Pediatric Electronic Health Records and Research

Pediatric providers use electronic health record systems to review patient information, to document care, to order clinical interventions, and to perform related administrative tasks. All of these activities create data that might be useful in research, although research is seldom the objective of EHR-related data entry. Providers may use other information systems (e.g., specialized systems for analyzing electrocardiograms), but the EHR is the central application for clinical and administrative clinical activities. While there are a few EHR systems designed specifically for care of pediatric patients, most pediatric providers adopt general-purpose EHRs that must be customized for specialized pediatric environments. In this chapter we outline the special functional requirements of EHRs (e.g., growth monitoring, medication dosing, and immunization management), the relative difficulty of meeting these requirements with EHRs that are currently available in the marketplace, and current adoption trends. We discuss workflows that present special challenges to EHR implementation. We discuss the typical workflow phenomena that affect the use of data for research and other secondary uses. We also discuss special aspects of terminology systems employed by EHRs that have implications for pediatric usability. Lastly, we address special issues in the use of EHR data for the extraction of care quality measures.