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Shafi O, Liu D, Thompson C, Margo T, Bennett T, Suresh S, Yu F. Defining Electronic Health Record Standards for Child Health: A State-of-the-Art Review. Appl Clin Inform 2024; 15:55-63. [PMID: 37813382 PMCID: PMC10794090 DOI: 10.1055/a-2188-0736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023] Open
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.
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Affiliation(s)
- Obeid Shafi
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Clinical Informatics, Department of Pediatrics, UAMS and Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - Daniel Liu
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Clinical Informatics, Department of Pediatrics, UAMS and Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - Cori Thompson
- Drummond Group, Portsmouth, New Hampshire, United States
| | - Todd Margo
- Drummond Group, Portsmouth, New Hampshire, United States
| | | | - Srinivasan Suresh
- Division of Health Informatics & Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Feliciano Yu
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Clinical Informatics, Department of Pediatrics, UAMS and Arkansas Children's Hospital, Little Rock, Arkansas, United States
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Jolliff A, Coller RJ, Kearney H, Warner G, Feinstein JA, Chui MA, O'Brien S, Willey M, Katz B, Bach TD, Werner NE. An mHealth Design to Promote Medication Safety in Children with Medical Complexity. Appl Clin Inform 2024; 15:45-54. [PMID: 37989249 PMCID: PMC10794091 DOI: 10.1055/a-2214-8000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Children with medical complexity (CMC) are uniquely vulnerable to medication errors and preventable adverse drug events because of their extreme polypharmacy, medical fragility, and reliance on complicated medication schedules and routes managed by undersupported family caregivers. There is an opportunity to improve CMC outcomes by designing health information technologies that support medication administration accuracy, timeliness, and communication within CMC caregiving networks. OBJECTIVES The present study engaged family caregivers, secondary caregivers, and clinicians who work with CMC in a codesign process to identify: (1) medication safety challenges experienced by CMC caregivers and (2) design requirements for a mobile health application to improve medication safety for CMC in the home. METHODS Study staff recruited family caregivers, secondary caregivers, and clinicians from a children's hospital-based pediatric complex care program to participate in virtual codesign sessions. During sessions, the facilitator-guided codesigners in generating and converging upon medication safety challenges and design requirements. Between sessions, the research team reviewed notes from the session to identify design specifications and modify the prototype. After design sessions concluded, each session recording was reviewed to confirm that all designer comments had been captured. RESULTS A total of N = 16 codesigners participated. Analyses yielded 11 challenges to medication safety and 11 corresponding design requirements that fit into three broader challenges: giving the right medication at the right time; communicating with others about medications; and accommodating complex medical routines. Supporting quotations from codesigners and prototype features associated with each design requirement are presented. CONCLUSION This study generated design requirements for a tool that may improve medication safety by creating distributed situation awareness within the caregiving network. The next steps are to pilot test tools that integrate these design requirements for usability and feasibility, and to conduct a randomized control trial to determine if use of these tools reduces medication errors.
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Affiliation(s)
- Anna Jolliff
- Department of Health and Wellness Design, Indiana University at Bloomington, Bloomington, Indiana, United States
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Hannah Kearney
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - James A. Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Michelle A. Chui
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Steve O'Brien
- Noble Applications, Madison, Wisconsin, United States
| | - Misty Willey
- Noble Applications, Madison, Wisconsin, United States
| | - Barbara Katz
- Family Voices of Wisconsin, Madison, Wisconsin, United States
| | - Theodore D. Bach
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Nicole E. Werner
- Department of Health and Wellness Design, Indiana University at Bloomington, Bloomington, Indiana, United States
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Randell KA, Ragavan MI, Query LA, Sundaram M, Bair-Merritt M, Miller E, Denise Dowd M. Intimate Partner Violence and the Pediatric Electronic Health Record: A Qualitative Study. Acad Pediatr 2022; 22:824-832. [PMID: 34455099 PMCID: PMC8882201 DOI: 10.1016/j.acap.2021.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 08/17/2021] [Accepted: 08/21/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore expert perspectives on risks associated with the pediatric electronic health record (EHR) for intimate partner violence (IPV) survivors and their children and to identify strategies that may mitigate these risks. METHODS We conducted semistructured interviews with multidisciplinary pediatric IPV experts (nursing, physicians, social workers, hospital security, IPV advocates) recruited via snowball sampling. We coded interview transcripts using thematic analysis, then consolidated codes into themes. RESULTS Twenty-eight participants completed interviews. Participants identified the primary source of risk as an abuser's potential access to a child's EHR by legal and illegal means. They noted that abuser's access to multiple pediatric EHR components (eg, online health portals, clinical notes, contact information) may result in escalated violence, stalking, and manipulation of IPV survivors. Suggested risk mitigation strategies included limited and coded documentation, limiting EHR access, and discussing documentation with the IPV survivor. Challenges to using these strategies included healthcare providers' usual practice of detailed documentation and that information documented may confer both risk and benefit concurrently. Reported potential benefits of the pediatric EHR for IPV survivors included ensuring continuity of care, decreasing need to repeatedly talk about trauma histories, and communication of safety plans. CONCLUSIONS Our findings suggest the pediatric EHR may confer both risks and benefits for IPV survivors and their children. Further work is needed to develop best practices to address IPV risks related to the pediatric EHR, to ensure consistent use of these practices, and to include these practices as standard functionalities of the pediatric EHR.
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Affiliation(s)
- Kimberly A Randell
- Division of Emergency Medicine (KA Randell, LA Query, and MD Dowd), Children's Mercy Kansas City, Kansas City, Mo; University of Missouri-Kansas City School of Medicine (KA Randell, LA Query, and MD Dowd), Kansas City, Mo.
| | - Maya I Ragavan
- Division of General Academic Pediatrics (MI Ragavan), University of Pittsburgh/Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Lindsey A Query
- Division of Emergency Medicine (KA Randell, LA Query, and MD Dowd), Children's Mercy Kansas City, Kansas City, Mo; University of Missouri-Kansas City School of Medicine (KA Randell, LA Query, and MD Dowd), Kansas City, Mo
| | - Mangai Sundaram
- University of California Berkley (M Sundaram), Berkeley, Calif
| | - Megan Bair-Merritt
- Division of General Academic Pediatrics (M B-Merritt), Boston University School of Medicine/Boston Medical Center, Boston, Mass
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine (E Miller), University of Pittsburgh/Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Mary Denise Dowd
- Division of Emergency Medicine (KA Randell, LA Query, and MD Dowd), Children's Mercy Kansas City, Kansas City, Mo; University of Missouri-Kansas City School of Medicine (KA Randell, LA Query, and MD Dowd), Kansas City, Mo
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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; 13:53-55. [PMID: 35021255 PMCID: PMC8754685 DOI: 10.1055/s-0041-1740922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Lori Wong
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Daniel Liu
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Cori Thompson
- Drummond Group, Portsmouth, New Hampshire, United States
| | - Todd Margo
- Drummond Group, Portsmouth, New Hampshire, United States
| | - Feliciano Yu
- Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas, United States,Address for correspondence Feliciano Yu, MD, MSPH, MSHI Division of Clinical Informatics, Department of Pediatrics, University of Arkansas for Medical Sciences1900 Maryland St, Mail Slot #512-8, Little Rock, Arkansas 72202United States
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