Medical Groups Call for Greater Focus on Pediatric Safety in Health IT

Children’s medical needs and treatments can differ significantly, both from those of adults and of each other, depending on factors such as their age, height, and weight. That’s why setting basic ground rules for electronic health records (EHRs) for the care of pediatric patients is so critical.   

The Office of the National Coordinator for Health Information Technology (ONC), the federal agency that oversees EHRs, recently proposed detailed criteria that digital systems used in the care of children would be encouraged to meet. The proposal spells out clinical priorities specific to pediatric care settings and explains how electronic systems could implement them.

ONC is currently reviewing comments by a wide range of stakeholders, including clinical societies representing medical and health IT professionals, health plans, hospitals, software developers, and others. When considering any changes, decision-makers should prioritize those criteria that can help limit medical errors and ensure that pediatric patients get safe, quality care.

As an example, determining whether children are growing appropriately requires comparing their heights and weights with what is expected at that age. Additionally, when prescribing medications, clinicians may need to calculate drug dosages based on a child’s weight. Finally, vaccines, especially for newborns or toddlers, should be scheduled and delivered at the appropriate times. Under the current system for certifying EHRs, these pediatric-specific needs are not always assessed.

The 21^st Century Cures Act, passed in 2016, gave ONC the authority to create new certification requirements for electronic health record systems used in pediatric care. To implement that provision, the office proposed 10 examples of key child-specific functions—such as computing weight-based drug dosages or supporting growth charts—and mapped those elements to existing and proposed EHR requirements.

In response to ONC’s proposal, many organizations, including groups representing medical professionals, agreed that the agency identified the correct clinical priorities to determine whether these systems can provide effective and safe care to children. For example, ONC focused on enhancing weight-based dosing capabilities and the use of agreed-upon growth charts, such as those from the World Health Organization.

Although many commenters, including the Healthcare and Information Management Systems Society (HIMSS) and the Health IT Advisory Committee, agreed these were the correct priorities, they called for additional guidance to protect children from risks arising from how these EHRs are designed and integrated into doctors’ and nurses’ workflows. In addition, the Drummond Group, a privately owned testing laboratory that helps certify EHR systems for use in hospitals, called for “further actions [to] be taken to provide greater assurance that the products function in accordance with pediatric needs than what already exists today.”

For example, ONC generally requires that EHR developers use testing scenarios that mirror real-life clinical situations, such as prescribing a medication. However, there is no requirement that EHRs used in the care of children be tested using pediatric-focused scenarios, such as ensuring that weight-based dosing can be done accurately. The American Medical Association (AMA), Medical Group Management Association (MGMA), HIMSS, and others called for such pediatric-focused testing requirements for EHRs used in caring for children. In particular, the Children’s Hospital Association said that ONC should “clarify that some of the testing scenarios must focus on situations involving children as patients to obtain certification for pediatric functionality.”

Multiple groups urged ONC to include end users—in this case, doctors, nurses, or other clinicians who use EHRs to care for pediatric patients—in the testing. Because these caregivers use the systems most frequently, they are better positioned to spot safety issues than those with less real-world experience. As the AMA said in its comments, “For pediatric-focused certification, at least five of all the end users testing a product should be clinicians who care for pediatric patients to obtain robust input from end users with experience caring for children.”

Likewise, without data that can accurately replicate real-world pediatric medical scenarios, an assessment would fall short in examining whether an EHR can provide quality care for those patients. So MGMA, AMA, the American Medical Informatics Association, and others called for ONC to supply data for simulated pediatric patients—essentially hypothetical children of varying weights, heights, and conditions—for use in these tests.

As ONC considers these and other comments, including a response submitted by The Pew Charitable Trusts that makes many similar points, the agency should ensure that any new guidelines recognize the specific needs of younger patients—and does so in a manner that can avert harm. That way EHRs can help children get the best and safest care possible.

Ben Moscovitch directs The Pew Charitable Trusts’ health information technology initiative.