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

410 J.H. Schneider
Table 31.1 (continued)
value greater than 99. HIEs need to report appropriate age-based normals in order to be useful,
but these are often not available from adult-based EMRs. Where age-based normals do
exist, they frequently vary by institution.
Reporting fetal surgery and prenatal maternal factors. EMR vendors are slowly recognizing
that these are an important parts of a child’s EMR.
Special Data Processing Needs
EMRs with good pediatric functionality have the built-in capability of doing special processing
on the following items:
Medications ordering in mg, cc, or tsp and calculated in mg/kg and mg/m 2 .
Immunizations recording with easy to use decision support and registry interfaces
Complex developmental analyses
A problem that HIEs may face is that the pieces of these (particularly immunizations and developmental
analyses) may be in different EMRs as children move and change pediatricians.
HIEs may find it difficult to do the analysis necessary to provide value in these areas.
Special Administrative Needs
There are many of these issues, but some of the more difficult for EMRs and therefore HIEs include:
Adolescent privacy. With different rules in many states, this area currently is one of the weakest
areas of pediatric EMRs. The problem for HIEs is that the rules that EMRs use to protect
privacy may be independent of the data in an EMR and therefore are not transmitted to the
HIE with the data. The data then becomes unintentionally available.
Guardianship, adoption, foster care and custodial versus financial responsibility. The complexity
that exists in pediatrics, where a child may have a guardian who is not financially responsible
for the care
Length of data retention time. HIEs that provide data storage are subject to the rules governing
pediatric medical records, which vary significantly by jurisdiction.
Medical record production. Clinicians who use HIEs that provide screen-only views need to be
concerned that the medical decisions that they are making are supported only by their notes,
as the HIE may be unable to demonstrate in a court of law what the clinician actually saw.
This would be particularly true for HIEs without a data repository.
31.8 Conclusion
There are many other challenges to HIEs, including:
The ability of patients to “opt-in” or “opt-out” of the HIE. “Opt-in” refers to
the situation where an individual patient must actively sign up for participation.
“Opt-out” refers to where the individual is included in the HIE unless they
request not to be included. Of the two, better participation is usually achieved
with the “opt-out” model.
The need for HIEs to avoid duplicate entries from multiple input sources. The
same medication information, for example, can come from pharmacies, payors,
and physicians. A HIE must be able to filter the duplicates if it is to provide
efficient information.
The disposition of medical information in the event of bankruptcy. It is likely
that some of the new HIEs will not survive. If these are built using the model
where the HIE stores patient data, it is unclear what happens to any data which
the HIE contains.