Study: Pediatric Physician Guidelines Not Prepared for EHR Integration

August 5, 2014 in News

Less than a quarter of recommendations by the American Academy of Pediatrics can easily be entered into an electronic health record system, according to a study in Applied Clinical Informatics, Health Data Management reports.

AAP’s Bright Futures guidelines are a set of health supervision recommendations for pediatric patients (Goth, Health Data Management, 8/4).


According to the study, an electronic version of the guidelines is needed (Finnell et al., ACI, August 2014).

Currently, the recommendations assume that patients visit their providers at each age. They do not compensate for cases in which children miss or delay visits, according to Health Data Management (Health Data Management, 8/4).

Details of Study

For the study, researchers with the Indiana University School of Medicine and Regenstrief Institute assessed the recommendations to:

  • Determine the current number of actionable recommendations in the guidelines; and
  • Recommend a format for facilitating computer implementation.

The researchers evaluated the actionability of the recommendations by assessing their:

  • Decidability, or whether the recommendation explains the exact conditions in which to perform the action; and
  • Executability, or whether the recommendation was stated specifically, unambiguously and with the necessary amount of detail (ACI, August 2014).


The researchers consolidated Bright Future’s 2,161 action items into 245 recommendations (Health Data Management, 8/4).

They found that just 21% of those final recommendations were actionable. Of the actionable items:

  • The majority addressed screening requirements, such a metabolic screening for infants or child safety screenings; and
  • 13 addressed other areas of anticipatory guidance. 

None of the recommendations pertaining to child discipline, mental health or overall family function met the actionability criteria, according to the study (ACI, August 2014).

Stephen Downs, primary author of the study, said that decidability and executability “are key to computer decision support,” adding, “So, extensive work will be needed to prepare the Bright Futures guidelines for [EHR] systems” (Health Data Management, 8/4).

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