Background: Clinicians have reported low satisfaction and described problems with efficiency and a lack of support for clinical cognition in using electronic health record (EHR) systems. Cognitive support is particularly important as clinicians care for children and youth with special health care needs (CYSHCN). We found in a prior study, that pediatricians and care coordinators rely on the EHR for situational understanding and spend significant time obtaining and organizing information from fragmented patient records from different healthcare organizations. EHR add-on apps, coupled with standards-based electronic health information exchange (HIE), have the potential to support clinicians in this process. In this study, we describe the design and development of the Pediatric Patient Summary (PPS), an add-on EHR app that automatically retrieves, organizes, and displays relevant patient information from multiple healthcare organizations to support the care of CYSHCN. Methodology: We followed an iterative user-centered design process, including needs assessment techniques, goal/task analysis, and user interface design through low and high-fidelity prototyping. In the iterative process, we requested frequent feedback from target users. To maximize the PPS app’s potential dissemination, the technical architecture leverages a stack of health information technology (HIT) standards, including the Health Level Seven (HL7) Clinical Document Architecture (CDA) standard for health information exchange and the SMART on FHIR (Fast Healthcare Interoperability Resources) standard for integration of add-on apps into EHRs. We also conducted a data quality review of various data sources and worked with data providers to address gaps. Discussion: A key component of the PPS is a Timeline that provides an overview of patient encounters, diagnoses, lab results, and medications over time (Figure 1). Hovering over specific items in the timeline provides details on-demand. Below the timeline, the PPS provides detailed lists of patient conditions, medications, laboratory results and care team members (Figure 2). Patient conditions are linked via “infobuttons” to provider reference and patient education materials within the Medical Home Portal (MHP), a Web portal dedicated to improving the care of CYSHCN. The PPS also includes access to an enhanced growth chart, as a separate SMART on FHIR app. The application is currently available within the Epic EHR and is being pilot tested by eight pediatricians at the University of Utah Health. Conclusion: Clinicians need a reliable and concise summary to support situational understanding in the care of CYSHCN. To achieve this goal, the PPS app can be seamlessly launched within the EHR to retrieve patient records from multiple healthcare organizations using national health IT standards. Ongoing and future work include design and development of a parent-facing version of the PPS and integration of the PPS with the Cerner EHR at Intermountain Healthcare.
Design and Development of an Electronic Health Record Add-on App to Support the Care of Children and Youth with Special Health Care Needs
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Damian A. Borbolla, Guilherme Del Fiol, Chuck Norlin, TERESA Taft, Ryan Cornia, Phillip Warner, Andrew Iskander, Heidi Kramer, Charlene Weir, Kensaku Kawamoto, David Shields; Design and Development of an Electronic Health Record Add-on App to Support the Care of Children and Youth with Special Health Care Needs. Pediatrics March 2021; 147 (3_MeetingAbstract): 8–9. 10.1542/peds.147.3MA1.8
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