1. Information Needs of Pediatric Clinics: An Example Farrokh Alemi, Ph.D. June 2007

2. Unique Data Needs Growth data.  Record, graph, display growth patterns benchmarked against normal growth  Small scales Patient identifier.  Identifier assigned before or at time of birth  Accommodate changing data (e.g, "Infant Boy Smith" or "Boy June Jones")  Multiple names used by a patient. Special terminology and information  Pediatric lexicon (e.g, developmental milestones, education progress, anticipatory guidance)  Physical findings (e.g, weak cry, bulging anterior fontanelle, and umbilical granuloma) Age-based normal ranges  Normal ranges for vital signs change with a child's age  Accept normative values provided by the reference laboratory  Normal ranges to represent specific ethnic or geographic populations Time of birth

3. Unique Reporting Needs Prescribing of medications  Based on the age, weight or body surface area of the child  Prescription tools needed Immunizations  Efficient recording of immunizations  Effective display of immunization data  Exchange with registry  Reminders for missed immunizations to providers  Reminders to patients  Alerts of contraindications Parents' special documentation requirements  Parents may ask to review or append chart information  Support summary reports to parents and others Reporting  Match mandated formats (e.g., school or camp physicals

4. Unique System Issues Special privacy issues  Adolescent privacy may preclude reporting to parents  Genetic information may be restricted to parents (donor embryo process)  Guardianship data may be different from biological parents  Represent relationships in families involving adopted children  Reporting requirements of social service agencies for foster care  Protect data in ways consistent with abuse and neglect laws  Parent or guardian may not be the financially responsible person Pediatric work settings  Data entry must work in busy pediatric settings Speech interfaces may be impractical in noisy environments Curious children may also present special challenges. Family member links  Links to records of other family members  Easy movement among records of siblings Registry linkages  Timely notification and follow-up

5. Take Home Lesson EHR systems need to be tailored to each practice’s operations