Defining Electronic Health Record Standards for Child Health: A State-of-the-Art Review

Abstract

Background Improving child health using health information technology (IT) requires a unique set of functionalities that are built into the electronic health record (EHR) and are used to support patient care. In this article, we review and discuss the milestones preceding the development of a new child health EHR standard and describe the salient features of this contemporary standard.

Methods and Results The Health Level Seven Pediatric Care Health IT Functional Profile (HL7 PCHIT FP) is an informative standard that encompasses the EHR functions required to care for patients less than 21 years of age in any clinical setting, developed to address the pediatric-specific functionality gaps in the EHR. It includes criteria that support communication between providers and all caregivers, inclusion of pediatric-specific vital signs and diagnosis, support for transition to adult care, and support for reporting and documentation of child abuse or neglect including communication with involved authorities. EHR functionalities for documentation and reporting of newborn screening tests with follow-up for abnormal results and functionality for children with special health care needs with support for identifying patients who may benefit from care coordination are also incorporated, in addition to school-based linkages enabling communication between the health care system and their school environment.

Conclusion The HL7 PCHIT FP is envisioned to be another vital step towards improving pediatric health by enhancing EHRs to address the unique health IT needs of children and their health providers. While the HL7 PCHIT FP is the most recently published standard on pediatric EHR systems, standards development is an iterative process, and recommendations for continuous refinement and additional functionalities for the next standards release are encouraged.

 

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Keywords

electronic health record - health level seven - child health - policy

Background and Significance

An electronic health record (EHR) is a patient-centered record, representing the digital repository of an individual's health information, designed to facilitate care provision and serve multiple legitimate uses and users of the record.[1] [2] The EHR system was identified by the Institute of Medicine as a critical element of health information technology (IT) infrastructure, and one which needs continual development.[3] EHRs were initially developed for providers catering to adult patients with the notion that pediatric providers could use the same EHRs, with the same functions and features.[4] And while EHR systems designed for pediatric patients and providers do exist, many EHR systems were not built specifically to support child health.[5]

Medical documentation has evolved considerably from the early 20th century practices of day-book records and patient case reports to paper patient record files and, subsequently, the digital patient records in the late 20th century.[6] While primary care providers began to improve EHR functionality for tasks unique to child health by the end of the 20th century, there remains considerable room for further maturing of the EHR. The “meaningful use” initiative has significantly increased the adoption of EHRs over the previous decade; however, a substantial proportion of pediatric providers feel that their EHR systems are not equipped with features that enable them to provide optimal care to children and report being highly burdened by EHR documentation.[7] [8] [9] By 2021, 97% of children's hospitals had adopted an EHR and around 90% of these EHRs were designated as certified EHR technology (CEHRT).[10] The widespread adoption of EHR systems makes it imperative to refine EHR systems to prevent them from acting as a disruptive tool in health care delivery for children.[11]

In this state-of-the-art review, we provide a broad-scope overview of pediatric EHR standards and describe the milestones leading to the development of a recent standard for child health EHR functionality. The review involved the identification and analysis of relevant literature, including grey literature (such as policy documents, legislation, and white papers) through recommendations from domain experts, authors of earlier child health standards documents, and pediatric informaticians. We envision the latest standard to be one more step towards improving and optimizing the health and wellbeing of pediatric patients by taking into consideration their unique needs regarding health IT.

 

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Background

While many of the features in EHRs were designed for the care of adults, there are unique care needs in pediatrics that require specific functionalities in the EHR. These features assist pediatric providers in the delivery of quality care and are also referred to as “pediatric functions.”[12] [13] Integrating these functions holds paramount importance in safeguarding the safety and quality of pediatric care while preserving patient privacy.[14] [15] [16] By addressing the distinct requirements of pediatric health care providers, this integration reduces errors through enhanced information assurance, thereby minimizing potential harm.[14] Moreover, appropriately configured EHRs have yielded significant advantages, including improved provider efficiency and higher user satisfaction among proficient users.[17] [18] The prevailing consensus emphasizes the indispensable need for EHRs in pediatric care to incorporate tailored functionalities that adeptly support child health care providers, ensuring the seamless delivery of high-quality care to pediatric patients.[13] Some of these pediatric functions are the tracking and graphical representation of a child's physical growth, medication dosing based on body weight, and age-based dosing decision support.[12] [13] Others include screening and care for newborns, connection of prenatal data to the child after birth, and calculation of gestational age. Seamless immunization tracking and data exchange with registries have been considered indispensable in pediatric care, and their importance extends to all age groups, playing a pivotal role in enhancing vaccination rates and provision of care.[19] Maintaining privacy while sharing information of adolescents with their parents, documentation of caregivers, including foster parents, and transitions of care for children who are adopted, documentation and reporting of child abuse, and capturing information specific to children with special needs are additional unique features for an EHR to have to support planning for and providing care to the pediatric population.[20]

Child EHR Standards History

As early EHRs were developed in the later part of the 20th century, pediatricians and other primary care physicians developed computerized clinical records, and early pediatric EHR systems were used by multiple practices by the end of the century.[6] Throughout the 1990s, the American Academy of Pediatrics (AAP) released periodic policy statements addressing EHRs and child health, including a manual called “Evaluating Practice Management Software for Pediatrics,” which was published in 2000.[6] [21] This manual offered a step-by-step process for providers to assess their information needs and evaluate the ability of different software to meet those requirements.[21] In 2001, the AAP Task Force on Medical Informatics published a comprehensive report titled “Special Requirements for Electronic Medical Record Systems in Pediatrics,” outlining essential features for a clinical information system tailored to pediatricians.[22]

The Health Level Seven International (HL7) is a not-for-profit American National Standards Institute (ANSI)-accredited standards development organization (SDO), which was founded in 1987.[23] While HL7 was previously involved in the development of messaging standards, an EHR Special Interest Group, which was subsequently promoted to a full Technical Committee (EHR-TC) was founded to establish standards for EHR system functions.[24] The HL7 EHR standards provide functional models (FMs) and functional profiles (FPs) that enable the constructs for the development and management of EHRs.[25] FMs, composed of a list of functions, define a standardized base model of the functions that may be present in EHR systems, containing all reasonably anticipated EHR functions; however, the FM on its own is not intended to be a list of all functions to be found in a specific EHR system. Instead, FPs, which are a selected set of functions applicable for a particular purpose, domain, realm (i.e., country), specialty, care setting, or service, offer a method to constrain the FM functions and conformance criteria to an intended use. In other words, the FP is a specification which indicates the EHR functions desired, required, or implemented in a specific care setting or application, using the FM as a foundation. While only a subset of all FM functions are included in any particular FP, the FP may also contain additional functions and criteria to specify features unique to a given type of EHR system.[24] [26]

In 2003, the HL7 Pediatric Data Standards Special Interest Group (PeDSSIG) was formed with the aim of providing SDOs with pediatric-specific requirements and workflows.[27] The PeDSSIG is credited for establishing a FP for EHR systems that are used to care for children, the HL7 EHR Child Health Functional Profile (CHFP), Release 1.[27] During the development of this FP, input was solicited from a range of stakeholders and organizations including: the AAP, the American Board of Pediatrics, American Academy of Family Physicians, the Child Health Corporation of America (CHCA), and the National Association of Children's Hospitals and Related Institutions (NACHRI). The CHCA and NACHRI have since merged to form the Children's Hospital Association.[28] [29]

The first iteration of the CHFP (released in 2008) laid out basic, general pediatric functions and specific conformance criteria for the emergency department, inpatient, and outpatient settings. However, it did not describe functions needed for the care of children with severe chronic conditions, newborn screening, or child welfare.[27] HL7 also created the Developmental Screening and Reporting Services Derived Profile, Release 1, a Functional Domain Profile that identified the essential capabilities for pediatric developmental screening and reporting in the EHR.[30] This FP incorporated content and functions from the HL7 Electronic Health Record System Functional Model, Release 2 (HL7 EHR-S FM, R2), and complemented the HL7 EHR CHFP, Release 1.

 

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Legislation and EHR Standards

As a part of the American Recovery and Reinvestment Act of 2009 (ARRA), the Health Information Technology for Economic and Clinical Health Act (HITECH) was enacted to promote the adoption and use of health IT.[31] The goal was to increase adoption and “meaningful use” of EHRs, enabling providers to achieve improvements in care delivery.[32] The legislation tied incentive payments for providers and hospitals specifically to the achievement of advances in health care processes and outcomes.[32] While the incentivization for “meaningful use” of EHRs resulted in an increase in implementation and use by pediatric providers, the availability of “pediatric-supportive” EHRs with functions like well-child visit tracking, support for anthropometric analysis (e.g., growth tracking), and so forth remained minimal.[33] [34]

After authorization by the 2009 Children's Health Insurance Program Reauthorization Act (CHIPRA), the Agency for Healthcare Research and Quality (AHRQ), in collaboration with Centers for Medicare & Medicaid Services (CMS), sought to improve the design and use of EHRs to better address health care needs specific to the care of children, particularly those enrolled in Medicaid or the Children's Health Insurance Program.[35] With this aim, in 2010, they funded a 3-year project to develop a set of software requirements called the Children's EHR Format (the Format), to provide guidance to EHR system developers about critical functionality, data elements, and other specifications.[34] The Format contained portions of the 2008 HL7 Child Health-FP, and was released publicly in 2013, but was identified to have some challenges during implementation by providers and software developers.[36] Clinicians expressed concerns regarding the absence or inadequacy of certain features in the Format, including social factors such as socioeconomic status, food insecurity, home conditions, language considerations, and assessments related to women, infants, and children. Implementation of the Format items was challenging due to excessive use of technical language, inadequate provision of examples or supporting materials, and the presence of ambiguous language, resulting in differing interpretations among stakeholders. The substantial quantity of requirements (547 items) and their inherent ambiguity further impeded effective prioritization.[37] A national multi-stakeholder work group sought to address some of these limitations with the “Children's EHR Format Enhancement: Final Recommendation Report” producing the 2015 Priority List Requirements and Recommended Uses for the Format.[36] The 2015 Children's EHR Format, which identified and refined 47 items drawn from the 2013 Format and developed 16 recommended uses, was intended to provide additional guidance to stakeholders and “spur dialogue among software developers, practitioners, provider organizations, professional organizations, and other stakeholders working to improve the care of children and the technologies supporting their care.” [37] It was hoped the enhanced Format would lead to better tracking and completion of immunizations, safer medication use, better screening of children with special needs, and improved knowledge and communication about growth and development among other benefits.

The 21st Century Cures Act (Cures Act) was passed into law in December 2016, with section 4001(b) of the act acknowledging the unique health IT needs of the pediatric population.[38] In response to the requirements delineated in the Cures Act related to pediatric health IT, the Office of the National Coordinator for Health Information Technology (ONC) published 10 recommendations for the voluntary certification of health IT for pediatric care; however, the ONC did not specify a separate certification program for pediatric care.[39] The 10 recommendations were informed by the AAP and parts of the 2015 Children's EHR Format.[40] The recommendations related to the Priority List included the use of biometric-specific norms for growth curves and support growth charts for children, computing weight-based drug dosage, the ability to document all guardians and caregivers, segmented access to information, synchronization of immunization histories with registries, age- and weight- specific single-dose range checking, transferrable access authority, and associating maternal health information and demographics with the newborn. The ONC's Cures Act Final Rule included recommendations for tracking incomplete preventative care opportunities and the ability to flag special health care needs.[41] The rule also includes certification criteria to support the voluntary certification of health IT for use by pediatric providers.[41] These certification program criteria, referred to as the 2015 Edition Cures Update, are inclusive of both the already adopted 2015 Edition Certification Criteria and new or revised certification criteria (and standards).[39]

To support the recommendations of the ONC and to improve upon the existing FP, the HL7 EHR working group sought to establish a standard set of pediatric functional requirements in the EHR to guide pediatric health providers, health IT vendors, certification organizations, and decision makers.[42] This led to the development of the recently published HL7 Pediatric Care Health IT Functional Profile (HL7 PCHIT FP), which is an informative standard describing the EHR functions required to care for patients less than 21 years of age in any clinical setting ([Fig. 1]).[5] [42]

Fig. 1 Milestones in pediatric EHR standards development. HL7 EHR-S FM, R1: HL7 Electronic Health Record System Functional Model, Release 1; HL7 EHR-S FM, R2.1: HL7 Electronic Health Record System Functional Model, Release 2.1.

 

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EHR Certification Bodies

EHRs can store data in a structured form, which facilitates health information to be securely and efficiently captured, managed, and exchanged to support patient care.[43] EHR systems are required to meet specific standards, capabilities, and implementation specifications established by the ONC Health IT Certification Program to be accredited as CEHRT.[44]

The Certification Commission for Health Information Technology (CCHIT) was founded in 2004 as a voluntary, private-sector organization through the collaboration of three health care information management and technology associations: Healthcare Information and Management Systems Society, American Health Information Management Association, and the National Alliance for Health Information Technology.[45] In 2005, the Department of Health and Human Services (HHS) awarded CCHIT a 3-year contract to bolster a nationwide health information network by developing certification programs for EHRs and health information exchanges. The criteria for certification were developed by various stakeholders including physicians, health agencies, vendors, hospitals, and health care consumers using a consensus-based approach.[45]

The CCHIT was approved as an EHR certification body by HHS and started certification programs in 2006. By the year 2009, more than 200 EHR programs and 75% of EHRs in the market were certified by CCHIT.[45] In 2008, they also began offering an optional child health certification which could be added on top of the base ambulatory certification for an EHR.[46] However, the criteria for the child health certification only addressed the general health care needs of children as a population and were not specified for use by pediatric subspecialists. The CCHIT ceased all operations in 2014.[45]

The Medicare and Medicaid EHR Incentive Programs (now known as the Medicare Promoting Interoperability Program) were established in 2011 by CMS to encourage eligible hospitals, critical access hospitals, and eligible clinicians to adopt, implement, and meaningfully use CEHRT.[47] [48] ANSI, which was selected as the approved accreditor for the ONC Certification Program for Health IT, accredited five organizations by 2012 as health IT certification bodies. The five were: CCHIT, Drummond Group, LLC (Drummond), ICSA Laboratories, Inc., InfoGard Laboratories, Inc., and Orion Register, Inc.[49]

The absence of voluntary pediatric EHR certification programs to improve child health outcomes motivated Drummond to develop an updated pediatric EHR testing and certification program which would address the needs of pediatric clinicians in practical and meaningful ways.[50]

Drummond Pediatric Health IT Certification Program

In 2019, Drummond created an advisory panel of leading pediatricians and pediatric EHR vendors to provide expert advice on reviewing the ONC's 10 recommendations for pediatric functionality in an EHR and the 47 requirements listed in the AHRQ Child Format 2015 report. As an ONC Authorized Certification Body (ACB) and Authorized Test Lab, Drummond leveraged its 20+ years of experience in developing and promoting the adoption of electronic data exchange and interoperability standards. With its testing and certification expertise, Drummond developed a voluntary pediatric health IT certification program which launched in October 2022.[51] Prior to the launch, Drummond refined the test scripts used for certification through a pilot with three leading pediatric EHR vendors, as well as with providers from Arkansas Children's Hospital. The program is structured with separate baseline certification requirements for EHRs in ambulatory and inpatient settings, and offers optional advanced functionality certifications, which are scored to differentiate capabilities among EHRs. The program's goal is to provide transparency to buyers of pediatric EHRs and encourage vendors to advance their capabilities in a more consistent and standardized way. The AAP has recognized the certification program on its website, which reinforces the importance of this initiative in achieving high-quality and equitable care for all children.[52]

 

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HL7 EHR-S FM R2.1 Functional Profile: Pediatric Health Care IT, Release 1 - US Realm

The HL7 PCHIT FP builds upon previous EHR standards for the pediatric population, leveraging the HL7 CHFP, the AHRQ Children's Format, and Priority List, and supports the 10 recommendations by the ONC for voluntary certification.[26] The HL7 EHR Work Group started the project to develop this FP standard in March 2021 with the HL7 Patient Care and Clinical Interoperability Council Work Groups acting as co-sponsors.[42] Drummond, as an ONC ACB for EHRs, was an industry partner during the development of this standard.[26] It is pertinent to mention that almost all of the work at HL7 is performed by “volunteers,” and participation in standards development is open to anyone, with different perspectives welcome.[53] Membership in HL7 or one of its affiliates is required for an official leadership role (e.g., co-chair of workgroup) and also to participate in the formal voting process. However, nonmembers can freely join calls during standards development, participate in HL7's community discussion forum, submit requests for change to the specifications, and actively contribute to the standards development process.[53]

As described earlier, a FP is a specification which tailors the FM to include the functions desired, required, or implemented for specific health care delivery settings, EHR systems, or for other purposes. This FP was based on the HL7 Electronic Health Record System Functional Model Release 2.1 (HL7 EHR-S FM, R2.1), published in June 2020.[26] It was developed with input from child health EHR subject matter experts (SMEs) and complements the other published HL7 pediatric-specific standards (e.g., CHFP, HL7 Developmental Screening and Reporting Services Derived Profile).[42]

Each function defined in a FP is associated with specific conformance criteria, which are statements used to determine if a particular function is met. The functions and conformance criteria in the HL7 PCHIT FP were incorporated after being vetted by the child health SMEs, a workgroup composed of pediatricians, health informatics specialists, and key pediatric stakeholders, who met regularly to review the criteria for their significance and applicability to the pediatric setting in the United States. The workgroup also considered current clinical practices and jurisdictional regulations as part of their review. As an HL7 informative standard, the FP underwent the HL7 ballot process and reconciliation of comments, including a check for normative action verbs, before being submitted for publication in May 2022 (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=593). The workgroup also drafted a companion overview document that details the methodology and contains a glossary of key terms and tools commonly used in pediatric care.

This FP includes criteria developed explicitly for the pediatric domain and seeks to address the pediatric-specific functionality gaps in EHR systems ([Table 1]).[5] [26] For example, in the primary care setting, the FP supports communication between providers and all caregivers; inclusion of pediatric-specific vital signs, diagnosis, and validated best practice tools for developmental screening; and support for transition to adult care. The HL7 PCHIT FP has criteria that support documentation and reporting of child abuse or neglect, and communication with involved authorities. Functionality for child welfare includes support for capturing various caregivers, and the authority of foster parents or custodians to give consent on behalf of a minor patient; and capturing transitions of care like adoption, foster care placement, or reunification.

Table 1 Salient features and novel conformance criteria included in the HL7 PCHIT FP

Functions	Support for:
Child abuse reporting	• Reporting and documentation of abuse/neglect  • Communication with involved authorities  • Following child abuse events across time
Child welfare	• Documentation of caregivers, including foster parents  • Documentation of transitions of care
Children with special health care needs	• Identifying patients for care management  • Capturing pertinent information like code status, palliative care involvement, DMEs  • Transmitting nonmedication orders, referrals, and updates to receiving systems (like dietary, ancillary service providers, DME company, home care provider, case management)
Confidentiality and privacy	• Appropriate data visibility for minor consents  • Capturing a patient's emancipated minor status  • Storing of consent, assent, and permission as separate documents  • Capturing adolescent patient's permission to release information to parents and/or guardians  • Automatically deny patient portal access to a guardian when a patient reaches age of majority
Medication and immunization	• Reconciling the immunization record with other HIEs  • Rendering age, weight, and date of last weight measurement when ordering a weight-based dosed medication
Newborns and breast milk products	• Presenting pertinent maternal history like GTPAL, relevant infections, and betamethasone doses received  • Rendering information like birth order, Apgar score, and resuscitation details  • Breast feeding/breast milk drug compatibility categories
Patient context-driven assessments	• Patient/parent completion of age and gender relevant previsit history forms (e.g., ASQ or PEDS).  • Library of patient/caregiver questionnaires for clinicians to choose from  • Ability to send, score, and support the results of questionnaires in a variety of formats (web-, paper-, or telephone-based)
Pediatric primary care	• Inclusion of pediatric-specific diagnoses, vital signs, and laboratory result ranges  • Transition from pediatric to adult care  • Communication between providers and all caregivers
Manage patient clinical measurements	• Growth charts adjusted for prematurity with ability to exclude selected data points  • Calculating growth percentiles and plot them over time on standardized growth curves  • Ability to capture and render bone age, mid-parental height, and growth velocity on growth charts
School-based linkages	• Support communication between the health care system caring for the child with their school and appropriate medical record access for school-based clinicians  • Compliance with Family Educational Rights and Privacy Act rules where applicable

Abbreviations: ASQ, ages & stages questionnaires; DME, durable medical equipment; GTPAL, gravida, term, preterm, abortion, and living; HIE, health information exchange; HL7 PCHIT FP, Health Level 7 Pediatric Care Health Information Technology Functional Profile Release 1; PEDS, parents' evaluation of developmental status.

Source: Adapted and modified from Wong L, Liu D, Thompson C, Margo T, Yu F. Comment on Dr. Chung's Editorial: pediatric health information technology—what we need for optimal care of children. Appl Clin Inform. 2022;13(01):053–055.

The HL7 PCHIT FP supports EHR functionality for newborn screening with criteria for documentation of the screening tests and reporting of their results, with follow-up for abnormal results. The FP incorporates provisions for identifying each infant of a multiple birth consistent with birth order and linking the identifier to the same individual based on birth order once a name is provided. Other functionalities include the ability to capture specific conditions diagnosed through prenatal testing, or other data for the newborn before the newborn's chart was created and then subsequently storing this information in the child's chart. The FP also describes functionality for children with special health care needs, with support for identifying patients who may benefit from enhanced care coordination and care planning. Criteria related to confidentiality and privacy include appropriate management of data visibility for minor consents (information about minor consent services is kept private and not exposed to parents/guardians without the minor's authorization); ability to capture the patient's emancipated minor status and parental permission for consenting minors to receive some treatments (as required by institutional policy or jurisdictional law). It also encompasses support for school-based linkages enabling communication between the health care system caring for the child and their school environment, such as appropriate access to the medical record for school-based clinicians and teachers.[5] [26]

The HL7 PCHIT FP incorporates several novel functions and conformance criteria; however, there are opportunities for refinements and augmentation to align with the evolving needs of providers and emerging technological advancements. Given the unique requirements and complexities associated with providing critical care for children, potential areas that could benefit from improvements include specialized functionalities designed for acute care settings in pediatric care. Incorporating Artificial Intelligence-powered tools, such as generative AI and clinical decision support systems, holds the potential to assist clinical decision-making. Furthermore, addressing reproductive health and privacy concerns are crucial, necessitating the integration of robust privacy features and compliance with evolving regulations to safeguard sensitive patient information. Enhancing the capture of social determinants of health data elements in EHR systems is another aspect that could improve care planning and allow a more holistic approach to patient care. In addition, linking the EHR standards closely with interoperability standards can significantly improve health care coordination and enable patient-centered care. For instance, EHR vendor-agnostic Web applications, Web services, and application programming interfaces offer an opportunity to provide pediatric functionalities, eliminating the need for each vendor to develop them separately.[54]

To access current and future work in EHR standards, relevant resources can be found on the HL7 website (http://www.hl7.org/Special/committees/ehr/index.cfm) and the Confluence platform. The HL7 EHR Work Group Projects page (https://confluence.hl7.org/display/EHR/EHR+WG+Projects) provides valuable insights into ongoing work and collaborative efforts aimed at advancing EHR standards. Interested stakeholders are encouraged to sign up for HL7 membership and join the EHR Work Group to engage in discussions and contribute to the development of future FPs. The next iteration and revision of the FP will be championed and linked with the HL7 EHR Work Group, serving as the platform for further refining the FP and aligning it with broader HL7 standards initiatives.

 

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Conclusion

The HL7 PCHIT FP is the most recent publication on child health standards for EHR systems. As part of the process to compile this FP, previous key child health EHR publications and standards were reviewed, and the pediatric health IT features were incorporated into the base HL7 EHR-S FM R2.1 to become the HL7 PCHIT FP Release 1 for the U.S. Realm. However, standards development is a continuous and iterative process, and suggestions for refinement and additional pediatric functionalities for the next HL7 PCHIT FP release are encouraged. It is vital for child health stakeholders to actively participate and advocate for the continuous improvement of the EHR systems that support pediatric care.

 

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Clinical Relevance Statement

While describing a new pediatric electronic health record standard, we review and discuss the milestones preceding the development of this contemporary standard. The recently published HL7 Pediatric Care Health IT Functional Profile is envisioned to be another vital step in addressing the unique health IT needs of children and their health providers. It is imperative for child health stakeholders to actively participate and advocate for the continuous improvement of the EHR systems through standards that support pediatric care.

 

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Multiple Choice Questions

1. What is the difference between functional models (FMs) and functional profiles (FPs) in the HL7 EHR standards?

   • FMs define a standardized base model of all EHR functions, while FPs specify a selected set of functions applicable for a particular purpose or care setting.

   • FPs define a standardized base model of all EHR functions, while FMs specify a selected set of functions applicable for a particular purpose or care setting.

   • FMs and FPs both define a standardized base model of all EHR functions.

   • FMs and FPs both specify a selected set of functions applicable for a particular purpose or care setting.

   Correct Answer: The correct answer is option a. FMs define a standardized base model of all EHR functions, while FPs specify a selected set of functions applicable for a particular purpose or care setting. FMs define a standardized base model of all EHR functions, which are generally applicable to all care settings. On the other hand, FPs specify a selected set of functions applicable for a particular purpose or care setting, such as pediatrics or emergency care. FPs are built on top of the FMs and provide a more specific set of requirements and constraints for the implementation of EHRs in a particular care setting.

2. What is the HL7 Pediatric Care Health IT Functional Profile?

   • An accreditation program for EHRs and health information exchanges

   • An informative standard describing the EHR functions required to care for pediatric patients in any clinical setting

   • A certification program for health IT for pediatric care

   • A nationwide health information network developed by the CCHIT

   Correct Answer: The correct answer is option b. An informative standard describing the EHR functions required to care for pediatric patients in any clinical setting. The HL7 Pediatric Care Health IT Functional Profile (PCHIT FP) is an informative standard describing the EHR functions required to care for patients less than 21 years of age in any clinical setting.

3. What is the purpose of the HL7 Pediatric Care Health IT Functional Profile?

   • To provide guidelines for pediatric care in a hospital setting

   • To address pediatric-specific functionality gaps in EHR systems

   • To develop a new coding system for pediatric diagnoses

   • To establish a standard set of procedures for pediatric care

   Correct Answer: The correct answer is option b. To provide pediatric-specific functionality gaps in EHR systems. The HL7 PCHIT FP seeks to address pediatric-specific functionality gaps in EHR systems and includes criteria developed explicitly for the pediatric domain.

 

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Conflict of Interest

All the authors were members of the HL7 PCHIT workgroup that produced the PCHIT FP R1. F.Y is an organizational member of HL7 and co-chair of the HL7 EHR Work Group. T. B. and C.T. are employees of Drummond Group. T.M. is a Drummond contractor. Drummond has a for-profit Pediatric Health IT Certification Program.

Protection of Human and Animal Subjects

This project did not involve human or animal subjects.

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Publication History

Received: 13 April 2023

Accepted: 06 October 2023

Accepted Manuscript online:
09 October 2023

Article published online:
17 January 2024