Children's EHR Format Enhancement

In 2010, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) funded the development of the Children’s Electronic Health Record (EHR) Format (Format), containing the requirements for data elements, standards, usability, functionality, and interoperability for a pediatric EHR. It also provided guidance to users about the ideal functionality of EHRs for children. The Format, released in 2013, was well received by software developers, practitioners using EHRs in the care of children, and provider organizations purchasing and configuring EHRs. Users of the Format, however, also identified challenges. Many of the requirements were not viewed as actionable by stakeholders. Early feedback on the Format suggested that its impact could be greater if software developers and other stakeholders were provided additional guidance in using it.

This project produced the Children’s EHR Format 2015 Priority List, and Recommended Uses of the Format, which are designed to provide this additional guidance. They are intended to enhance the use of the Format by providing a short list of items for all stakeholders to focus on as a priority, and are meant to encourage dialogue and collaboration among software developers, practitioners, provider organizations, professional organizations, and other stakeholders working to improve the care of children and the technologies supporting their care.

The specific aims of the project were to promote greater use of the Format by developing recommendations to:

• The Office of the National Coordinator for Health Information Technology (ONC) for high priority requirements related to child health that could be considered for EHR certification.
• The Center for Medicaid and CHIP Services (CMCS) for suggested “uses” of the Format to advance child health, such as through interoperable immunization data for health systems, schools, and public health agencies. 

A multi-stakeholder workgroup (MSWG) of 19 members was convened to create a set of high-priority requirements drawn from the Format, along with a list of recommended uses of those items and of the Format in general. Implementation notes were added to provide detail felt to be helpful to software developers and other stakeholders. The Children's Health Insurance Program Reauthorization Act (CHIPRA) grantee experience with the Format was gathered by conducting interviews in North Carolina and Pennsylvania with solo practitioners, small group practices, hospital-based practices, and software vendors. A Federal Workgroup of 19 members was convened to review the MSWG’s work, provide feedback, and share the project activities with their respective agencies and centers.

It is hoped that the adaptation of EHRs used in the care of children to meet the 2015 Priority List requirements will lead to safer medication use, better tracking and completion of childhood immunizations, improved communication and knowledge about growth and development, better screening, and improvements in the management of children with special health care needs.