Technology in the trenches: Electronic health records for pediatrics

Many physicians use the terms electronic medical record (EMR) and electronic health record (EHR) interchangeably, but to do so is in fact incorrect. The National Alliance for Health Information Technology (NAHIT) has defined an EMR as an electronic record of health-related information on a patient that is created and managed by staff from a single organization involved in the person's health and care.

In contrast, an EHR is the aggregate electronic record of health-related information on a patient that is created and gathered cumulatively across more than 1 health care organization.

If your system currently is creating patient records but does not "speak" to other systems, it is likely an EMR. Despite these NAHIT definitions, most medical journals continue to use EHR as a generic term for computerized medical records, so this article will continue that trend to avoid confusion.

The major advantages of computerized documentation are legibility of encounters and the ease with which one can develop and maintain problem and medication lists.

Disadvantages are cost (often requiring an initial investment of as much as $20,000 per physician for software alone) and the potential for negatively affecting productivity and office workflow.

It is a daunting project to convert an office from paper-based charting to an EHR system, but there are ample online resources for interested physicians to prepare themselves for taking the plunge.

Many relevant articles about EHR implementation have been written for this publication as well as others (see Contemporary Pediatrics, July 2006). Additionally, the American Academy of Pediatrics (AAP) has devoted significant resources to this topic as well ( http://www.aap.org/informatics/AAPoverview.html).

Basic EHRs facilitate documentation of patient visits, medication lists, and problems lists and generate paper-based prescriptions.

Comprehensive EHRs perform electronic prescribing, check for drug interactions, and advise physicians regarding best practices on the basis of existing guidelines. Furthermore, they can directly integrate electronically delivered lab reports, analyze these reports, and flag out-of-range values that require attention.

Many comprehensive EHRs also integrate with an online patient portal that facilitates communication between patient and provider.

It is apparent that EHR adoption is increasing rapidly, and many pediatricians either have already implemented an EHR or have started to investigate them. Many commercial EHRs cater to the unique needs of pediatric practice: Office Practicum, EncounterPRO, and Physician's Computer Company (PCC) EHRs are examples of such systems.

These systems excel at assisting pediatricians in recording immunizations, plotting growth and body mass index data, and documenting child developmental milestones.

Such programs also can assist in generating useful reports, such as the percentage of patients who are fully immunized, patients with diabetes who have had a hemoglobin A_1C performed in the last year, or patients who are due for a well-child visit.

This ability to analyze recorded information is one of the enormous benefits of EHR implementation. With EHRs, it is easier for practitioners to identify the quality of care a practice provides. They can be used to quantify selected outcome measures so that pediatricians can work toward practice improvement.

Although it is hard to predict what health care reform will look like once politicians have finalized legislative changes over the next few years, it is not a leap of faith to imagine that all physicians eventually will be required to use EHRs that are capable of generating outcomes data.

Furthermore, physicians may be compensated on the basis of demonstrated performance measures and must be able to quantify and transmit data with government-approved EHRs.

Worldwide standards already have been developed to facilitate the communication of one EHR system with another (by Health Level 7 International), and universal interoperability and communication (while maintaining patient confidentiality) between systems is one of the major goals of health information technology.