So this is the second in a series of rants regarding some of the more silly aspects of the Meaningful Use Stage 1 Final Rule. Let’s visit core obective 7 for hospitals (pg 257 Fed Reg):
(7)(i) Objective. Record and chart changes in the following vital signs:
(A) Height.
(B) Weight.
(C) Blood pressure.
(D) Calculate and display body mass index (BMI).
(E) Plot and display growth charts for children 2–20 years, including BMI.
The writers of the Meaningful Use rules were on a good roll there. A through D are totally reasonable. I believe every EHR should capture these things and hospital should be document these vital signs for most inpatient stays.
My best friend’s Dad ran a manufacturing plant. I remember him saying that the way to find the optimal setting on a piece of equipment is to turn the dial until it breaks, then go back one setting. I kind of feel that is what happened with this objective. They should have stopped at (D). Growth charts are great, every pediatric practice should maintain one for each child, and in this day and age they should be computerized. But why would a growth chart be a requirement for a hospital stay? Does that make any sense? I have spoken to a few pediatricians and none of them have stated that there is a medical need for a growth chart in the hospital stay.
This looks like a sloppy cut and paste from the Eligible Provider Objectives to the hospital objectives without thinking through the different environments.
Candid CIO 
Another good question would be why an EHR NOT sold to pediatricians or pediatric specialists would ever need this. We did it and got it certified. But if I got a penny for every time one of our client base used it, at the end of the year, I doubt I’d have enough for a cup of coffee.
Spot on – well played…
Um. Whose height changes during a hospital stay?
Back up a step and, at its core, the problem here is trying to enumerate what is valid in raw data. Why not just expose the measurements and let client systems make of it what they will.
Take this example patient: are all 295 vitals meaningful? vitals of an example patient in a live EHR … Perhaps a client is only interested in measurements at admission and discharge or those associated with a particular condition or …?
In a nutshell, your post showcases one of the problems with “meaningful use”: does it drive exposure of raw measurements or does it enumerate summary reports and if the latter, what summaries are meaningful and when? Surely, it’s too much to expect that any body could enumerate every meaning from a vast set of raw data?
For me, disk space is cheap, bandwidth is plentiful, so go raw and let the consuming application decide what is meaningful – subject to patient willingness, of course.
Agreed. We spent countless hours building this into our EHR to get CCHIT/meaningful use certified for outpatient and inpatient environments. We have several hospitals live using the system, and none of them have ever so much as asked about growth charts…. because, as the author noted, they are completely irrelevant for hospitals.
It’s such a shame to see the government kill so much innovation. Instead of allowing EHR vendors to experiment and innovate, they’re all converging to the same (not very good) standard.
I am unable to judge relative value of Growth Charts compared to other EHR functionality. However, having analyzed Growth Charts usage statistics in a hospital, I can definitely state that, as soon as electronic Growth Charts become available, their usage skyrockets. Others reported the same conclusion (see )
Some of the reasons for their use include:
1. Percentile, recent weight and growth velocity changes – all have diagnostic value.
2. Visual display of percentile must be the very first thing in assessing overall health of a child.
3. Rapid weight gain is a common indicator of kidney, heart and liver failure. For a grown-up gaining 2 kg in a few days is clear danger sign. For kids this value should be adjusted according to their age.
4. Some kids spend most of their life in a hospital. Some of them live to 18-20.
5. There are charts with daily resolution. Important for oncologists, transplant specialists, cardiologists etc. E.g. weight changes should be closely monitored during chemotherapy.
6. It is an important tool for endocrinologists, nutritionists, gastroenterologists, etc.
7. Charts for infants, especially prematurely born infants are very important for neonatologists
Full disclosure: our company makes the most advanced Growth Charts software.
The important differntiator is that the common defintion of a growth chart is that it is “……used by pediatricians and other health care providers to follow a child’s growth over time.” “Over time” implies a collection of data in a non-acute care environment. Your reference to highly specialized care of acutely ill children reflect the need for hospital systems to generate graphical views of data collected in a compressed time frame; for example, in neonates weight may be measured more than once in a single day. Such frequent measurements would be unreadable in the commonly accepted growth chart format pictured in this post.
I love RNs with viewpoints 🙂
The growth of children must be according to their age and weight, so mentioned an article from FindRXonline about the rules of growth in children and adolescents.
I’m with you on this one. I think the EHR meaningful use idea tries to put every aspect of healthcare into one box, when that has never been the way it functions. Different places of care need to operate differently to perform their tasks to the best of their ability. Meaningful use often takes away from that ability. I agree with Kyle, it is in the EHR developers’ hands to create a product that will survive and be appealing to care agencies.