Pediatric Health IT Guidance

Pediatric HealthIT Guidance Provided by ONC Leaders on June 24th.

On June 24th, 2020 from 4-5 pm the Office for the National Coordinator (ONC) for Health Information Technology provided an overview of the recommended areas of focus for Pediatric HealthIT.    This teleconference included a review of the ten recommendations for Pediatric HealthIT.   These ten recommendations are:

1. Use Biometric-Specific Norms for Growth Curves and Support Growth Charts for Children
2. Compute Weight-Based Drug Dosage.
3. Ability to Document All Guardians and Caregivers
4. Segmented Access to Information
5.  Synchronize Immunization Histories with Registries
6. Age- and Weight-Specific Single-Dose Range Checking
7.  Transferrable Access Authority
8. Associate Maternal Health Information and Demographics with Newborn
9. Track Incomplete Preventative Care Opportunities.
10.  Flag Special Health Care Needs

The ONC team developed a Pediatric Health IT Developer Information Resource to help developers with these future requirements.  These are future standards that will align to the certification criteria.  Note that the PediatricXpress system already has many of these future recommendations built into the system and the Physician Xpress team is committed to enhancing the application to integrate future certification requirements.  We are also committed to integrating the technology from end to end and providing service as a High-Value Pediatric E.H.R. 

The information is related to the Cures Rule and can be found at https://www.healthit.gov/curesrule/. 

Let’s look at each area in more detail:

1.  Use Biometric-Specific Norms for Growth Curves and Support Growth Charts for Children

The criteria listed in the document:

Age and sex-specific weight, height / length, head circumference, and body mass index (BMI) percentile measurements are important for assessing normal growth or changes in growth pattern, and problems with growth and development such as obesity, failure to thrive, and certain hormone disorders. User-friendly displays that provide longitudinal information with automatic calculation of growth patterns and comparison with normal velocity are critical components of an EHR supporting care of children, on par with vital signs.

The PediatricXpress system contains these functions and features.

    2. Compute Weight-Based Drug Dosage.

The criteria listed in the document:

Displaying a calculated medication dose and how the calculated dose was determined supports safe medication prescribing for pediatric patients by performing independent, redundant checking. Accurate and recently recorded height / length and weight are key inputs to dose calculation for pediatric patients when the medication dose varies based on these factors.

The PediatricXpress system contains these functions and features.

   3. Ability to Document All Guardians and Caregivers

The criteria listed in the document:

Due to the unique caregiver and guardianship scenarios for pediatric patients, such as adoption, foster care, and extended or stepfamilies, maintaining an accurate and structured record of a patient’s Care Team has been identified as a critical component of an EHR supporting pediatric patients. A Care Team includes all the people, teams, and organizations who participate in the coordination and delivery of care for a single patient or group of patients. Care Team members may have access to a patient’s data and/or have authority to make medical decisions. The composition of a Care Team is dynamic over time and members may be transient.

The PediatricXpress system contains these functions and features.  We are making enhancements and updates as well.

   4. Segmented Access to Information

The criteria listed in the document:

This recommendation addresses the need for privacy of certain services by segmenting information and providing access to specific segments of the record to specific users. If this recommendation is not accomplished, disparities in care may result when information cannot be appropriately protected.

The PediatricXpress system contains these functions and features.

   5.  Synchronize Immunization Histories with Registries

The criteria listed in the document:

Access to accurate and up-to-date pediatric immunization information is critical for comprehensive, age-based, preventive care. EHR synchronization with Immunization Information Systems (IIS) and Health Information Exchanges (HIE) is necessary to confirm current immunization status both during and between visits to avoid unnecessary and missed immunizations. Interoperability with IIS allows EHRs to take advantage of the immunization forecasting features provided by many of the state registries. This feature removes the burden from developers of health IT modules to maintain immunization forecasting rules. Messaging standards established through Meaningful Use requirements remain in place to confirm bidirectional communication and reconciliation function. 

The PediatricXpress system contains these functions and features.

   6. Age- and Weight-Specific Single-Dose Range Checking

The criteria listed in the document:

Single dose treatment for definitive therapy or a loading dose puts pediatric patients at unique risk of subtherapeutic or toxic doses. Evaluation of the age and weight of a pediatric patient is critical to ensure a single dose will not cause harm. EHRs supporting the care of children should reflect this capability by providing alerts where appropriate and displaying normal pediatric ranges for reference and weight-based dose calculations.

The PediatricXpress system contains these functions and features.

   7. Transferrable Access Authority

The criteria listed in the document:

The Care Team members allowed to access a pediatric patient’s health record may change due to family dynamics (e.g., foster care, adoption, and divorce) or patient emancipation. Capturing relationships and roles associated with the patient (see Recommendation 3), including a mechanism to manage transitions of access authority, is necessary to support transfer of access authority.

The PediatricXpress system contains these functions and features.  We are making enhancements and updates as well.

   8. Associate Maternal Health Information and Demographics with Newborn

The criteria listed in the document:

Point-of-care access to some maternal health and demographic information is critical for the care of a newborn patient. Critical health information may include but is not limited to maternal infections, immunizations, blood type, maternal substance use that can affect babies (tobacco, alcohol, opiates), behavioral health disorders, and heritable genetic conditions. Associating maternal information with a newborn is important to the well-being of children in inpatient hospitals and upon transfer to an outpatient pediatric setting or another hospital. This recommendation suggests that a minimum set of data related to maternal health and demographics is available to an authorized care team member.

The PediatricXpress system contains these functions and features.   Birth History is an area to record information about birth mother including the information listed above.

   9. Track Incomplete Preventative Care Opportunities.

The criteria listed in the document:

Clinical guidelines for the care and treatment of pediatric patients are well established and regularly updated to incorporate new evidence. Pediatric clinical guidelines include age-specific preventive care encounters and procedures such as vaccinations and well visits. Identifying preventive care that is overdue or expected soon is key to maintaining a pediatric patient’s health. This recommendation addresses the need to alert pediatricians when a child presenting at a visit has not received or is due for preventive care services, including age-based well child visits, immunizations, and screening tests. Alerts visible at point of care support a clinician’s review of the preventive care schedule with the guardian. Aligning with this recommendation may include re-purposing the retrospective quality reporting infrastructure to provide a list of patients who have missed preventive services to support patient outreach, prospective reporting to provide a list of patients who should be scheduled for preventive services, and implementation of integrated workflow notifications.

The PediatricXpress system contains these functions and features.

   10.  Flag Special Health Care Needs

The criteria listed in the document:

All pediatric practices provide care for individuals or groups of patients whose needs cannot always be accurately captured by using standard code systems. The definition of special needs can also vary significantly by the type of practice; for example, a specialty care clinic may define special needs differently from a primary care practice. Tools that allow flexible, customizable identification of patients with special needs, including medical complexity, may be necessary to support this recommendation. The tools should support accurate and timely reporting and allow the designation to be communicated in a clear and intuitive manner. Patients with special needs may also be identified by evaluating a problem list, laboratory results, or inclusion in a patient cohort such as a registry. Information in a patient’s record may be used to prospectively identify children with special needs and/or medical complexity. Flags identifying this information may be added during clinician workflow or as a result of a CDS rule.

The PediatricXpress system contains these functions and features.  We are making enhancements and updates as well.