The Pew Charitable Trusts on Friday called on Office of the National Coordinator for Health IT head Donald Rucker, MD, to focus on electronic health records safety particular to pediatric patients as it institutes a voluntary certification program.

“The use of EHRs has contributed to new, unanticipated safety concerns that were not present with paper-based records, and left some safety hazards unmitigated,” Pew wrote in the letter to Rucker. “Many of these safety challenges directly affect care for pediatric patients.”

Pew’s letter was cosigned by the American College Cardiology, American College of Physicians, American Medical Group Association, American Nurses Association, and Children’s Hospital Association.


While EHR vendors already have to prove that their products comply with certain ONC requirements, those neither apply to pediatric populations nor home in on functionality that the letter explained could cause medical errors.

That’s about to change. The 21st Century Cures Act, in fact, includes Section 4001, which requires ONC to establish voluntary certification criteria requirements specifically for pediatric EHRs by the end of 2018.

“Specifically, the criteria developed through this voluntary program should include provisions to detect potential safety concerns before EHR systems are installed and used, and after implementation to identify challenges associated with, for example, customization by a healthcare facility,” the letter said.  

Pew highlighted aspects relevant to pediatric patients including weight-based drug dosing, age-related determinations and tracking height, weight and other vital indicators as EHR functionality particularly susceptible to medical errors.

The letter also urged ONC to integrate existing into the voluntary certification program. The National Quality Forum, for instance, has guidance for evaluating safety, notably the Retract and Re-order measure to avoid drugs being prescribed to the wrong patient.

Another is the Leapfrog Group’s standard for CPOE that includes a test to alerts clinicians when at least 50 percent of common and serious errors arise, which ONC could hold up as an example.

And Pew suggested ONC use its own voluntary Safety Assurance Factors for Electronic Health Record Resilience (SAFER) Guides for evaluating, as well as resurrecting the National Council for Prescription Drug Programs SCRIPT that ONC proposed but did not previously include in the EHR certification requirements.

“As ONC implements provisions from the 21st Century Cures Act,” the letter stated, “we urge you to consider and incorporate improvements to safety — especially for pediatric patients.”

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Email the writer: tom.sullivan@himssmedia.com