Division of Emergency Medicine (KA Randell, LA Query, and MD Dowd), Children's Mercy Kansas City, Kansas City, Mo; University of Missouri-Kansas City School of Medicine (KA Randell, LA Query, and MD Dowd), Kansas City, Mo.
Division of General Academic Pediatrics (MI Ragavan), University of Pittsburgh/Children's Hospital of Pittsburgh, Pittsburgh, Pa.
Acad Pediatr. 2022 Jul;22(5):824-832. doi: 10.1016/j.acap.2021.08.013. Epub 2021 Aug 27.
To explore expert perspectives on risks associated with the pediatric electronic health record (EHR) for intimate partner violence (IPV) survivors and their children and to identify strategies that may mitigate these risks.
We conducted semistructured interviews with multidisciplinary pediatric IPV experts (nursing, physicians, social workers, hospital security, IPV advocates) recruited via snowball sampling. We coded interview transcripts using thematic analysis, then consolidated codes into themes.
Twenty-eight participants completed interviews. Participants identified the primary source of risk as an abuser's potential access to a child's EHR by legal and illegal means. They noted that abuser's access to multiple pediatric EHR components (eg, online health portals, clinical notes, contact information) may result in escalated violence, stalking, and manipulation of IPV survivors. Suggested risk mitigation strategies included limited and coded documentation, limiting EHR access, and discussing documentation with the IPV survivor. Challenges to using these strategies included healthcare providers' usual practice of detailed documentation and that information documented may confer both risk and benefit concurrently. Reported potential benefits of the pediatric EHR for IPV survivors included ensuring continuity of care, decreasing need to repeatedly talk about trauma histories, and communication of safety plans.
Our findings suggest the pediatric EHR may confer both risks and benefits for IPV survivors and their children. Further work is needed to develop best practices to address IPV risks related to the pediatric EHR, to ensure consistent use of these practices, and to include these practices as standard functionalities of the pediatric EHR.
探讨专家对儿科电子健康记录（EHR）与亲密伴侣暴力（IPV）幸存者及其子女相关风险的看法，并确定可能减轻这些风险的策略。
我们通过滚雪球抽样法招募了具有多学科儿科 IPV 专业知识的（护理、医生、社会工作者、医院保安、IPV 倡导者）进行半结构化访谈。我们使用主题分析对访谈记录进行编码，然后将代码合并为主题。
28 名参与者完成了访谈。参与者认为主要风险源是施虐者通过合法和非法手段获取儿童 EHR 的潜在途径。他们指出，施虐者可以访问多个儿科 EHR 组件（例如，在线健康门户、临床记录、联系信息）可能导致暴力升级、跟踪和对 IPV 幸存者的操纵。建议的风险缓解策略包括有限和编码的文档记录、限制 EHR 访问权限以及与 IPV 幸存者讨论文档记录。使用这些策略的挑战包括医疗保健提供者通常详细记录信息的做法，以及记录的信息可能同时带来风险和利益。报告的儿科 EHR 对 IPV 幸存者的潜在好处包括确保护理连续性、减少反复谈论创伤史的需求以及传达安全计划。
我们的研究结果表明，儿科 EHR 可能为 IPV 幸存者及其子女带来风险和利益。需要进一步努力制定与儿科 EHR 相关的 IPV 风险的最佳实践，以确保这些实践的一致使用，并将这些实践纳入儿科 EHR 的标准功能。
