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.

中文翻译：

---

亲密伴侣暴力与儿科电子健康记录：定性研究

 目标

探讨专家对亲密伴侣暴力 (IPV) 幸存者及其子女的儿科电子健康记录 (EHR) 相关风险的看法，并确定可以减轻这些风险的策略。

 方法

我们对通过滚雪球抽样招募的多学科儿科 IPV 专家（护理、医生、社会工作者、医院保安、IPV 倡导者）进行了半结构化访谈。我们使用主题分析对采访记录进行编码，然后将代码合并到主题中。

 结果

二十八名参与者完成了采访。参与者将风险的主要来源确定为施虐者可能通过合法和非法手段获取儿童的电子病历。他们指出，施虐者访问多个儿科 EHR 组件（例如在线健康门户、临床记录、联系信息）可能会导致 IPV 幸存者的暴力、跟踪和操纵升级。建议的风险缓解策略包括有限的编码文档、限制 EHR 访问以及与 IPV 幸存者讨论文档。使用这些策略的挑战包括医疗保健提供者通常会进行详细记录，并且记录的信息可能会同时带来风险和收益。据报道，儿科 EHR 对 IPV 幸存者的潜在好处包括确保护理的连续性、减少反复谈论创伤史的需要以及安全计划的沟通。

 结论

我们的研究结果表明，儿科 EHR 可能会给 IPV 幸存者及其子女带来风险和益处。需要进一步开展工作来制定最佳实践，以解决与儿科 EHR 相关的 IPV 风险，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。