The Need for Pediatric-Specific Functionality in EHRs
By Sue Kressly, MD
Pediatricians repeat this message often: Children are not just little adults. This sentiment rings true in both how we practice medicine and in what we need from our EHR technology. Despite our unique challenges in treating children and adolescents, according to a recent AHRQ Technical Brief, only 8 percent of pediatricians are using a fully functional EHR with pediatric functionality.
As healthcare providers have transitioned from paper to electronic records, we will soon see the first generation of patients who have never had a paper record. For these patients, their entire lifespan will be captured in electronic format. However, if pediatricians are using an adult-based model to capture, support, and record the information of young patients, how can they possibly trust its accuracy? Quite frankly, it’s akin to building a skyscraper knowing the first 21 floors were built with faulty materials.
While much work went into developing the Model Children’s EHR format, the majority of physicians who care for children are still waiting for basic functionality that keeps children safe and supports pediatric evidence-based guidelines. Accurate and useable pediatric growth charts, alerts for abnormal pediatric vital signs according to normative values (120/80 is not a normal blood pressure for a three year-old), and accurate and useable weight-based medication prescribing and liquid dose calculations should be ubiquitous by now – but they aren’t. Unfortunately, pediatricians are still pulling out their smartphones to calculate medication doses.
Incorporating recall systems for annual preventive care is easy and available. However, children are seen, at varying intervals, 12 times in the first three years of life, according to the Bright Futures periodicity schedule. This is the foundation of pediatric medical care, yet very few EHRs provide the ability to recall patients for caring, according to this well-established guideline. Further, recording details of an examination is fraught with its own difficulties. Many adult-based EHRs are delivered with templates including a neurologic exam that reports “alert and oriented x 3.” This is completely inappropriate for an infant, and there is often no easy way to document the subtleties of the physical exam for children, because of their dynamic nature change over time. For example, documentation about an anterior fontanelle and infant hip exam are of crucial importance in the first year of life, as is scoliosis screening and Tanner staging during adolescence. However, these templates for documentation are not available in one-size-fits-all EHRs.
Support for vaccine inventory and clinical decision support surrounding immunization forecasting are integral to pediatric care. Yet, most EHRs do not support and update immunization information in a meaningful way. In addition, adolescent privacy presents its own challenges. What demographic is more poised to want to interact with their physician via electronic technology than teens and young adults? However, most portal technology lacks the ability to tackle the unique challenges of communication with both parents/guardians and teens on sensitive matters, such as such as communicating directly with a teen about her chlamydia screening test or a parent about the results of a parental ADHD survey.
Pediatricians want robust health IT for both their patients and their practices. It’s time for the industry to step up and deliver what the future of our community deserves as pointed out by the American Academy of Pediatrics’ Blueprint for Children – Pediatric functionality to support and promote the health of children and the pediatricians who care for them.