AHRQ: New functionalities for pediatric EHRs need to be added 'thoughtfully'

Electronic health records being used for pediatric care need certain specific functionalities that have been overlooked in EHRs designed for adult care, according to the latest technical brief published by the Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ).

The brief, prepared for AHRQ by Vanderbilt University's Evidence-Based Practice Center, is part of an effort to prioritize the functionalities for pediatric EHRs, since the recommendations for such systems are inconsistent and often omitted in general EHR design. The researchers conducted literature and other online research and held conversations with key informants. 

They found certain functionalities that would be particularly helpful in pediatric EHRs, including medication dosage, vaccinations, pediatric disease management, pediatric norms such as growth charts, and relations between children and their caregivers, including adolescent privacy issues. For instance, it's important for a pediatric EHR to contain a flexible, longitudinal record that integrates information about the child, his or her family and family history, and to be agile enough to display the correct information at the correct time, given the high volume nature of pediatrics. Pediatric EHRs also need to reflect local and regional immunization requirements and communicate with vaccine registries.

The brief noted that Meaningful Use incentives and the growth of patient centered medical homes were causing more pediatricians to adopt EHRs despite the lack of functionalities and consistent recommendations. It also acknowledged that there were challenges in developing and implementing functionalities for pediatric EHRs, and that introducing a new pediatric functionality to an EHR should be done "thoughtfully" and ideally "in consideration of utility, testability and usability principles."

The brief recommends that more research be conducted.

"We hope this report encourages all stakeholders to collaborate on this effort to improve electronic health records, ensuring we provide the best possible care for children," the authors said.

Other studies have found that more pediatricians are adopting EHRs despite the lack functionalities geared to their specialty, which requires them to develop workarounds, reducing their productivity and efficiency. Efforts are underway to identify better designs for pediatric EHRs and transition preventive guidelines to electronic format.

To learn more:
- read the brief (.pdf)