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Pew Calls on ONC to Improve Usability of Pediatric EHRs

September 29, 2017
by Rajiv Leventhal
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Electronic health records (EHRs), while reshaping healthcare delivery, also have contributed to new and unanticipated safety concerns—some of which directly affect care for pediatric patients, according to The Pew Charitable Trusts.

As such, as the Office of the National Coordinator for Health Information Technology (ONC) implements provisions from the 21st Century Cures Act, Pew has sent a letter to ONC National Coordinator Don Rucker, M.D., “urging [him] to consider and incorporate improvements to safety—especially for pediatric patients.”

The letter specifically stated that several issues specific to children—such as weight-based dosing and age-related medical determinations—raise the risk that EHR usability can contribute to medical errors. For example, wrote Pew and some other healthcare associations, children’s weight affects the doses of medication received, which may differ from the dose typically administered to a fully grown adult. EHR design may influence how clinicians order weight-based doses of medications, and could contribute to children receiving incorrect drug doses. In a well-known example, the weight-based dosing usability of an EHR contributed to a 16-year old receiving 39 times the intended dose of a medication, they said.

In another example in the letter, the organizations point to EHRs’ ability to correctly track pediatric patients’ height, weight and other vital indicators is necessary to ensure that children are within normal ranges. Incorrect or unclear information can cause clinicians to make care decisions negatively impacting the patient, they said.

In the end, EHR usability—which refers to their layout, design, how they fit into different workflows, and customizations made within healthcare facilities—can influence the efficiency of using these systems, user satisfaction with health information technology, and patient safety, the letter stated.

Currently, EHR developers must test whether their products perform certain functions as laid out in ONC’s certification requirements; these requirements are not specific to the pediatric population. Additionally, those requirements do not focus on safety—for example whether certain functions can inadvertently contribute to medical errors, the organizations attested.

To this end, the development of voluntary certification criteria for pediatric EHRs—as required by Section 4001 of the 21st Century Cures Act within two years (end of 2018)—offers ONC an opportunity to focus on improving the safety and usability of these health record systems, the organizations noted.

Specifically, the criteria developed through this voluntary program should include provisions to detect potential safety concerns before EHR systems are installed and used, and after implementation to identify challenges associated with—for example—customization by a healthcare facility, the letter attested.

Pew and others recommend that ONC could leverage several existing efforts that focus on better testing and assessments of safety, such as: aspects of NQF (National Quality Forum) existing efforts that focus on better testing and assessments of safety; a Leapfrog Group standard for computer provider order entry that includes a test for inpatient EHRs that alerts clinicians to at least 50 percent of common, serious errors; as well as some of ONC’s own existing safety methods, such as its SAFER guides, which document methods to evaluate EHRs installed within a healthcare facility for safety.

The letter concluded, “The development of voluntary certification criteria for pediatric EHRs affords ONC an opportunity to improve safety of children. We urge ONC to promptly begin work on the pediatric EHR certification criteria and to include provisions that monitor and test for safety through all of the stages of EHR development.”

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