Call to focus on digital health technologies in hospitalised children’s pain care: clinician experts’ qualitative insights on optimising electronic medical records to improve care

Thank you to APS members Nicole Pope, Denise Harrison, and Greta Palmer and their colleagues Mike South and Ligyana Korki de Candido for sharing the following recent publication.

Article first published online: 5 January 2023

Journal Reference: Pope N, Korki de Candido L, Crellin D, Palmer G, South M, Harrison D. A call to focus on digital health technologies in hospitalized children’s pain care: clinician experts’ qualitative insights on optimizing electronic medical records to improve care. PAIN [Internet]. 2023.

DOI: http://dx.doi.org/10.1097/j. pain.0000000000002863

Abstract

Background

Most hospitalised children experience pain that is often inadequately assessed and undertreated. Exposure to undertreated childhood pain is associated with negative short-term and longterm outcomes and can detrimentally affect families, health services, and communities. Adopting electronic medical records (EMRs) in paediatric hospitals is a promising mechanism to transform care. As part of a larger program of research, this study examined the perspectives of paediatric clinical pain experts about how to capitalise on EMR designs to drive optimal familycentred pain care.

Methods

A qualitative exploratory design was used to illustrate the perspectives of paediatric clinical pain experts about EMR designs that support optimal pain care for hospitalised children and families. A purposive sample of participants were recruited via email invitation. Reflexive content analysis was conducted in parallel with ongoing recruitment to evaluate sample size requirements in relation to the principles of information power. Data were managed in Nvivo. This research was approved by the University of Melbourne Human Research Ethics Committee (protocol number 2021-22171-23430-6).

Results

Fourteen nursing (n=9) and medical (n=5) experts from 10 paediatric hospitals across five countries (United States, Canada, United Kingdom, Australia, and Qatar) were interviewed online using Zoom for Healthcare. The researchers developed four broad categories during qualitative content analysis. They were labelled as follows: (1) capturing the pain story, (2) working with user-friendly systems, (3) patient and family engagement and shared decision making, and (4) augmenting pain knowledge and awareness.

Conclusions

User-centred, evidence and theory-informed EMR designs are critical to improving pain care for hospitalised children. Participants with a range of EMR experience called for a greater focus on optimising hospital EMRs to drive clinicians beyond searching for objective measures of pain and pharmacological interventions toward including psychological, social, and developmentally targeted assessments and treatments. Intuitive, customised EMR interfaces draw clinicians to the most pertinent data and safeguard highrisk practices without overwhelming them. Findings demonstrate that no single action will ensure that EMRs guide clinicians toward evidence-based practices. Pain education and institutional approaches that support quality improvement remain pillars of effective pain care. Electronic medical record use in children’s pain management is an evolving practice. We must leverage their potential to highlight pain as a priority. Further research should study the use of patient-controlled interactive technology integrated with the EMR and their potential to support and promote shared decision making.

Declaration

Nicole Pope is a PhD candidate and has received funding from the Melbourne Research Scholarship and the Be Sweet to Babies studentship to support her doctoral studies. She is also the recipient of the Vera Scantlebury Brown Child Welfare Memorial Trust Scholarship and the Australian Nurses Memorial Centre Prince Henry’s Affiliates Scholarship facilitating her PhD nursing studies.