Disposition of Comments Report
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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.
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.
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.
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.