Defining Electronic Health Record Standards for Child Health: A State-of-the-Art Review

Abstract

Background Improving child health using health information technology (IT) requires a unique set of functionalities that are built into the electronic health record (EHR) and are used to support patient care. In this article, we review and discuss the milestones preceding the development of a new child health EHR standard and describe the salient features of this contemporary standard.

Methods and Results The Health Level Seven Pediatric Care Health IT Functional Profile (HL7 PCHIT FP) is an informative standard that encompasses the EHR functions required to care for patients less than 21 years of age in any clinical setting, developed to address the pediatric-specific functionality gaps in the EHR. It includes criteria that support communication between providers and all caregivers, inclusion of pediatric-specific vital signs and diagnosis, support for transition to adult care, and support for reporting and documentation of child abuse or neglect including communication with involved authorities. EHR functionalities for documentation and reporting of newborn screening tests with follow-up for abnormal results and functionality for children with special health care needs with support for identifying patients who may benefit from care coordination are also incorporated, in addition to school-based linkages enabling communication between the health care system and their school environment.

Conclusion The HL7 PCHIT FP is envisioned to be another vital step towards improving pediatric health by enhancing EHRs to address the unique health IT needs of children and their health providers. While the HL7 PCHIT FP is the most recently published standard on pediatric EHR systems, standards development is an iterative process, and recommendations for continuous refinement and additional functionalities for the next standards release are encouraged.

Keywords

electronic health record - health level seven - child health - policy

Protection of Human and Animal Subjects

This project did not involve human or animal subjects.

Publication History

Received: 13 April 2023

Accepted: 06 October 2023

Accepted Manuscript online:
09 October 2023

Article published online:
17 January 2024

• References

• 1 What is an electronic health record (EHR)?. HealthIT.gov. Accessed May 29, 2022 at: https://www.healthit.gov/faq/what-electronic-health-record-ehr
• 2 Melton GB, McDonald CJ, Tang PC, Hripcsak G. Electronic health records. In: Shortliffe EH, Cimino JJ. eds. Biomedical Informatics. Cham:: Springer; 2021
• 3 Institute of Medicine (US) Committee on Data Standards for Patient Safety. Key Capabilities of an Electronic Health Record System: Letter Report. Washington, DC: National Academies Press (US);; 2003
• 4 Chung SL. Pediatric health information technology-what we need for optimal care of children. Appl Clin Inform 2021; 12 (03) 708-709
• 5 Wong L, Liu D, Thompson C, Margo T, Yu F. Comment on Dr. Chung's Editorial: pediatric health information technology-what we need for optimal care of children. Appl Clin Inform 2022; 13 (01) 53-55
• 6 Wasserman RC. The patient record and the rise of the pediatric EHR. Curr Probl Pediatr Adolesc Health Care 2022; 52 (01) 101108
• 7 Nakamura MM, Harper MB, Castro AV, Yu Jr FB, Jha AK. Impact of the meaningful use incentive program on electronic health record adoption by US children's hospitals. J Am Med Inform Assoc 2015; 22 (02) 390-398
• 8 Temple MW, Sisk B, Krams LA, Schneider JH, Kirkendall ES, Lehmann CU. Trends in use of electronic health records in pediatric office settings. J Pediatr 2019; 206: 164.e2-171.e2
• 9 Frintner MP, Kaelber DC, Kirkendall ES, Lourie EM, Somberg CA, Lehmann CU. The effect of electronic health record burden on pediatricians' work-life balance and career satisfaction. Appl Clin Inform 2021; 12 (03) 697-707
• 10 Office of the National Coordinator for Health Information Technology. Adoption of electronic health records by hospital service type 2019-2021,. Health IT Quick Stat #60. April 2022 . Accessed June 7, 2022 at: https://www.healthit.gov/data/quickstats/adoption-electronic-health-records-hospital-service-type-2019-2021
• 11 Lehmann CU, O'Connor KG, Shorte VA, Johnson TD. Use of electronic health record systems by office-based pediatricians. Pediatrics 2015; 135 (01) e7-e15
• 12 Spooner SA. Council on Clinical Information Technology, American Academy of Pediatrics. Special requirements of electronic health record systems in pediatrics. Pediatrics 2007; 119 (03) 631-637
• 13 Dufendach KR, Eichenberger JA, McPheeters ML. , et al.   Core Functionality in Pediatric Electronic Health Records. Rockville, MD: Agency for Healthcare Research and Quality (US);; April 2015
• 14 Lehmann CU. Council on Clinical Information Technology. Pediatric aspects of inpatient health information technology systems. Pediatrics 2015; 135 (03) e756-e768
• 15 Zuckerman AE. The role of health information technology in quality improvement in pediatrics. Pediatr Clin North Am 2009; 56 (04) 965-973
• 16 Elias J, Gossey JT, Xi W. et al. Sharing clinical notes while protecting adolescent confidentiality and maintaining parental insight. Appl Clin Inform 2023; 14 (03) 555-565
• 17 Tanny SPT, Hsu RP, Teague WJ, Truong D, Cheng DR. Workflow improvement of electronic health record usage in a tertiary pediatric burns clinic. Appl Clin Inform 2023; 14 (02) 205-211
• 18 Kissel AM, Maddox K, Francis JKR. et al. Effects of the electronic health record on job satisfaction of academic pediatric faculty. Int J Med Inform 2022; 168: 104881
• 19 Hirsch MD. EHRs critical in HHS' attempts to improve adult vaccination rates. Fierce Healthcare. February 15, 2016 . Accessed July 24, 2023 at: https://www.fiercehealthcare.com/ehr/ehrs-critical-hhs-attempts-to-improve-adult-vaccination-rates
• 20 Patterson ES, Zhang J, Abbott P. et al. Enhancing electronic health record usability in pediatric patient care: a scenario-based approach. Jt Comm J Qual Patient Saf 2013; 39 (03) 129-135
• 21 AAP Task Force on Medical Informatics, Practice Management Software Review Panel, The Council on Pediatric Practice, Section on Administration and Practice Management, and the Section on Computers and Other Technologies. Evaluating Practice Management, Software for Pediatrics. Itasca, IL:: American Academy of Pediatrics;; 2000
• 22 American Academy of Pediatrics. American Academy of Pediatrics: Task Force on Medical Informatics. Special requirements for electronic medical record systems in pediatrics. Pediatrics 2001; 108 (02) 513-515
• 23 About Health Level Seven International. HL7 International. Accessed March 20, 2022 at: https://www.hl7.org/about/index.cfm?ref=nav
• 24 HL7 Standards Product Brief - HL7 Electronic Health Record-System (EHR-S) Functional Model. (FM), Release 1. HL7 International. Accessed June 3, 2022 at: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=18
• 25 HL7 Standards - Section 1b: EHR - Electronic Health Records. HL7 International. Accessed June 4, 2022 at: https://www.hl7.org/implement/standards/product_section.cfm?section=11
• 26 HL7 Standards Product Brief - HL7 EHR-S FM R2 1 Functional Profile: Pediatric Health Care IT, Release 1 - US Realm. HL7 International. Accessed June 4, 2022 at: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=593
• 27 HL7 Standards Product Brief - HL7 EHR Child Health Functional Profile (CHFP). . Release 1. HL7 International. Accessed June 3, 2022 at: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=15
• 28 Barr P. Children's hospital associations aim to merge. Modern Healthcare. December 2010 . Accessed June 3, 2022 at: https://www.modernhealthcare.com/article/20101202/NEWS/312029981/children-s-hospital-associations-aim-to-merge
• 29 Child Health Corporation of America Selects Novation as Its Supply Cost Reduction Partner. PR Newswire. February 2012 . Accessed June 3, 2022 at: https://www.prnewswire.com/news-releases/child-health-corporation-of-america-selects-novation-as-its-supply-cost-reduction-partner-138935514.html
• 30 HL7 Standards Product Brief - HL7 EHRS-FM Release 2 Functional Profile: Child Health Functional Profile Release 1; Developmental Screening and Reporting Services Derived Profile, Release 1 - US Realm. HL7 International. Accessed June 3, 2022 at: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=468
• 31 HHS.gov. Act Enforcement Interim Final Rule HITECH. Accessed March 29, 2022 at: https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html
• 32 Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med 2010; 363 (06) 501-504
• 33 Gray SH, Pasternak RH, Gooding HC. et al; Society for Adolescent Health and Medicine. Recommendations for electronic health record use for delivery of adolescent health care. J Adolesc Health 2014; 54 (04) 487-490
• 34 Leu MG, O'Connor KG, Marshall R, Price DT, Klein JD. Pediatricians' use of health information technology: a national survey. Pediatrics 2012; 130 (06) e1441-e1446
• 35 Children's Electronic Health Record Format. Digital Healthcare Research. Accessed May 28, 2022 at: https://digital.ahrq.gov/health-it-tools-and-resources/pediatric-resources/childrens-electronic-health-record-ehr-format
• 36 Wald JS, Rizk S, Webb JR. et al. Children's EHR Format Enhancement: Final Recommendation Report. AHRQ Publication No.15-0077-EF. Rockville, MD: Agency for Healthcare Research and Quality. November 2015 . Accessed March 29, 2022 at: https://digital.ahrq.gov/sites/default/files/docs/page/children-ehr-format-enhancement-final-recommendation-report.pdf
• 37 Wald JS, Haque SN, Rizk S. et al. Enhancing Health IT functionality for children: the 2015 children's EHR format. Pediatrics 2018; 141 (04) e20163894
• 38 21st Century Cures Act, Pub. L. No. 114-255. An Act to Accelerate the Discovery, Development, and Delivery of 21st Century Cures, and for Other Purposes. Office of the Federal Register, National Archives and Records Administration; 2016 . Accessed May 28, 2022 at: https://www.congress.gov/114/plaws/publ255/PLAW-114publ255.pdf
• 39 Health IT for Pediatric Care and Practice Settings. HealthIT.gov. Accessed May 28, 2022 at: https://www.healthit.gov/topic/health-it-pediatric-care-and-practice-settings
• 40 Pediatric Health Information Technology: Developer Informational Resource. Office of the National Coordinator for Health Information Technology (ONC). June 2020 . Accessed May 28, 2022 at: https://www.healthit.gov/sites/default/files/page/2020-06/Pediatric-Health-IT-Developer-IR-06102020.pdf
• 41 Office of the National Coordinator for Health Information Technology (ONC), Department of Health and Human Services (HHS). 85 FR 25642 - 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program. Fed Regist 2020; 85 (85) 25642-25961 . Accessed May 28, 2022 at: https://www.federalregister.gov/documents/2020/05/01/2020-07419/21st-century-cures-act-interoperability-information-blocking-and-the-onc-health-it-certification
• 42 Pediatric Care Health IT Functional Profile - Project - Electronic Health Records - Confluence. . Accessed May 28, 2022 at: https://confluence.hl7.org/display/EHR/Pediatric+Care+Health+IT+Functional+Profile+-+Project
• 43 Certified EHR. Technology. CMS. Accessed June 4, 2022 at: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Certification
• 44 About the ONC Health IT Certification Program. HealthIT.gov. Accessed June 4, 2022 at: https://www.healthit.gov/topic/certification-ehrs/about-onc-health-it-certification-program
• 45 Learn about Health Information Technology. CCHIT.org. Accessed March 20, 2022 at: https://www.cchit.org/
• 46 EHRs. Certification is extending to specialty EHRs. Medical Economics. May, 2008 . Accessed March 23, 2022 at: https://www.medicaleconomics.com/view/ehrs-certification-extending-specialty-ehrs
• 47 Promoting Interoperability Programs. CMS. Accessed May 28, 2022 at: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms
• 48 Promoting Interoperability. HealthIT.gov. Accessed May 28, 2022 at: https://www.healthit.gov/topic/meaningful-use-and-macra/promoting-interoperability
• 49 Five Firms Named EHR Certification Bodies. Healthcare Innovation. Accessed May 28, 2022 at: https://www.hcinnovationgroup.com/clinical-it/electronic-health-record-electronic-medical-record-ehr-emr/news/13019897/five-firms-named-ehr-certification-bodies
• 50 Thompson C, Margo T, Yu FB, Lehmann CU. Developing a pediatric EHR testing & certification program in the USA: initial phase. Stud Health Technol Inform 2022; 290: 1020-1021
• 51 Pediatric Health IT Certification. Drummond Group. Accessed September 26, 2022 at: https://www.drummondgroup.com/pediatric-ehr-certification/
• 52 Selecting an EHR. American Academy of Pediatrics. Published February 1, 2023 . Accessed July 26, 2023 at: https://www.aap.org/en/practice-management/health-information-technology/selecting-an-ehr/
• 53 McKenzie L. Participating in HL7. Hl7.org. Accessed July 21, 2023 at: https://confluence.hl7.org/display/HL7/Participating+in+HL7
• 54 Weinberg ST, Monsen C, Lehmann CU, Leu MG. COUNCIL ON CLINICAL INFORMATION TECHNOLOGY. Integrating web services/applications to improve pediatric functionalities in electronic health records. Pediatrics 2021; 148 (01) e2021052047