Pediatric EMRs and the unique needs of children

In order that Electronic Health Record(EHR) systems meet the needs of pediatricians, several core functionalities need to be included. Children have unique health care needs and their providers have unique data needs.

The June 4th meeting of the Meaningful Use Workgroup of the Health IT Policy Committee focused on “using HIT to eliminate disparities.” As part of that hearing, Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), described a joint project between the AHRQ and the Centers for Medicare and Medicaid Services (CMS) intended to research and address these unique needs.

Dr. Clancy reported that “A study reported in the journal Pediatrics showed an electronic health record (EHR) adoption rate among pediatricians as being about 21.3 percent,. However, according to a 2009 American Academy of Pediatrics survey, only 6 percent of pediatricians reported having an EHR that included all the components of a fully functional system.

“Overall, EHRs frequently lack the specification necessary to enable safe, quality care for children. This lack of functionality is second only to cost as the most cited barrier to pediatricians’ adoption of EHRs and creates a disparity in the ability of clinicians to provide quality care to their patients. Therefore EHR systems must be adapted to address the unique needs of providing health care to children to help ensure successful health IT implementation and meaningful use by providers serving children.”

The joint AHRQ-CMS project is intended to develop a model children’s EHR format. This project will incorporate multi-disciplinary stakeholder input, examine the “state of the industry today” and come up with a gap analysis, develop a model format that can be used by multiple audiences, disseminate the model format, and encourage EHR vendors to incorporate these features.

Though the specifics are not yet detailed, the kinds of things needed in pediatric EHRs need to include growth charts and vaccination charts (with prompting). In addition, according to the 2009 National Healthcare Disparities Report, areas needing additional focus are counseling on healthy eating (childhood obesity is a national priority with the current administration).

Patient engagement is important in reducing disparities and improving health outcomes. Using interactive systems, such as e-mail and telemedicine, improves access to care – and in the case of pediatrics, the use of such e-access is important in schools and daycare centers. Another way of encouraging patient engagement is to encourage the development of health IT applications that interact with the communication devices used by children and young adults, such as iPhones. Interaction with such devices may well become a certification requirement for EHRs for 2013 or 2015 (stage 2 and 3) .

As we commented previously, many pediatricians are effectively shut out of access to ARRA/HITECH incentive moneys for “meaningful use of certified EHRs” – the distribution of funds is through CMS. Medicare is not a significant payor for pediatricians, which leaves only Medicaid as the channel through which pediatricians can access such money. Pediatricians need to have at least 10% of their practice be Medicaid (in a 90-day period) in order to access Meaningful Use incentive payments. Owing largely to very low pay for Medicaid services – cognitive services (the bread-and-butter of primary care) are paid at a rate [less than half of what Medicare pays – care for Medicaid pediatric patients is concentrated in institutions and clinics, and solo or small-group practices often cannot afford to accept Medicaid patients in the proportions needed to access Meaningful Use incentives.

Nevertheless, the laudable efforts of the ONC to address healthcare disparities, and recognize the unique needs for pediatrics, will have a positive impact on the kinds of EHRs available generally and will improve the tools pediatricians will have available (regardless of whether they qualify for Meaningful Use incentives or not). We await with interest the findings of the AHRQ-CMS project, and stand ready to improve our already-robust pediatric offering.

Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR