Core Functionality for Pediatric EHRs

Clinicians, informaticists, policymakers, 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 (available at: https://digital.ahrq.gov/childehrFormat). While the EHR Format included multiple desired functions, most vendors, when confronted with Meaningful Use requirements, did not leverage the format to improve their products.

The project team developed a technical brief on the state of practice and the current literature around core functionalities for pediatric EHRs to describe current practice and to provide a framework for future research. To do so, the project team (1) conducted key informant interviews with clinicians, policy experts, and researchers; (2) searched online sources for information about currently available programs and resources; and (3) conducted a literature search to identify currently available research on the effectiveness of individual functionalities.

The project team found 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 support the delivery of quality care to pediatric patients. These functionalities relate to a child’s evolving physiology and maturity, as well as 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 also will better support the care of all patients.

While many of the key functionalities identified are not restricted to pediatrics, their key role in the care of children in contrast to their minimal role for adults could mean their omission 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 new pediatric functionality to an EHR should be done thoughtfully and ideally 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 could be driven in the future.