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Study of Pediatric EMR Use Yields Insights, Highlights Opportunities

June 28, 2016

Raleigh, NC – Despite significant expense and widespread changes to medical practices, electronic health records remain frustrating to doctors and haven’t yet paid off in higher quality care or better service. That is especially true for pediatrics practices that have somewhat different needs than practices primarily serving adults. Under a grant from the federal CHIPRA program, Community Care of North Carolina (CCNC) worked closely with pediatricians, Electronic Health Record (EHR) vendors and practice staff to help define a “Model” EHR Format for pediatrics.

 The five-year project used the Model Format to review EHRs and to identify gaps between what doctors want and need in a pediatric EHR versus what is available in the marketplace today.

 “Although there are hundreds of EHR systems available, only a few are really designed for the needs of a pediatrics practice,” said Marian Earls, M.D., MTS, FAAP. “But vendors who worked with CCNC Pediatrics have incorporated feedback, and we found that most office staffs can often get more out of their current EHR than they realize.”

CCNC found that some vendor’s EHRs are a better fit for pediatrics than others, but key gaps remain with most, for example a lack of tools for oral health risk assessment and referral tracking for developmental screening. However, CCNC also found that EHRs may have valuable capabilities of which clinical/office staff are unaware, such as the ability to build and use care plans.

 “The good news is that EHRs seem to be improving generally,” said Dr. Earls, “and vendors are very interested in hearing and incorporating feedback from clinicians.” An area of particular promise cited by Dr. Earls is the ongoing development of more versatile reporting capabilities so clinicians can better track the growing list of activities on which they are asked to measure and report. CCNC’s findings have been shared with RTI International, the nonprofit research institute has helped to define a Model Pediatric EHR Format for the federal government.

Said Dr. Earls: “This is a key to future practice stability as third-party payments will increasingly be tied to such measures.”

16 Key Pediatrics Measures for EMRs

  •  Oral Health


  • Documentation of dental home


  • Evidence of oral health anticipatory guidance, referral or caries risk, and dental varnish


Developmental and Behavioral Health

Postpartum depression screening and follow-up


  • Developmental screening and follow-up


  • Autism risk screening and follow-up


  • School Age Screening - Pediatric Symptom Checklist and follow-up


  • Adolescent Screening follow-up




  • Obesity assessment, counseling and referral for children and adolescents


  • Weight for length percentile, with plot (up to age 2) and referral


 Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)


  • Vision screening


  • Hearing screening


  • Immunizations:


             Tetanus, Diphtheria, Pertussis immunization by age 11 or 6th grade


             Meningococcal immunization


             HPV immunization




  • Diagnosis and assessment of children with Asthma


  • Asthma pharmacologic therapy




Full measurement specifications available at:

Other resources


RTI Pediatric Model

For details on the RTI Pediatric EMR model please see this link:


A report from AHRQ on pediatric EMRs (“Children’s EHR Format Enhancement: Report on Implementation Experiences in North Carolina and Pennsylvania”) is available online at:




The Children’s Health Insurance Program Reauthorization Act (CHIPRA) is a Federal program that provides health insurance to children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The CHIPRA Quality Demonstration Grant was an enhancement to the program aimed at identifying strategies for improving the quality and cost-effectiveness of healthcare provided to children enrolled in the program. North Carolina was one of 18 states awarded this federal grant. 


About CCNC

CCNC’s family of companies includes parent company CCNC, Inc. and NC Community Care Networks, a community-based, public-private partnership that creates “medical homes” in all 100 counties for north Carolina Medicaid recipients. The CCNC enterprise is dedicated to innovative approaches to population management that improve health and reduce costs, particularly for vulnerable populations. To learn how CCNC improves quality and saves millions of dollars every year, visit

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