Development of an Electronic Health Record Format for Children (Maryland)

Project Details - Ended

Project Categories

Summary:

Electronic health records (EHRs) have typically been developed and implemented for an adult population. Missing functionality, inadequate implementation, issues with usability, and insufficiently trained users are some of the reasons why EHR systems to date generally have not optimally supported the care of children.  As such, organizations frequently need to make modifications to their EHRs to accommodate the unique medical and social needs of children and better support their care. 

This project, funded by the Centers for Medicare & Medicaid Services, developed an EHR format (Format) for children enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). It contains the requirements for data elements, standards, usability, functionality, and interoperability for a pediatric EHR. It also provides guidance to users about the ideal functionality of EHRs for children. The targeted users of the Format include EHR developers and vendors, purchasers of EHR systems, Children’s Health Insurance Program Reauthorization Act (CHIPRA) demonstration grantees and their partners, State Medicaid agencies, and trade and advocacy organizations for children’s health. 

The objectives of this project were to:

  • Conduct an environmental scan and gap analysis. 
  • Develop an EHR format for children that can be used readily. 
  • Package the EHR format in a way that facilitates broad incorporation into EHR systems.

The Format was informed by an environmental scan and gap analysis. The scope was limited to primary and general acute care for children, both well and sick, and did not include subspecialty care. A technical expert panel was involved throughout the project and included physician informaticists, physician and nursing professional organizations, children’s advocacy organizations, State Medicaid agencies, vendors, and Federal agency representatives. In addition, the project received input from a Federal workgroup that included representatives from the Administration for Children and Families, Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services, the Health Resources and Services Administration, and the National Institute of Standards and Technology, among others. Two CHIPRA demonstration grantees, North Carolina and Pennsylvania, participated in the testing and evaluation of the Format.

The gap analysis identified 22 topic areas not adequately represented by current EHR systems, including growth data, newborn screening, and medication management in children. The format includes over 500 unique requirements within these 22 topic areas, all EHR system-neutral, allowing the Format to be compatible with existing and future EHR systems. Requirements were structured using a hierarchy standard developed for the HL7 EHR-System Functional Model.

Prototypes for an Annotated Growth Chart and Medication Dose Rounding were developed based on the Format. A conformance assessment of the requirements was conducted relative to several selected vendor products. A process was developed for a feedback and validation approach from key stakeholders.  Upon completion of the Format, the project team developed a number of documents to assist users of the Format including a user guide and FAQs.

Development of an Electronic Health Record Format for Children - 2012

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    Inter-Agency Agreement
  • Contract Number: 
    290-09-0023I03
  • Project Period: 
    March 2010 – November 2012
  • AHRQ Funding Amount: 
    $4,749,214
  • PDF Version: 
    (PDF, 265.38 KB)

Summary: Existing electronic health record (EHR) systems are typically designed, implemented, and used with an adult patient population in mind and therefore do not always support the provision of health care to children. Special medical and other considerations that arise in pediatric patient care are often missing or poorly supported.

Westat collaborated with several organizations to develop and disseminate a children’s EHR format focused on children enrolled in Medicaid or the Children’s Health Insurance Programs. The ‘Format’ refers to various requirements for data elements and standards, usability, functionality, and interoperability. The project team strived to understand how the Format’s structure and content might be used to develop new or enhance existing EHR products to help providers optimize health care for children. The goals of this project were supported by a technical expert panel (TEP) to ensure broad stakeholder input at every stage of the project. Two Children’s Health Insurance Program Reauthorization Act grantees are testing and evaluating the Format’s impact on quality and cost of care.

This project helped identify which core elements of an EHR for children could be incorporated into vendor systems and provided user guidance about the ideal functionality of EHRs for children.

Project Objectives:

  • Conduct an environmental scan and gap analysis. (Achieved)
  • Develop a children’s EHR format that can be used readily. (Achieved)
  • Package the EHR format in a way that facilitates broad incorporation into EHR systems. (Achieved)

2012 Activities: The project focused on developing and incorporating additional enhancements into the Format; conducting a conformance assessment of the Format requirements relative to several selected vendor products; finalizing two prototypes; and developing a key stakeholder feedback process and validation approach. The project was completed in November 2012. Online access to both the full and abridged Format is available through the AHRQ Web site: https://digital.ahrq.gov/childehrFormat.

Impact and Findings: Overall, the results of the environmental scan and gap analysis suggest that efforts to develop health information technology for children are making progress but that existing EHR systems and products lack a number of functionalities, particularly for 22 topic areas related to the treatment of children, such as growth data, newborn screening, and medication management.

The TEP prioritized the topic areas to provide guidance on the direction and scope of the overall analysis. Written summaries for each of the topics, including a topic description, details about the literature review, a description of findings, and information on relevant aspects of the Format, with particular attention to data elements, data standards, and functionality, were prepared. The Medication Dose Rounding and the Annotated Growth Chart prototypes were developed based on the findings from the gap analysis and conformance testing. Development teams were composed of experienced software development professionals. Prototype development required research to elaborate on the requirements and specifications beyond what the Format provided.

The Medication Dose Rounding prototype development team found that not having access to a clinician was an impediment to effective development of the module, suggesting that a vendor would benefit from access to clinical-content experts to facilitate the use of the Format requirements. This lesson refuted the initial assumption that the Format could be usable by programmers without additional analysis.

In addition, many requirements in the Format were estimated to have “moderate” or “low” achievability, often based on circumstances beyond the developer’s control, such as missing standards or cumbersome information exchange methods that make the feature difficult or impossible to implement. The Format exposes these gaps in a central place where they can be examined and prioritized and potentially serve as inspiration for parallel activities to improve the infrastructure for child-optimized EHRs.

In hindsight, several structural improvements could be developed for a future release of the Format, but they would require significant work across numerous requirements. Tools to help the Format’s efficiency for specific purposes, such as an online vendor self-assessment tool to enable developers to “score” their systems’ conformance, could be developed. Another powerful way to make EHRs become more effective for the care of children is to incorporate key pediatric needs into the meaningful use certification criteria, particularly since most EHR systems are marketed to health care environments that include pediatric patients. In its current state, the Format provides a strong foundation for the improvement of EHRs in the care of children.

Target Population: Medicaid, Pediatric*, Teenagers

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

* This target population is one of AHRQ’s priority populations.

Development of a Model Electronic Health Record Format for Children - 2011

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Contract Number: 
    290-2009-0023I03
  • Project Period: 
    March 2010 - November 30, 2012
  • AHRQ Funding Amount: 
    $4,749,214
  • PDF Version: 
    (PDF, 166.67 KB)

Summary: Existing electronic health record (EHR) systems typically are designed, implemented, and used with an adult patient population in mind and therefore do not always support the provision of health care to children. Special medical and other considerations that arise in pediatric patient care are often missing or poorly supported.

Westat is collaborating with several organizations to develop and disseminate a model EHR format for children enrolled in Medicaid or Children's Health Insurance Programs. The "format" refers to the various requirements for data elements and standards, usability, functionality, and interoperability. The project team is working to understand how the model format, its structure, and content might be used to develop new or enhance existing EHR products to help providers optimize health care for children. The goals of this project are supported by a technical expert panel to ensure broad stakeholder input at every stage of the project. Two Children's Health Insurance Program Reauthorization Act grantees also are testing and evaluating the format's impact on quality and cost of care.

The outcome of this project will identify core elements of an EHR for children that can be incorporated into vendor systems, and will provide guidance to users of EHRs about the ideal functionality of EHRs for children.

Project Objectives:

  • Conduct an environmental scan and gap analysis. (Achieved)
  • Develop a model EHR format for children that can be used readily. (Achieved)
  • Package the EHR format in a way that facilitates broad incorporation into EHR systems. (Upcoming)

2011 Activities: The focus of activities in 2011 was on finalizing the EHR format and initiating the development of two prototypes based on selected format requirements, growth charting and medication management. The contract was extended by 8 months to enable a number of activities to be undertaken in 2012. These include developing and incorporating additional enhancements of the format; conducting a conformance assessment of the format requirements relative to several selected vendor products; finalizing the two prototypes; and developing a process for a key stakeholder feedback process and validation approach.

Preliminary Impact and Findings: The environmental scan and gap analysis suggest that existing EHR systems and products lack a number of functionalities related to more than 30 topic areas (growth data, newborn screening, medication management, etc.) related to the treatment of children and for which the project is currently developing requirements.

Target Population: Medicaid, Pediatric*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

*This target population is one of AHRQ's priority populations.

Development of a Model Electronic Health Record Format for Children - 2010

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Contract Number: 
    290-2009-00023I-3
  • Project Period: 
    March 2010 – March 2012
  • AHRQ Funding Amount: 
    $4,749,214
  • PDF Version: 
    (PDF, 515.51 KB)


Target Population: Medicaid, Pediatric*

Summary: Existing electronic health record (EHR) systems typically are designed, implemented, and used with an adult patient population in mind and therefore, often do not optimally support the provision of health care to children. Special medical and other considerations that arise in pediatric patient care are often missing or poorly supported.

Westat is collaborating with several organizations to develop and disseminate a model EHR format for children enrolled in Medicaid or Children's Health Insurance Programs. The “format” refers to the various requirements around data elements and standards, usability, functionality and interoperability. The project team is working to understand how the model format, its structure and content can be used to develop new or enhance existing EHR products to help providers optimize health care for children. The goals of this project will be supported by a technical expert panel to ensure broad stakeholder input at every stage of the project. Two Children's Health Insurance Program Reauthorization Act grantees also will test and evaluate the format’s impact on quality and cost of care outcomes.

The outcome of this project will identify core elements of an EHR for children that can be incorporated into vendor systems, and will provide guidance to users of EHRs about the ideal functionality of EHRs for children.

Project Objectives:
  • Conduct an environmental scan and gap analysis. (Achieved)
  • Develop a model EHR format for children that can be used readily (Ongoing)
  • Package the EHR format in a way that facilitates broad incorporation into EHR systems. (Upcoming)

2010 Activities: The focus of activity was on conducting the environmental scan and gap analysis. Development of the model EHR format is also underway.

Preliminary Impact and Findings: The environmental scan and gap analysis suggest that existing EHR systems and products lack a number of functionalities related to over 30 topic areas (e.g., growth data, newborn screening, medication management, etc.) related to the treatment of children and for which the project is currently developing requirements.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

*AHRQ Priority Population.

This project does not have any related resource.
This project does not have any related survey.
This project does not have any related project spotlight.
This project does not have any related survey.
This project does not have any related story.
This project does not have any related emerging lesson.