United States Health Information Knowledgebase

 

Frequently Asked Questions for the Children's Electronic Health Record Format

What is the Children's EHR Format?

The Children's Electronic Health Record (EHR) Format is a list of functional requirements that was released publicly in 2013 to address the gap between the functionality present in most EHRs currently available, and the functionality required to support the care of children. Specifically, the Format provides information to EHR system developers and others about critical functionality, data elements, and other software requirements that need to be present in an EHR system to address health care needs specific to the care of children, especially those enrolled in Medicaid or the Children's Health Insurance Program (CHIP). The Children's EHR Format is not, itself, a specification or a software product; rather, it is a list of 547 functional requirements ("normative statements") organized hierarchically within topical areas ("headers" and "function statements"), and available on the United States Health Information Knowledgebase (USHIK) Web site.

In 2015, the Children's EHR Format (the Format) was expanded and enhanced by adding 47 items that were developed by a national multi-stakeholder work group. The work group selected a small number of original Format items and updated them to create each new item, which aimed to improve language clarity and item feasibility, and also aimed to identify a small number of high priority items.

What information does the Format include?

The Format includes a broad list of functional requirements grouped into 26 topics that include Prenatal and Newborn Screening, Immunizations, Growth Data, Children with Special Healthcare Needs, and Well Child/Preventive Care, among others.

Within those requirements are, in some cases, references to data elements and applicable data standards that can be used as a starting point or checklist for EHR developers seeking to create a product that supports practitioners who serve the needs of children.

The Format also highlights the importance of interoperable exchange of data collected in a variety of settings including school-based, primary, and inpatient care; the relevance of EHR standards; and the need to address gaps in quality measurement through collection of clinical quality data.

Development of the Format was authorized by the 2009 Children's Health Insurance Program Reauthorization Act (CHIPRA) and sponsored by the Agency for Healthcare Research and Quality (AHRQ) in close collaboration with the Centers for Medicare & Medicaid Services (CMS).

What is the distinction between the 2013 Format and the 2015 Priority List?

2013 Format: The Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) funded a project in 2009 to develop the Children's EHR Format (the Format), an extensive set of software functional requirements that included 547 normative statements grouped in a hierarchy beneath 148 headers and function statements.

Publicly released in 2013, the Format was well received by software developers identifying gaps in functionality, practitioners using EHRs in the care of children, and provider organizations purchasing and configuring EHRs. The 2013 Format is considered a release package containing 695 items numbered between 89 and 1290. Users of the Format also identified challenges. Hundreds of the function statements were not viewed as actionable by stakeholders, despite the organization into topic areas, the hierarchical grouping, and the use of SHALL, SHOULD, and MAY in the narrative statements themselves. Early feedback on the Format suggested that its impact could be greater if software developers and other stakeholders were provided additional guidance in using it.

Publicly released in 2013, the Format was well received by software developers identifying gaps in functionality, practitioners using EHRs in the care of children, and provider organizations purchasing and configuring EHRs. The 2013 Format is considered a release package containing 695 items numbered between 89 and 1290. Users of the Format also identified challenges. Hundreds of the function statements were not viewed as actionable by stakeholders, despite the organization into topic areas, the hierarchical grouping, and the use of SHALL, SHOULD, and MAY in the narrative statements themselves. Early feedback on the Format suggested that its impact could be greater if software developers and other stakeholders were provided additional guidance in using it.

2015 Priority List: The Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) funded a project in 2014 to enhance the Children's EHR Format (the Format) in order to address some limitations identified during implementation by providers and software developers.

A multistakeholder work group (MSWG) met for six months, reviewed the Format, and identified a number of items as high priority. The MSWG produced the 2015 Priority List a short list of 47 items for all stakeholders to focus on. These items were edited or rewritten for clarity, include implementation notes that expand upon what is contained in the description of the requirement, and were intended to 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. The 2015 Priority is considered a release package containing 47 items in the Format, numbered 2001-2047. A companion document, the Recommended Uses for the Format, was also developed to provide guidance in how the Format and the 2015 Priority List might be used by stakeholders who design, develop, or use EHRs, and who rely on EHR data for related initiatives such as statewide immunization tracking and school-based health tracking.

Who established the 2013 Format and the 2015 Priority List?

In both cases the Agency for Healthcare Research and Quality (AHRQ) funded the development of the requirements in close collaboration with the Centers for Medicare & Medicaid Services (CMS).

How can I download the 2013 Format and the 2015 Priority List?

The Format requirements can be downloaded in a variety of ways from the USHIK Web site (this site) and can be searched, filtered, and configured for download based on user instructions.

Note that the 2013 Format release package includes items numbered between 89 and 1290, whereas the 2015 Priority List release package includes items numbered between 2001 and 2047. Please select the Downloads tab and follow the step by step instructions to complete your download.

Where can I learn more?

For more information about the 2013 Format, the 2015 Priority List, any individual requirements or the Children EHR Format in general, please contact us via the USHIK Help/Feedback form.

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