Help with pediatric electronic health records

Finally, help exists for making electronic health records (EHRs) in pediatric practice more useful and user friendly. The National Institute of Standards and Technology recently released a guide for creating EHR systems that focus more on the people-physicians, nurses, and others-who use them and on the specific challenges generated by a pediatric population.

The guide was developed with the help of experts in ambulatory and intensive care pediatrics, human factors engineering, usability, and informatics. It was peer reviewed by professionals and clinicians in pediatric health care organizations in the United States and Canada.

Although EHR systems are rapidly being adopted in all types of medical practices, the pediatric population offers unique challenges that are inhibiting adoption of such systems in this arena. For example, the rapid development of the patient population is a challenge because so many facets of care are size and age dependent. This makes selection and arrangement of information displays, definition of “normal,” and thresholds for alerts as well as many other interface considerations more difficult to design and implement. Another challenge is that young patients often cannot communicate what is wrong accurately, and caregivers are often inaccurate proxies.

The report focuses on “safety-critical” interactions between the user (physician, nurse, pharmacist, caregiver, patient) and the EHR, which can potentially lead to costly errors or, worse, patient harm.

In addition to other elements, the guide specifically suggests that information in EHRs in menu items and on charts and graphs be displayed without truncating critical information, such as dosing and measurement units. It supports 1-click access to growth charts in standard display format. It also advocates eliminating automated changes to adult doses for medication orders and advises about protecting against ordering medications in the wrong units to help avoid dosing errors.

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