Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, August 16, 2007

Thoughts on the Paediatric EHR and Paediatric e-Prescribing.

In the last few days a useful pair of documents on the differences between Electronic Health Records (EHR) and e-Prescribing for adults and children have appeared from the Council on Clinical Information Technology of the American Academy of Pediatrics.

The broad outline of the contents of the two documents is found here:


Report Details Pediatric EHR Needs

(August 10, 2007) A recent report in Pediatrics, the journal of the American Academy of Pediatrics, explains the special functionalities necessary in electronic health records systems to support pediatric care.

“Child health care providers often find that clinical information systems have limited usefulness in pediatrics because they seem to be designed for adult care,” according to the report.

The report covers necessary EHR functions in such areas as immunization management, growth tracking, medication dosing, patient identification, norms of pediatric measurement data that change over time, privacy, pediatric terminology, and precision of the data being collected and presented.


The Elk Grove Village-based association also has published a policy statement on the rationale and functionality requirements of electronic prescribing systems for pediatrics.

See the URL above for the full article.

The original articles can be found here (e-prescribing) and here (Paediatric EHR Functionality).

The first article is entitled: Electronic Prescribing Systems in Pediatrics: The Rationale and
Functionality Requirements”

The abstract reads:

“The use of electronic prescribing applications in pediatric practice, as recommended by the federal government and other national health care improvement organizations, should be encouraged. Legislation and policies that foster adoption of electronic prescribing systems by pediatricians should recognize both specific pediatric requirements and general economic incentives required to speed the adoption of these systems. Continued research into improving the effectiveness of these systems, recognizing the unique challenges of providing care to the pediatric population, should be promoted.”

The article is available on-line (in full and free) and makes very interesting reading in thinking about just what complexity the paediatric patient brings to health IT implementation.

The second article really extends the theme!

It is entitled: “Special Requirements of Electronic Health Record Systems in Pediatrics”

The abstract reads:

“Some functions of an electronic health record system are much more important in providing pediatric care than in adult care. Pediatricians commonly complain about the absence of these "pediatric functions" when they are not available in electronic health record systems. To stimulate electronic health record system vendors to recognize and incorporate pediatric functionality into pediatric electronic health record systems, this clinical report reviews the major functions of importance to child health care providers. Also reviewed are important but less critical functions, any of which might be of major importance in a particular clinical context. The major areas described here are immunization management, growth tracking, medication dosing, data norms, and privacy in special pediatric populations. The American Academy of Pediatrics believes that if the functions described in this document are supported in all electronic health record systems, these systems will be more useful for patients of all ages.”

Each of the major areas discussed in the full article (available on-line for free) brings up surprising issues. Questions I had never really thought of such as just what is the level of precision required in medication dosage recording when dealing with a neonate and how best should the sex of a child be recorded when the genitalia are ambiguous.

Even more interesting are the privacy issues that are raised when an EHR is used to record potentially sensitive information on adolescents – especially when different laws apply in different States (both here in the US).

All in all, a valuable exercise in getting together in one place a large range of issues which, if addressed, will much improve paediatric practice support.

It is, of course, important to bear in mind that, given the paediatric component of General Practice , virtually all the features and functionality cited in these articles are important in all GP systems.


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