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|Requirement ID:||Req-851: Length/Height||Req-2042: Support growth charts for children|
|Release Package:||2013 Format||2015 Priority List|
|Title:||Length/Height||Support growth charts for children|
|Description:||Length is typically measured in newborns and then at every well-child visit through 36 months of life. Afterwards, height is typically recorded. Length/height may also be measured at other times based on clinician concern.||The system shall support display of growth charts that plot selected growth parameters such as height, weight, head circumference, and BMI (entered with appropriate precision or computed as described in Req-2019) along with appropriate sets of norms provided by the CDC or in a compatible tabular format (typically based on Lambda-Mu-Sigma [LMS] curve fitting computational method).|
|Topic Area(s):||Growth Data, Primary Care Management, Well Child/Preventive Care||Growth Data|
|Requirement Type:||Function||Normative Statement|
|Implementation Notes:||An EHR should do more than replicate paper processes using a computer; therefore, a growth chart should be more than a plot of height, weight, and other growth parameters superimposed on an image or PDF of a paper form that was used to plot growth data in a paper medical record. Data that are the basis for computing and displaying growth chart percentiles are provided by CDC at http://cdc.gov/growthcharts and is age- and sex-specific as well as expected to change over time as new population data becomes available. Vendors may provide a variety of usability enhancements such as offsets for gestation age, offsets for bone age, annotation of special circumstances of individual values, or precision of the measurement; but these user interface enhancements are not part of the core requirement. Magnification and printing should be provided as appropriate for other graphical data in the EHR and for sharing with patients or other providers. The primary growth parameter data on which the growth chart is based always should be available for display and should include computed values such as units conversion, BMI, and percentiles as described under the Req-2019 implementation note. If data are available, they should include annotation of the source of values that were not entered directly into the EHR at a visit on the date of the measurement. It may be desirable to display or print growth charts in different units such as metric for providers and pounds and inches for parents. When this is done, the guidelines in Req-2019 for measurements in only one unit and mathematical conversion of one set of primary data should be followed in accordance with the precision of measurement. The data currently provided by the CDC are limited to metric percentiles as that is the preferred unit of measurement. Mathematical conversion of the percentile data to pounds or inches should be performed, but should not be rounded to the precision of the actual patient measurements. Users may request growth charts for specialized populations such as Down Syndrome, Turner Syndrome, or certain ethnicities or medications; however, the vendor can provide such growth charts only when the necessary data for computing percentiles is available from the CDC or in equivalent format. A variety of approaches exist for computing ideal or target weight, and for predicting adult height based on mid-parent height or bone age and it is not possible to make these clinical decision-support and user-interface enhancement tools part of the core requirement. Vendors are encouraged to consider including these enhancements and links to obesity management information when feasible and appropriate.|