Different usability standards are needed for pediatric electronic health records

A pediatrician and his patient
A new viewpoint published in JAMA Pediatrics highlighted the importance of specialized design of electronic health records used by pediatric clinicians. (Getty/shironosov)

When it comes to medicine, children are not just little adults—and that premise extends to the electronic health records their clinicians rely on, according to a new viewpoint published in JAMA Pediatrics this week.

"There are unique usability and safety challenges for our pediatric populations," said Raj Ratwani, Ph.D., a researcher with the National Center for Human Factors in Healthcare at Columbia, Maryland-based MedStar Health, in an interview with FierceHealthcare.

For example, he said, when a doctor is giving a medication to a child, they have to take the child's weight into consideration for dosing.

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Raj Ratwani (MedStar Health)

But right now, a lot of clinicians don't have EHRs set up to tell them the correct dosage and instead compensate by using a separate dosing calculator or even their phone as a calculator, he said.

RELATED: Lack of real-world EHR testing causes patient safety problems, experts say

The 21st Century Cures Act, passed by the U.S. Congress in 2016, calls for the ONC to develop a voluntary program that would certify EHRs in a way that accounts for unique issues in pediatric patient care.

Ratwani and researchers Ben Moscovitch and Josh P. Rising, M.D., from The Pew Charitable Trusts partnered to offer considerations to ONC on the matter.

"The majority of EHR technology is catering to the adult population and not to children," Ratwani said. "That creates serious safety challenges and puts our children of our country at risk. We need to start building technology that understands the needs of clinicians treating children. It would be safer if that was integrated into the EHR itself."

RELATED: Study finds EHR implementation still taking too much time, causing serious errors

Among the recommendations offered to ONC, the researchers said future certification should require EHR vendors to:

  • Provide evidence they've employed a user-centered design process
  • Require that usability test participants represent the clinical end users
  • Define and require the use of rigorous test cases to assess usability and safety
  • Consider the entire EHR life cycle—not just the development phase
  • Encourage transparency in sharing usability and safety challenges to improve safety and EHR products.

The ideal technology solution would take into consideration the particular population and be tailored to the subspecialties it is serving, Ratwani said. "Children in need of cancer care are going to have different needs than a subspecialty that's primary care," Ratwani said.

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