator even if your practice is not applying for Meaningful Use incentives. Federal certification assures the tools meet technical, functional, and security requirements established by the Department of Health and Human Services.
Questions to consider:

  1. Is the functionality critical, essential, or optional to my practice? For example: vaccine administration, patient portal access, and portable access to the EMR.

  2. Is there any functionality missing? If there are things (or features) that are missing, where is this functionality on their development roadmap? When is it expected to be available?

  3. Does the EHR have pediatric specific content for documentation, charting and orders? Will we need to customize? If so, how much?

  4. How well does the EHR perform this functionality? What is the number of clicks and scrolls to accomplish a task?

  5. How usable is the EHR in my practice? What basic IT support is needed, and what does the vendor provide?

  6. How integrated are appointments and billings? Does the vendor have experience with the insurance companies my practice needs?

  7. How does this EHR exchange information with immunization information systems (IIS), newborn (NB) screening registry, hospital systems, labs, radiology offices, regional health information exchanges and other health information exchanges?

  8. What is the pricing for technical support/upgrades?

  9. If you are switching to a new system: What functionalities support transfer of data from your current system?

Important Pediatric Functionality

Pediatricians and other clinicians who care for children have specific needs for health information technology (HIT) tools to help them provide the highest quality care for their patients. The following eight priorities were identified by the AAP’s Child Health Informatics Center as essential to increase the functionality of HIT tools for the pediatric population and their providers.

Use biometric-specific norms for growth curves and support growth charts for children. Every pediatric HIT system should include the ability to use pediatric age-specific norms for weight, height/length, head circumference, and Body Mass Index (BMI) to calculate and display growth percentiles and plot them over time on standardized CDC/WHO growth curves as appropriate. The system should support display of growth charts that plot selected growth parameters such as height, weight, head circumference, and BMI, along with appropriate sets of norms provided by the CDC or in a compatible tabular format (typically based on Lambda-Mu-Sigma [LMS] curve fitting computational method.

Compute weight-based drug dosage. A pediatric HIT system must have the capability to compute drug does, based on appropriate dosage ranges, using the patient’s body weight and body surface area, and display the dosing weight and weight-based dosing strategy (when applicable) on the prescription.

Ability to document all guardians and caregivers. A HIT system should provide the ability to record information about all guardians and caregivers (biological parents, foster parents, adoptive parents, guardians, surrogates, and custodians), siblings, and case workers; with contact information for each.

Segmented access to information. The pediatric HIT system should provide users the ability to segment health care data to keep information about minor consent services private and distinct from other content of record, such that it is not exposed to parents/guardians without the minor’s authorization. Privacy concerns regarding adolescent health data must be considered.

Synchronize immunization histories with registries. All HIT systems should support updating and reconciling a child’s immunization record with information received from Immunization Information Systems (IISs) or other Health Information Exchanges (HIEs).

Age– and weight-specific single dose-range checking. A pediatric HIT system must provide medication dosing decision support that detects a drug dose that falls outside the minimum-maximum range based on the patient’s age, weight, and maximum recommended adult dose (if known) or maximum recommended pediatric dose (if known), for a single dose of the medication.

Transferrable access authority. The HIT system should provide a mechanism to enable access control that allows a transferrable access authority, e.g., to address change in guardian, child reaching age of maturity, etc.

Associate mother’s demographics with newborn. All HIT systems should provide the ability to associate multiple identifying parent or guardian demographic information, such as relationship to child, street address, telephone number, and/or email address for each individual child.

Identify incomplete preventive care opportunities. A fully functional HIT system should track and report the completion of recommended health supervision visits delivered according to the recommended periodicity of visits included in Bright Futures for a panel of patients. Note: AAP does not consider this an exhaustive list of requirements for EHRs used in pediatric care.

AAP Resources to Support Use of EHRs and Health IT in Pediatric Care
Other Resources to Support Clinicians in Selecting and Using EHRs and Health IT
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