How Important Is an Independent EHR for Pediatric Hospitals?

Feb. 18, 2021
Researchers identify correlation between independent measures of pediatric hospital quality and having an EHR independent of the partner adult hospital

Pediatric hospitals often share an electronic health record instance with a partner adult hospital. But researchers at Stanford Children’s Health in California have identified a correlation between measures of pediatric hospital quality and having an EHR independent of the partner adult hospital.

Their paper, “Correlation Between an Independent Electronic Health Record & External Ranking of Children’s Hospitals,” was published in the journal Health. The  co-authors are Lane F. Donnelly, M.D., chief quality officer and Christopher G. Dawes Endowed Director of Quality at Lucile Packard Children’s Hospital and Stanford Children’s Health; David Scheinker, director of systems design and collaborative research; Natalie M. Pageler, M.D., chief medical information officer;  and Andrew Y. Shin, a clinical professor of pediatrics.

Their study found a statistically significant association between children’s hospitals that have an independent EHR and a higher ranking on the US News & World Report survey of children’s hospitals as a proxy for quality.

The 21 top-ranked adult hospitals were associated with 17 children’s hospitals ranked in the top 50. Of those, 7 had an independent EHR and 10 had a shared EHR. The median ranking for those with an independent and shared EHR was 7 and 28, respectively.

The presence of an independent EHR was a much more significant predictor of children’s hospital performance than was the US News & World Report ranking of their partner adult hospital, the researchers found. “Given the multiple unique pediatric needs of the EHR, it is not surprising that those children’s hospitals that have an increased ability to customize their EHR exclusively to the needs of children would have a favorable performance in USNWR rankings,” the authors noted.

The authors described their own setup at Stanford. Their organization consists of an overarching university, a school of medicine, an adult hospital system, and a pediatric and maternal hospital. The adult hospital and the pediatric and maternal hospital are on separate instances of the same brand of EHR. “Because there are operational inefficiencies and potential communication lapses related to certain groups of patients and certain groups of caregivers having to move back and forth between the two hospital systems, there is sometimes discussion about moving to a single instance of the EHR,” they wrote. “Others argue strongly that there are primary differences in the needs of the EHR for children and that an independent pediatric EHR combined with local pediatric clinical informatics expertise is essential to the EHR being tailored to and providing high-quality quaternary pediatric care.”

They describe a number of functions that are either unique to or much more important in pediatric health care than in adult care, including weight-based medication dosing and need for related safety features such as dose range checking; requirements related to immunization; graphing normal growth and calculating height and weight percentiles.

The authors note that relationship between a pediatric-specific (independent) EHR for children’s hospitals and quality of care compared to that achieved using a shared EHR system has not been studied specifically. But they hypothesize that children’s hospitals that have an independent EHR have the ability to specifically focus on pediatric healthcare delivery and may be advantaged in the quest to provide higher quality care.

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