The benefits of electronic health records (EHRs) may become more widely available to children through an EHR format for children's health care announced February 8 by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS).
Growing use of EHRs continues to improve the quality and safety of health care in the United States, but many existing EHR systems are not tailored to capture or process health information about children. The EHR format for children's health care just announced includes recommendations for child-specific data elements such as vaccines and functionality that will enable EHR developers to broaden their products to include modules tailored to children's health.
"Health care for children is a calling that carries special challenges," said AHRQ Director Carolyn Clancy, M.D. "This new children's EHR format will help software developers meet the needs of health care providers for children by combining best practices in clinical care, information technology and the contributions of health care providers who treat children every day."
The children's EHR format was authorized by the 2009 Children's Health Insurance Program Reauthorization Act (CHIPRA) and developed by AHRQ and CMS. The format is intended to improve care for children, including those enrolled in Medicaid and the Children's Health Insurance Program (CHIP), by guiding EHR developers to understand the types of information that should be included in EHRs for children. The format is designed for EHR developers and providers who wish to augment existing systems with additional features or to build new EHR systems for the care of children.
The format includes a minimum set of data elements and applicable data standards that can be used as a blueprint for EHR developers seeking to create a product that can capture the types of health care components most relevant for children. Child-specific data elements and functionality recommendations are sorted into topic areas that include prenatal and newborn screening tests, immunizations, growth data, information for children with special health care needs and child abuse reporting. The EHR format provides guidance on structures that permit interoperable exchange of data, including data collected in school-based, primary and inpatient care settings. The format is compatible with other EHR standards and facilitates quality measurement and improvement through the collection of clinical quality data.
"We have been pleased to partner with AHRQ on this first and much needed step to move EHR products to better capture the health care needs of children and adolescents," said Cindy Mann, CMS deputy administrator and director of CMS's Center for Medicaid and CHIP Services. "The EHR format provides a foundation upon which developers can build EHRs that, by differentiating between children and adults, ultimately will lead to better quality information about children's health."
AHRQ and CMS led development of the children's EHR format by multiple experts including the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians. The format is built on specifications from sources that include the Health Level Seven International (HL7®) EHR-S Functional Model, the HL7 Child Health Work Group's Child Health Functional Profile, and the HHS Health Resources and Services Administration's Health IT for Children Toolbox.
"Children are special -- they are not little adults where one size can be made to fit all, including one-size EHRs," said Thomas McInerny, M.D., president of the AAP. "Until now many EHRs have lacked child-specific functionality such as the ability to record age-appropriate development, nutrition, immunizations, or growth."
Next steps include testing by two CHIPRA quality demonstration grantees, the Commonwealth of Pennsylvania and the State of North Carolina. As part of the longer term vision, CMS will work toward integration of the format into future editions of the Office of the National Coordinator for Health Information Technology's EHR Standards and Certification Criteria. This would be required for achieving "meaningful use" of certified EHR technology in future stages of the Medicare and Medicaid EHR incentive programs.
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