Unfortunately, meaningful use has shifted the market attention away from child EMRs, according to Feliciano “Pele” Yu, Jr., MD, chief medical information officer at St. Louis Children’s Hospital. But it doesn’t means that specialists have stopped working to get pediatric functionality right. They are working hard to bring result oriented changes in pediatric electronic health record. These steps would improve the technology for child health and pediatricians.
“Meaningful use is by no means perfect for pediatrics, but the trajectory that we have seen is amazing. [CMS and ONC] have worked hard and well for the last few years,” said Christoph Lehmann, MD, medical director of the American Academy of Pediatrics (AAP) Child Health Informatics Center. “In Stage 1 we were very concerned because we were afraid that pediatricians would be left behind,” he added.
Lehman said that, recently, ONC and CMS received some pediatricians’ complaints and that was addressed in Stage 2. For instances the experts have modified the existing definition of what makes a Medicaid encounter. According to it the patients who have Children’s Health Insurance Programs (CHIP) are eligible for it. There are approximately 36 states where CHIP is working with Medicaid and supporting up-to 60 percent of pediatricians. Similarly, in Stage 2 several new pediatric-specific clinical quality measures and reporting mechanisms are also included.
Mark Del Beccaro, MD, FAAP, chairman of the Council on Clinical Information Technology at AAP, said that irrespective of this, AAP applauds these changes, but still it might create implementation problem, especially for small pediatricians’ healthcare centers. He further explained that a small initiative by vendors probably doesn’t deliver a result oriented effect on children’s care, particularly, for those who have frequent dental decay or cavities which is one of the pediatric-specific measures. This needs more “sophisticated” software. He believes that many pediatrics could not earn much money because of low volume of patient, that is why, vendors aren’t expressing their attention to this type of functionality.
Lehmann said the AAP knows that vendors are in stress to assist their customers report on meaningful use,” and they have very short time to make these improvements. That’s why Child Health Informatics Center is aiming to develop a project on creating own clinical decision app. Lehmann said, “The project is still in its evaluation stages, and is not a done deal,” but it is facing a funding problem, if the funding get approval, one day vendors could easily implement it into their EHRs. AHRQ and CMS are committed to develop a joint-project for the improvement children’s EHR format. The project is expected to be launched at the end of January 2013. According to Lehmann, “The project defines features that should be in an EHR for children, and the whole format is designed to be picked up by vendors,” he added.
Furthermore, HL7 Child Health Work Group is also looking to improve the standards for child health EHRs. Its co-chaired Feliciano spent approximately four years on developing the Child Health Functional Profile. Similarly, the National Institute of Standards and Technology has also worked on to develop a guide that “looks at how software should be designed specifically for a child health worker,” said Feliciano.
Feliciano is confident that all this work will lead to a “really strong standard.” He is looking forward on the challenges the pediatric community. “Meaningful use decision-makers and stakeholders should listen to child health stakeholders who are promoting these types of standards.”
But, for that to happen, there should be some certification for child health adoption, Feliciano believed. Feliciano had long relation with CCHIT Child Health Work Group since when it was operational and known for the nonprofit and turned to meaningful use certification. He is positive and hopeful that after certification of meaningful use it will rearrange with a much more “solid” foundation to work with. “CCHIT or other [certifying] groups should consider [child health] certification. Then we can educate purchasers that “there is a body that they can use to demand certain functions,” he said.