Pediatric-Specific Functions and Data Needs for Inpatient Electronic Systems Stakeholders
Use age-specific time units
Accept, store, and present time data in commonly used and meaningful units.
Ages in months, weeks, days, hours, and minutes for infants.
Use pediatric-specific units for weight and height
Accept, store, and present anthropomorphic data in different units that can be used interchangeably with those used in older children and adults. Avoid nonmetric measures.
Weights in grams (vs kilograms) and lengths in centimeters (vs meters) for infants).
Allow pediatric-specific data options
Accept, store, and present child/infant-specific data options.
Apgar scores at multiple time intervals (1, 5, 10, 20 min). Gender as indeterminate if needed (as opposed to unknown); postconceptual age in weeks and days; pediatric-specific end-of-life directives.
Specify mother–infant data linkages
Make pertinent maternal data available to users of a child’s record.
Maternal blood type and screen, medication list, TORCH screen, GBS screen, syphilis screen, gonorrhea screen, HIV screen linked to the infant record. Other desired data include gestational diabetes, maternal drug use, delivery method, rationale, and complications, etc.
Standardize family structure documentation
Provide standard electronic format (data entry and presentation) of biological and social linkages of a child to others.
Universal format for pedigree documentation. Extensible notation for varying family structures like adoption or same-sex couples, including guardianship (such as foster care).
Ensure adolescent privacy
Allow configuration of information access to adolescent clinical data according to legal status.
Isolation of clinical content and billing data for adolescent care according to local jurisdictional laws. Confidentiality for emancipated minors.
Maintain continuity and rights to data in foster/custodial care
Allow configuration of access and consent to records for children in foster/custodial care according to law.
Child protective services: bidirectional access to data in emergency placement of children.
Facilitate safe and accurate care transitions
Facilitate transfer of relevant pediatric-specific data in handoffs.
Age-specific data available during change of shift or perioperatively. Reports usable for children between care teams (inpatient to ambulatory, pediatric to adult care providers).
Allow seamless electronic data transfer between hospitals and associated pediatric practices including maternal/perinatal medical records.
Electronic summary of hospital course is available to the primary care provider for integration into her EHR.
Manage newborn screening data
Facilitate accurate procurement, recording, tracking, and timely communication of infant screening.
Metabolic and hearing screening completion and tracking.
Manage immunization data
Calculate infant and child vaccination needs based on patient-specific data (age, known immunization lapses).
Identification of immunization lapses in admitted patients. Immunization documentation to the medical home and the local immunization registry. Support for 2-dimensional vaccine barcodes.
Provide interactive reminders and alerts for providers to reduce “missed opportunities” to vaccinate.
Provide support for vaccine procurement and dose management (inpatient pharmacy).
Support documentation and reporting of immunization (inpatient, ambulatory, health information exchange).
Share health maintenance schedules
Share data on health maintenance issues (screening, immunizations, growth, etc; inpatient, medical home, health information exchange).
Updating and communicating of health maintenance issue list and problem list.
Document and share growth data appropriately
Share point-of-care measures of height, weight, BMI, and percentiles.
Recording and communicating of height, weight, and trends etc for premature infants or internationally adopted children on special growth charts.
Provide pediatric-specific normal values and reference materials
Incorporate and display as appropriate normal pediatric values with links to references.
Age-appropriate norm values provided for weights, blood pressures, laboratory values.
Pediatric specific complications.
Document and share developmental data
Promote documentation of developmental milestones.
Inclusion of developmental screening notation (such as the ASQ).
Support age-appropriate nutrition
Provide decision support for selecting age-appropriate nutrition.
Default choices for age-appropriate nutrition orders (in conjunction with growth data) such as human milk.
Provide patient and family-appropriate educational materials
Provide relevant age-specific health education materials tailored to children and their parents, based on their level of health literacy.
Surgery education in Spanish for a Hispanic family with a child who has a congenital heart defect.
Facilitate weight- and body surface area–based dosing
Facilitate dose calculation of medications, nutrition based on patient data.
Just-in-time drug dosing information for resuscitation.
Facilitate recording and tracking of exposure
Facilitate cumulative recording of exposure to medications or radiation.
Lifetime dose information for a child receiving chemotherapy or radiation.
Acquire, use, and maintain pediatric-specific drug dictionaries and formularies
Ensure accurate pediatric drug information through the use of drug dictionaries and formularies that provide weight-based dosing, pediatric-specific decision rules.
Drug dictionaries with pediatric-specific dose ranges and alerts that include single-dose, daily-dose, and cumulative-dose decision support (for cancer chemotherapy).
Develop and implement pediatric-appropriate orders and order sets
Provide pediatric-specific order menus and order sets including nutrition, laboratory, radiology, and other ancillary service orders.
Decision support for inpatient admission promoting an evidence-based asthma-specific order set for a child with status asthmaticus.
Provide evidence-based disease-specific orders and order sets conforming to national best practice standards and AAP guidelines.
Support prenatal and preadmission orders
Permit anticipatory specification of admission orders and order sets for pediatric inpatients not “in-house.”
Ordering of medications for the expected delivery of a preterm infant (likely to go to the NICU).
Registration and ordering for a critically ill child being transported to a PICU from outside the hospital.
Manage patient-specific tissues and body fluids
Allow storage, tracking, and appropriate management of patient-specific biological samples.
Record, store, track and administer human milk to an infant appropriately. Record, store, track, and use cord blood of an infant for a relative.
Support pediatric-specific sample collection
Provide data and laboratory infrastructure support for collection, processing and storage of variable amounts of samples (lower blood volumes needed for testing) for children.
Pediatric-specific laboratory orders linked to microcontainers for CBC count, chemistries, and blood cultures.
CBC, complete blood cell; DDST, Denver Developmental Screening Test; GBS, group B Streptococcus; TORCH, toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and HIV.