Pediatricians lag with EHR adoption

Experts point to complexity, unique features of pediatric systems
By Erin McCann
12:00 AM
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Pediatricians in the U.S. continue to adopt electronic health records (EHRs) at an underwhelming rate, citing costs and hesitancy over potential system benefits, according to a  report published in November.

The study, published in Pediatrics and conducted by researchers at the Seattle Children's Hospital, East Carolina University and the American Academy of Pediatrics, sought to shed light on the often opaque and limited data surrounding pediatricians and health IT adoption rates.

After examining survey results on adoption rates and potential barriers, researchers estimated that pediatricians are on average about one to two years behind physicians in other specialties when it comes to EHR adoption.

Although self-reported pediatrician EHR use was pegged at 41 percent, findings show only 19 percent of the systems met the definition of a basic EHR, and a paltry 6 percent were considered "fully functional."

Moreover, data confirms only 3 percent of pediatricians used a system that was both fully functional and "pediatric-supportive."

"Even if the pediatricians are adopting the systems, the systems they're adopting don't have the features that would really make the practice easier," said Michael Leu, MD, co-author of the study. "Pediatric systems have to be designed so they're a little bit more complicated."

There are several key differences between pediatric system needs and adult system needs, he points out. Normal EHR systems typically don't have something called "weight-based dosing" because adults usually have one dose amount across the board, for instance.

"In pediatrics, we support kids that are all different sizes and shapes," Leu said. "So a small child gets a small amount of medicine, and a large child gets a larger amount of medicine." Without this capability, pediatricians would need to calculate the dosages on their own.

In the study commentary, S. Andrew Spooner, MD, pediatrician at Cincinnati Children's Hospital Medical Center, wrote, "The programming logic that would support well-child visit tracking or immunization prediction is not trivial." He further added that it wasn't likely that vendors would implement these "sophisticated features." 

According to data conducted by healthcare research firm SK&A and shared with the American Medical Association, EHR adoption among pediatricians is pegged at 48.5 percent. Adoption among family practice physicians was estimated to be at 54 percent. 

Report authors said the most significant factor dissuading physicians from adopting such systems was financial barriers, with more than half (56 percent) of pediatrician respondents citing cost concerns.

Moreover, some 40 percent reported that actually finding a system that met the provider's particular needs was another substantial concern. Because EHR systems don't typically have weight-based dosing features, in addition to automatic growth chart plotters, immunization tracking and catch-up immunization calculations, Leu said it makes sense that providers are concerned over finding a system that meets pediatric needs. 

Other barriers cited included concern over loss of productivity during transition (36 percent), qualms regarding return on investment (34 percent) and apprehension that the system will be outmoded and dated by the time it is implemented (34 percent).

Solo pediatrician practices or those with two physicians were less likely to have a fully functional and pediatric supportive EHR system.

After seeing the numbers, Leu said the next step is to start talking to the vendors. If they have no insight or pressure from pediatricians regarding what features should be added to improve the systems, it's likely pediatricians will continue to lag with EHR adoption.  

"We need to figure out some way to convince vendors that it's worth while to actually provide these features in their systems," he said. 

"Is there some way we can work with vendors to maybe help them catalyze the development of these features by creating certain components?"

In the meantime, Leu said, "If there is some way to certify the EHRs for child health appropriateness, then that might be helpful because then at least the pediatricians would know what they should be purchasing." 

While these suggestions aren't necessarily the conclusive answer, they are most certainly headed in the right direction, he added.