Use of health information technology (HIT)/Electronic Health Records (EHR) in Healthcare research at CPCE focuses on improving and standardizing the secure use and sharing of HIT/EHR in pediatric medicine to improve health outcomes. This technology is also being used to deliver interventions and decision support directly to healthcare providers within the clinical setting and in clinical effectiveness research.

Implementation Science for HIT Interventions

Creation of Databases for Clinical Effectiveness (CE) Research

Secondary Use of EHR Data

Use of HIT/EHR in Healthcare Published Research

Implementation Science for HIT Interventions

This research project studies methods to promote the integration of research findings and evidence into the development of effective HIT interventions in healthcare. We are now working to foster the effective implementation of HIT systems to support families, clinicians and other stakeholders in medical decision-making across different conditions.

Researchers also intend to provide guidance to clinical and genomic researchers needing to extract data from the EHR.

What’s Next: Researchers are actively working on studies to improve electronic surveillance for wound infection ambulatory pediatric surgery and the quality of pediatric emergency care using the EHR and clinician feedback, as well as to determine the effectiveness of primary care drug therapeutics using the pediatric EHR.

See the Published Research

Funding: National Institutes of Health (NIH), Agency for Healthcare Research and Quality (AHRQ), Health and Services Administration Maternal and Child Health, NIH National Center for Advancing Translational Sciences

Please contact Robert Grundmeier, MD, Director, Clinical Informatics, Department of Biomedical and Health Informatics and an attending physician at CHOP, for more information about this line of research.

Creation of Databases for Clinical Effectiveness (CE) Research

The goal of this research is to build on the existing Pediatric Health Information System (PHIS) database, containing clinical and financial details for more than 6 million patient cases from 42 leading children’s hospitals. We have already developed the infrastructure for accurately and reliably adding laboratory and radiology data for children seen in ambulatory and inpatient departments of six large children’s hospitals. This rich data source offers academic clinicians the ability to study large subsets of the pediatric population to answer comparative effectiveness questions that affect hospitalized children.

What’s Next: CPCE researchers are continuing to augment the PHIS database with clinical data with the goal of significantly enhancing the quality and scope of pediatric comparative effectiveness research.

See the Published Research

Funding: Agency for Healthcare Research and Quality (AHRQ)

Please contact Ron Keren, MD, CPCE associate director for implementation, and CHOP vice president of quality and chief quality officer and professor of pediatrics, for more information on this line of research.

Secondary Use of EHR Data

This line of research involves the extraction and cleaning of electronic health record (EHR) data to promote numerous types of clinical research. We have several active research projects underway to improve the quality of care in pediatric emergency and primary care settings through use of EHR.

• Improving the Quality of Pediatric Emergency Care Using an Electronic Medical Record Registry and Clinician Feedback – Researchers are developing an emergency care visit registry for pediatric patients to collect performance measures for important pediatric medical and trauma conditions.
• Primary Care Drug Therapeutics Comparative Effectiveness Research in a Pediatric Electronic Health Record Network (CER) – Researchers are studying the effectiveness of using the EHR in primary care to evaluate the safety and efficacy of drugs used in this setting, as well as the role of clinical decision support to improve medication management.

Funding: The Children’s Hospital of Philadelphia, National Institutes of Health (NIH)

Please contact Robert Grundmeier, MD, Director of Clinical Informatics, Dept. of Biomedical and Health Informatics and an attending physician at CHOP, for more information about this line of research.

Use of HIT/EHR in Healthcare Published Research

Implementation Science For HIT Interventions

Feemster KA, Li Yimei, Grundmeier RW, Localio AR, Metlay JP. Validation of a Pediatric Primary Care Network in a US Metropolitan Region as a Community-Based Infectious Disease Surveillance System. Interdiscip Perspect Infect Dis, 2011. 219859.

Mayne S, Karavite D, Grundmeier RW, Localio AR,Feemster KA, DeBartolo E, Hughes CC, Fiks AG. The implementation and acceptability of an HPV vaccination decision support system directed at both clinicians and families. AMIA Symposium, 2012. 616-24.

Fiks AG, Grundmeier RW, Margolis B, Bell LM, Steffes J, Massey J, Wasserman RC. Comparative effectiveness research using the electronic medical record: an emerging area of investigation in pediatric primary care. J Pediatr, 2012. 160(5): 719-24.

Glatz AC, Shah SS, McCarthy AL, Geisser D, Daniels K, Xie D, Hanna BD, Grundmeier RW, Gillespie MJ, Rome JJ. Prevalence of and risk factors for acute occlusive arterial injury following pediatric cardiac catheterization: a large single-center cohort study. Catheter Cardiovasc Interv. 2013. 82(3):454-62.

Gerber JS, Prasad P A, Fiks AG, Localio AR, Grundmeier RW, Bell LM, Wasserman RC, Keren R, Zaoutis TE. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA, 2013. 309(22): 2345-52.

Tarczy-Hornoch P, Amendola L, Aronson SJ, Garraway L, Gray S, Grundmeier RW, Hindorff L A, Jarvik G, Karavite D, Lebo M, Plon SE, Van Allen E, Weck KE, White PS, Yang Y. A survey of informatics approaches to whole-exome and whole-genome clinical reporting in the electronic health record. Genet Med, 2013.15(10):824-32.

Fiks AG, Grundmeier RW, Mayne S, Song L, Feemster KA, Karavite D, Hughes CC, Massey J, Keren R, Bell LM, Wasserman R, Localio A R. Effectiveness of Decision Support for Families, Clinicians, or Both on HPV Vaccine Receipt. Pediatrics, 2013. 131(6): 1114-24.

Gerber JS, Prasad PA, Localio AR, Fiks A G, Grundmeier RW, Bell LM, Wasserman RC, Rubin DM, Keren R, Zaoutis TE. Racial differences in antibiotic prescribing by primary care pediatricians. Pediatrics, 2013. 131(4): 677-84

Forrest CB, Fiks AG, Bailey LC, Localio AR, Grundmeier RW, Richards T, Karavite DJ, Elden L, Alessandrini EA. Improving adherence to otitis media guidelines with clinical decision support and physician feedback. Pediatrics, 2013. 131(4): e1071-81.

Fiks AG, Zhang P, Localio AR, Khan S, Grundmeier RW, Karavite DJ, Bailey C, Alessandrini Evaline A, Forrest CB. Adoption of Electronic Medical Record-Based Decision Support for Otitis Media in Children. Health Serv Res, 2014. 50(2): pages 489–513.

Fierro JL, Prasad PA, Localio A R, Grundmeier RW, Wasserman RC, Zaoutis TE, Gerber JS. Variability in the diagnosis and treatment of group a streptococcal pharyngitis by primary care pediatricians. Infection Control and Hospital Epidemiology, 2014. 35 Suppl 3: S79-85.

Weiss SL, Fitzgerald JC, Balamuth F, Alpern ER, Lavelle J, Chilutti M, Grundmeier RW, Nadkarni VM, Thomas NJ. Delayed antimicrobial therapy increases mortality and organ dysfunction duration in pediatric sepsis. Critical Care Medicine, 2014. 42(11): 2409-17.

Mayne SL, duRivage NE, Feemster KA, Localio AR, Grundmeier RW, Fiks AlG. Effect of decision support on missed opportunities for human papillomavirus vaccination. Am J Prev Med, 2014. 47(6):734-44.

Fiks AG, Mayne S, Karavite DJ, Debartolo E, Grundmeier RW. A Shared e-Decision Support Portal for Pediatric Asthma. The Journal of ambulatory care management. 2014. 37(2): 120-6.

Fiks AG, Grundmeier RW. Elucidating Challenges and Opportunities in the Transition to ICD-10-CM. Pediatrics, 2014. 134(1): 169-70.

Creation of Databases for Clinical Effectiveness

Narus SP, Srivastava R, Gouripeddi R, Livne OE, Mo P, Bickel JP, de Regt D, Hales JW, Kirkendall E, Stepanek RL, Toth J, Keren R. Federating Clinical Data from Six Pediatric Hospitals: Process and Initial Results from the PHIS+ Consortium. AMIA Annu Symp Proc, 2011. 994-1003.

Gouripeddi R, Warner PB, Mo P, Levin JE, Srivastava R, Shah SS, de Regt D, Kirkendall E, Bickel J, Korgenski EK, Precourt M, Stepanek RL, Mitchell JA, Narus SP, Keren R. Federating Clinical Data From Six Pediatric Hospitals: Process and Initial Results for Microbiology From the PHIS+ Consortium. AMIA Annu Symp Proc, 2012. 281-90, 2012.

Secondary Use of EHR Data Published Research

Feemster KA, Li Yimei, Grundmeier RW, Localio AR, Metlay JP. Validation of a Pediatric Primary Care Network in a US Metropolitan Region as a Community-Based Infectious Disease Surveillance System. Interdiscip Perspect Infect Dis, 2011. 219859.

Mayne S, Karavite D, Grundmeier RW, Localio AR,Feemster KA, DeBartolo E, Hughes CC, Fiks AG. The implementation and acceptability of an HPV vaccination decision support system directed at both clinicians and families. AMIA Symposium, 2012. 616-24.

Fiks AG, Grundmeier RW, Margolis B, Bell LM, Steffes J, Massey J, Wasserman RC. Comparative effectiveness research using the electronic medical record: an emerging area of investigation in pediatric primary care. J Pediatr, 2012. 160(5): 719-24.