Kimberly A Randell1, Maya I Ragavan2, Lindsey A Query3, Mangai Sundaram4, Megan Bair-Merritt5, Elizabeth Miller6, Mary Denise Dowd3. 1. 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. Electronic address: karandell@cmh.edu. 2. Division of General Academic Pediatrics (MI Ragavan), University of Pittsburgh/Children's Hospital of Pittsburgh, Pittsburgh, Pa. 3. 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. 4. University of California Berkley (M Sundaram), Berkeley, Calif. 5. Division of General Academic Pediatrics (M B-Merritt), Boston University School of Medicine/Boston Medical Center, Boston, Mass. 6. Division of Adolescent and Young Adult Medicine (E Miller), University of Pittsburgh/Children's Hospital of Pittsburgh, Pittsburgh, Pa.
Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Julian Schwarz; Annika Bärkås; Charlotte Blease; Lorna Collins; Maria Hägglund; Sarah Markham; Stefan Hochwarter Journal: JMIR Ment Health Date: 2021-12-14