Leading pediatric preventive guidelines not ready for EHR prime time

A "substantial" amount of work is needed to convert the American Academy of Pediatrics' "Bright Futures" guidelines into an electronic format, according to a new study published in Applied Clinical Informatics.

Bright Futures is the leading pediatric preventative care guideline in the United States. With the increased adoption of electronic health records by pediatricians, there has been a corresponding need for the guidelines to be included in EHRs. An electronic version would also be able to generate clinical decision support (CDS) using a child's age and gender, and by tracking what services the child has already received.

The researchers, from the Indiana University School of Medicine and the Regenstrief Institute, evaluated how well the current guidelines could be adapted to EHRs and CDS. They consolidated Bright Futures' 2,161 action items into 245 recommendations and identified 52 (21 percent) as actionable, such as screenings and safety items.

However, because of how the guideline originally was developed, "substantial modifications to Bright Futures will be required before it can be effectively implemented in computerized CDS," the researchers found. For instance, some recommendations need to be more executable; others use language inconsistently since different portions of the guideline were written by different people.

Other studies have shown that EHRs can improve the health of children in many different ways, such as prevention of illness, the identification of potential risks, and the reduction of adverse patient safety events. But since pediatric care differs from adult care, not all EHRs are equipped to handle those unique needs despite efforts to help vendors customize their products for this population.

"There is a demand for an electronic version of Bright Futures Guidelines but the number of actionable recommendations suitable for computer implementation in the current Bright Futures Guideline is very limited," the study authors stated. "Recommendations in areas believed to be important by many pediatricians and researchers today, such as discipline, family function and mental health, are not presented in an actionable way. A systematic assessment of the Bright Futures Guidelines suitability for computer implementation is therefore required."

To learn more:
- read the study abstract