Pediatricians: EHRs lacking in 5 main functions

A study and associated commentary in the December issue of Pediatrics lay out five basic functions pediatricians say they need in their electronic health record systems. They also note that, even with meaningful requirements in place, it’s nearly impossible to find an EHR that meets those standards.

Lead author Michael Leu, MD, a pediatrician at Seattle Children’s Hospital, said EHR systems that support adult health care are easier to build, because they do not require the customization and advanced features of pediatric systems. EHR vendors have no strong incentive to build pediatric-supporting EHR systems. Most are focused on building systems to meet the meaningful use certification requirements, which haven’t adequately addressed the needs of pediatricians, he said.

Dr. Leu and his fellow authors detail five basic functions pediatricians need in a fully functional EHR: tracking of well-child visits; support of growth chart analysis; immunization tracking; immunization forecasting; and weight-based drug dosing.

S. Andrew Spooner, MD, a pediatrician from Cincinnati Children’s Hospital Medical Center, wrote in a commentary accompanying Dr. Leu’s study that of the five criteria, only one — growth charts — is close to being specifically called for in the meaningful use requirements. A core objective included in stage 1 that will carry over to stage 2 is a requirement for doctors to record height, weight and blood pressure on more than 50% of patients 2 years or older.

“The programming logic that would support well-child visit tracking or immunization prediction is not trivial,” Dr. Spooner wrote. “Given the resources necessary on both the vendor and the customer side to meet [meaningful use] criteria, it is not likely that there will be widespread efforts to implement these sophisticated features.” What pediatricians must do in the meantime, the authors wrote, is try to get their systems customized to meet their needs.

In the study, a random survey was taken of 646 postresidency pediatricians from February to July in 2009, before the meaningful use incentive program began. Only 3% at that time used a system described as fully functional and pediatric-supportive.

The most recent research shows that EHR adoption among pediatricians is at 48.5% and at 61.7% in the specialty internal medicine/pediatrics, according to data shared with American Medical News in November by the Irvine, Calif.-based health care marketing research firm SK&A. The firm conducts ongoing surveys of EHR adoption and use at more than 250,000 practices across the country. Family practice EHR adoption was at 54%, while internists were at 47.6%. The survey measures only adoption and does not determine the level of a system’s functionality.

Dr. Leu said pediatricians probably are not getting as good a payoff as their counterparts who treat adult patients, because the lack of some needed functions costs them a lot of time.

The meaningful use incentive program does include expectations for physicians who treat children, including objectives such as immunization reporting and clinical quality measures for child health, said Peter Ashkenaz, spokesman for the Health and Human Services Dept. Office of the National Coordinator for Health Information Technology. “Many EHRs do a good job with immunization management, well-child visits and weight-based dosing,” he added, although they are not required for meaningful use at this time.Ashkenaz said HHS’ Agency for Healthcare Quality and Research has created a model children’s health EHR format that outlines child-specific functions that EHRs should have to address child health needs. He said these requirements have not yet been incorporated into EHR certification criteria but are being reviewed and considered for future stages of the program.This is the second time in two months that Pediatrics highlighted issues pediatricians had with EHRs. In November, it published a statement from the American Academy of Pediatrics, its publisher, calling for EHR modifications to improve privacy for teenage patients.

The AAP, in a policy also endorsed by the Society for Adolescent Health and Medicine, said EHRs should be designed so parts of the patient record can be restricted. That way, teens would have assurance that certain care, such as treatment of a sexually transmitted infection, would not have to be shared with their parents or guardian. Some state laws allow teenage patients to restrict sharing that information.