The 2015 Priority List includes several requirements that encourage vendors to extend their functionality for better system integration. Req-2028 calls for use of established immunization messaging standards and Req-2011 calls for immunization reconciliation with data in immunization registries that will require data sharing and requests to correct discrepant data. Req-2036 expands electronic prescribing to include re-checking weight-based dosing at the time of refills, and Req-2037 calls for age- and weight-specific dose checking for medications before they are prescribed. Req-2001 calls for linking to and importing birth information found in the mother’s record into the infant’s record when possible to eliminate the need for manual entry in the hospital and ambulatory setting. Req-2021 facilitates this transfer of birth data by linking mother’s demographics to the infant. Req-2017 calls for recording newborn screening diagnoses on the problem list so that they will transfer to other providers as part of a patient summary document. The comprehensive approach to pediatric vital signs and growth data in Req-2002 supports use of these data in a standard patient summary of care document shared with other practitioners, and in public health organizations to aggregate population data. Req-2043 calls for a wide range of pediatric specialized scales and scoring that Req-2004 and Req-2023 will use as screening tools for well child and preventive care by capturing this type of data completed by the parents prior to a visit or in the waiting room.
Interoperability is important for a children’s EHR since it enables a comprehensive longitudinal picture of care a child receives. It is essential to assess the current care a child has received with the benefit of information from critical periods in a child’s history. For example, transfer of growth data between practices is essential for completing growth charts, transfer of birth data from the birth hospital to the medical home is essential for neonatal and infant care, and transfer of complete newborn screening and immunization data is essential to meet key public health objectives.
There is not yet full agreement on screening periodicity schedules, and there are also gaps in the availability of fully computable electronic resources for existing or emerging standard schedules. Periodicity schedules in Medicaid are discussed here. Req-2020 for age-specific findings, and Req-2024 for access to age-specific guidelines for EPSDT and Bright Futures™, highlight these gaps. An important challenge to immunization information system (IIS) interoperability has been local variations in standards compliance concerning the transmission of standard messages and IT security.