Pediatric Informatics: Computer Applications in Child Health (Health ...

296 A.E. Zuckerman and G.R. Kim
� Advance Directives
� Clinical information
� Problems lists, encounters, procedures, chronic conditions
� Medications, immunizations, and allergies
� Vital signs including weight, length/height, and body mass index
� Laboratory Results
� Family History
� Birth History
� Durable Medical Equipment and Supplies
Data integrity protection and clear identification of the source of all data.
PHR standards should align with the special requirements for pediatric
EHRs23 .
PHRs should adhere to privacy standards, including special privacy requirements24 and concerns for adolescents and children in foster care.
PHR functionality should include:
� Data entry by patients or parents/guardians that is easily identifiable and
provisions for providers who do not use an EHR to enter data efficiently.
� Extensibility tools that include clinical decision support (such as vaccination
reminders), growth chart visualization, report generation and linkages to
immunization and newborn screening information registries.
Pediatricians should incorporate PHRs in ALL encounters to maintain continuity
of the PHR with the EHR.
21.4 Current and Future Challenges
Many of the aforementioned issues are still in the development stage. A report
of early experiences with three different PHR implementations 25 has produced a
number of challenges and questions for future developments, including:
Sharing of certain parts of the medical record that may reveal diagnoses, including
problem lists, medication and allergy lists and laboratory and diagnostic test
results, be shared
Mechanisms by which patients and caregivers are to be authenticated and
authorized to access the PHR
Privacy issues re: minors and sharing of information via proxies
Inclusion of functionalities such as secure messaging, integration of external
knowledge sources (such as school-based health records), connection to online
communities of support with others of similar diagnoses, surveillance and
participation in clinical trials
Interoperability of institution-based PHRs
In addition to these are individual barriers that vary according to population, 26
including: access to computers (and associated devices) and PHR systems, physical