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What are the requirements for an EHR that serves children from 0 to age 21?

There are many unique requirements that set pediatric and adult EHR systems apart.  These differences arise because children are not simply small adults, and children have specific health care concerns that are not addressed in EHR systems designed for adults.  While a few of these health care concerns may not be unique to children ages 0 to 21, the American Academy of Pediatrics (AAP) states that they are critically important in pediatrics and are also referred to as "pediatric functions." In a Clinical Report from the journal Pediatrics, the AAP identifies the most critical pediatric functions.  These functions focus on:

• Immunization Management - This includes recording immunization data, linking to immunization information systems, and immunization decision support.
• Growth Tracking - This function requires that EHRs support graphical representations of growth along predicted trends and percentile calculations of body measurements.
• Medication Dosing - This function would allow the EHR to provide weight-based dosing information to the provider.  Also included would be functions that check the dose-range, round to safe and convenient doses, provide age-based dosing decision support, and support dosing for the school day.
• Patient Identification - This function should be able to identify all relevant information associated with a patient, including data from newborns not yet issued a social security number and prenatal data.  Other functions should account for name changes and ambiguous gender.
• Norms for Pediatric Data - The EHR should include age-based norms for numeric and non-numeric data.  Additional norms should be included based on other factors including gender, height, and gestational age.
• Privacy - This refers to privacy provisions specifically for adolescents, foster children, adopted children and their parents, consent by proxy, emergency treatment, and guardians.

While these represent broad functions, in the Clinical Report the AAP details more specific functions falling into each of these larger categories.  This additional detail provides lists of actual functionalities of a pediatric electronic health record.  Furthermore, this Clinical Report from the AAP sets standards that EHR vendors should follow when developing EHR systems for use in pediatrics, according to a 2007 report from Pediatrics in Review.

An additional useful EHR functionality may include mechanisms for informing a provider about the child's family situation and the possibility for early exposures that could pose a behavioral or health risk to the child.  This functionality would be particularly useful in pediatrics, and would allow the provider to understand better the greater context of a child's overall health.  More information on behavioral health and the EHR can be found in the section of this module entitled, "Creating Comprehensive Medical Records."

Related Resources:

• Electronic Growth Charts: Watching our Patients Grow (U. of Texas, PubMed)
• Parental Access to the Electronic Medical Record (Dean Health System) (PDF - 166KB)
• Implementing Pediatric Growth Charts into an Electronic Health Record System (JAMIA)
• HIT Policy Committee Hearing on Meaningful Use Measures - Pediatrician Alan Zuckerman, Georgetown University (PDF - 287KB)