Making EHRs better for pediatricians

Meaningful use has unintentionally shifted the market's attention away from child health electronic health records (EHRs), according to Feliciano "Pele" Yu, Jr., MD, chief medical information officer at St. Louis Children's Hospital. However, this has not stopped advocates from working to get pediatric functionality into EHRs through innovative projects – some soon to be announced and others in the works – that could improve the technology for pediatricians and child heath.

“Meaningful use is by no means perfect for pediatrics, but the trajectory that we have seen is amazing. [CMS and ONC] have worked hard and well for the last few years,” said Christoph Lehmann, MD, FAAP, medical director of the American Academy of Pediatrics (AAP) Child Health Informatics Center. “In Stage 1 we were very concerned because we were afraid that pediatricians would be left behind,” he added.

However, CMS and ONC heard pediatricians' complaints, said Lehmann, and addressed them in Stage 2.  For example, in Stage 2 the definition of what constitutes a Medicaid encounter was changed to allow patients covered by the Children's Health Insurance Programs (CHIP) to be eligible for inclusion. There are 36 states where CHIP enrollees count toward the Medicaid patient volume threshold, bringing eligibility up to 60 percent for pediatricians. Stage 2 also includes new pediatric-specific clinical quality measures and reporting mechanisms that can be found here.

Mark Del Beccaro, MD, FAAP, chair of the Council on Clinical Information Technology at AAP, said that while the AAP applauds these changes, it may be more difficult for pediatricians -- especially those in smaller practices -- to execute them. He explained that a small startup vendor probably doesn't provide a module for reporting on children who have dental decay or cavities – one of the pediatric-specific measures. This requires more “sophisticated” software, he pointed out, and because pediatrics doesn't bring in a large volume of patients – or money – vendors aren't directing their attention to this type of functionality.

Lehmann said the AAP recognizes that vendors are “stressed to help their customers report on meaningful use,” and they have little time to work on making these improvements. That's why a project driven though its Child Health Informatics Center aims to create its own clinical decision app. “The project is still in its evaluation stages, and is not a done deal,” commented Lehmann, but if the funding is approved, one day vendors could implement it into their EHRs. There is also a joint AHRQ-CMS project underway to develop a model children’s EHR format, expected to be released at the end of January 2013, according to Lehmann. “The project defines features that should be in an EHR for children, and the whole format is designed to be picked up by vendors,” he added.

In addition, a lot of ongoing work is targeted toward making standards for child health EHRs. The HL7 Child Health Work Group, which is co-chaired by Feliciano, spent four years developing the Child Health Functional Profile and the National Institute of Standards and Technology has also developed a guide that "looks at how software should be designed specifically for a child health worker,” said Feliciano. 

Feliciano believes all this work will lead to a “really strong standard.” What comes next, he noted, requires market adoption forces and “that is the challenge with the pediatric community.” “Meaningful use decision-makers and stakeholders should listen to child health stakeholders who are promoting these type of standards.”

But, for that to happen, there has to be some type of certification for child health adoption, Feliciano noted. Feliciano served on the CCHIT Child Health Work Group when it is was operational – before the nonprofit turned to meaningful use certification. He likes to say the group is just on “hiatus” and is hopeful that after meaningful use it will regroup with a much more “solid” foundation to work with. “CCHIT or other [certifying] groups should consider [child health] certification. Then we can educate purchasers that “there is a body that they can use to demand certain functions,” he said.