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

32 Developing Pediatric Data Standards 417
For example, an EHR system designed to support pediatric practice should
perform several basic functions. The American Academy of Pediatrics (AAP)
Task Force on Medical Informatics recently published the statement, “Special
Requirements for Electronic Medical Record Systems in Pediatrics.” The Task
Force’s report includes a listing of desirable pediatric EHR system attributes, with
formal definitions of how they envision the attributes to be implemented. 10 The
Task Force categorized the quality standards as relating to data representation,
data processing and system design. The specific standards are listed in Table 32.1.
Table 32.1 Standards for data representation in EHR systems 10
Content
Growth data Permit recording, graphic display, special calculations of growth
patterns, and comparing a child’s growth against populationbased
percentiles and other normal ranges
Patient identifier Provide for assignment immediately at the time of birth or prenatal
testing, accommodate temporary names, and allow searching
for multiple names for a single patient.
Special terminology Common terms used for pediatric preventive care (e.g., “developmental
milestones” and “anticipatory guidance”) and exam
findings (e.g., “weak cry,”, “bulging fontanelle,” and “umbilical
granuloma”)
Age-based normal ranges Allow the user to easily compare a patient’s vital signs and laboratory
results with age-based normal ranges
Time of birth Use the time of birth to calculate the patient’s exact age in the
first days and weeks of life
Data processing
Prescribing Dosing and decision support should be based on the age and
weight or body surface area of the child, and should include
child-friendly formulations (e.g., elixirs and chewable tablets)
Immunizations Efficient recording and effective display and printing of immunization
data, with reminders and decision support, and ability
to change with vaccine guideline updates
Parental documentation Permit parents to review or append chart information
Reporting Customize reports to match mandated formats (e.g., school or
camp physicals or reports to school nurses)
System design
Special privacy issues Address adolescent privacy, genetic information, flexible guardianship
data (e.g., adoption, foster care, divorce, and remarriage)
and financial responsibility
Pediatric work settings Need to function in busy pediatric practice workflows and in the
presence of active children
Family member links Maintain linkages, as appropriate, to relatives having similar
social, family medical or past medical histories
Registry linkages Share immunization, newborn screening and disease outbreak
data with government registry systems to ensure timely diagnosis,
notification, and follow-up
Consider policy statements AAP policies regarding the design and use of EHR systems
should be considered in the design of software systems for use
in pediatric health care