Intimate Partner Violence and the Pediatric Electronic Health Record: A Qualitative Study

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 semi-structured 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 (e.g., 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.

Conclusion:

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.

The electronic health record (EHR) is now a standard component of healthcare practice. Components of the EHR include the traditional medical record, as well as online patient portals that allow patients and/or caregivers access to various medical record components and to communicate with the healthcare team. Previous work demonstrates growing acceptability and use of the EHR by caregivers and healthcare teams.^1–3 EHR use has been driven by benefits such as enhanced coordination of care and communication, as well as federal programs to incentivize meaningful EHR use. However, the EHR may also create risk, including potential compromised confidentiality. Confidentiality is of particular concern for the pediatric EHR, since parents and other caregivers have legal access to the child’s medical record. Recognition of this risk has prompted research and recommendations around specific situations, such as adolescent reproductive and sexual health, child abuse and neglect, and the access healthcare employees have to their own or a relative’s EHR.^4–9

One area with less EHR-related guidance is caregiver intimate partner violence (IPV). IPV is a pediatric public health issue, with approximately 1 in 6 US children exposed to IPV and numerous negative child health outcomes of such exposure.^10–14 Pediatric healthcare settings offer unique opportunities to address IPV. However, caregiver IPV disclosure may indicate escalated or severe abuse.¹⁵ Pediatric healthcare teams must take care to ensure that response to IPV disclosure does not further heighten risk. Pediatric clinical guidelines around IPV do address medical record-related risks, but were written before the widespread use of EHRs.^{16, 17} For example, these guidelines do not address potential implications of pediatric online health portals for IPV survivors. Guidance for pediatric providers on how the EHR may contribute to risks for caregivers experiencing IPV is needed to provide safe, family-centered care for IPV survivors and their children.^{16, 17} Therefore, the goals of this qualitative study were to: 1) explore pediatric EHR-associated risk for IPV survivors and their children and 2) identify strategies to mitigate this risk.

Methods

Study design

We conducted interviews with pediatric IPV experts, focusing on experts as a means to efficiently explore complex and sensitive topics.¹⁸ This work was part of a larger qualitative study centered on understanding power and control behaviors abusive partners use against IPV survivors in pediatric healthcare settings; more information about the larger study can be found elsewhere.¹⁹ This study was approved by our Institutional Review Boards.

Interview guide development

After conducting three interviews for the larger study, we identified EHR safety as an emerging theme. As scant literature exists on this topic, we expanded interview prompts to more specifically address use of EHR when caring for IPV survivors and their children in pediatric healthcare settings. These prompts centered around: 1) best practices for documenting about IPV in pediatric clinical notes; 2) areas apart from documentation which may create risk; and 3) documentation recommendations for pediatric healthcare providers. We revised the prompts based on feedback from an IPV advocate before their use.

Participants and recruitment

Individuals from diverse backgrounds (social work, medicine, public safety, advocacy) who self-identified as IPV experts and had worked clinically with IPV survivors in pediatric healthcare settings were eligible to participate.¹⁹ We used snowball sampling as a recruitment strategy; this method uses participant suggestions to identify additional potential participants.²⁰ Thirty-two participants total were contacted; four declined to participate.

Data collection

A study team member with qualitative expertise (KR, MR, LQ) conducted interviews (in person or via phone). Interviews were confidential, lasted 60 minutes, and were audio-recorded and transcribed verbatim. On average, participants spent around 15 minutes discussing the topics described in this article. Additional study findings on IPV power and control behaviors used in pediatric healthcare settings have been previously published.¹⁹ Participants received a $20 gift card after interview completion.

Data analysis

We used an inductive thematic analysis process.^{20, 21} Two team members (MR, KR) independently coded the first three transcripts line-by-line using the DeDoose qualitative software program,²² then met to compare coding and create a codebook. The remaining transcripts were each analyzed by 2 team members (MR, KR, LQ, or MS); the team met weekly to resolve discrepancies via transcript review and discussion. Upon completion of coding, KR compiled individual codes into larger themes which were reviewed and revised by the full team via discussion. To identify data saturation (i.e. the point at which no new codes emerged), data collection and analysis occurred concurrently.^{20, 23}

Results

We conducted 27 interviews among 28 participants; two hospital security officers at the same institution requested a joint interview. Participants included 12 IPV advocates, six medical social workers, three hospital security officers, and six pediatricians (general pediatrics, pediatric emergency medicine, child abuse pediatrics).

We identified four main themes: 1) potential risks of the pediatric EHR, 2) potential benefits of the pediatric EHR, 3) challenges to addressing IPV-related pediatric EHR risk; and 4) recommendations to mitigate risk. Themes and subthemes are summarized in Table 1, with illustrative quotes provided below. Supplemental quotes are provided in Table 2.

Table 1:

Themes and Subthemes

Theme 1: Potential risks of the pediatric EHR
Subthemes:	Abusive partners may access the pediatric EHR    Multiple types of information in the EHR may facilitate varied abusive behaviors
Theme 2: Potential benefits of the pediatric EHR
Subthemes:	Trauma-informed continuity of care    Communicate processes for safety    Repository for legal documents    Documentation as advocacy
Theme 3: Challenges to addressing IPV-related pediatric EHR risks
Subthemes:	Information in the EHR may confer both benefit and risk    Medicolegal aspects of documentation
Theme 4: Recommendations to mitigate risks
Subthemes:	Protect records from release    Careful attention to documentation    Confer with the IPV survivor    Educate the healthcare team

Table 2:

Supplemental quotes from participants

Theme 2: Potential Benefits of the EHR
Repository for legal documents	“Something I’ve heard time and time again is, like, ‘Well, if we don’t have the court order, you know, in the medical chart. If we don’t have a copy of that, if it’s not scanned in … we can’t know for sure.’” (social worker).
Theme 3: Challenges to Addressing IPV-related EHR Risk
Information in the EHR may confer both risk and benefit	“You want to put the information in because you don’t want things to get lost or fall off. At the same time, putting in all that information … has so much risk associated … Say I meet with someone in [the IPV program], talk to them about documentation, and they give their best practices. We follow that, of not giving out safety plans in documentation, not specifics, all that stuff. What does that mean for the impact of care? I might not be here one day, and they’re seeing a different social worker. Doctors are on rotations; residents are constantly on rotations.” (social worker)
Medicolegal aspects of documentation	“We had a case recently where the parent disclosed DV to us for the first time, and they had – they had an ongoing [child protective services (CPS)] worker but hadn’t disclosed it to the [CPS] worker. Didn’t want us to tell the [CPS] worker, for obvious reasons. And I think it was very high-risk, but we also felt that if the perpetrator of this [IPV] who’s also the father of three of these kids were to in any way get access to this information it would be incredibly dangerous for the parent. So, we kind-of reached a middle ground … And even that I felt was more than I would really want to put. But I also felt like we needed to be explicit about the fact the [CPS] didn’t know about this, that this was a new disclosure, and that we didn’t feel that there was a level of risk that required us to file a [hotline report]. Because God forbid something bad happens to the family and it looks like we didn’t report.” (pediatrician) “It’s complicated because a lot of what is driving this on the legal side, we don’t have access to that information, and I think we need to be careful not to discriminate against dads who come in, who say they have custody, and they justifiably have custody, and they deserve to have access to some of the information in the chart.” (pediatrician)
Theme 4: Recommendations to mitigate risk
Protect records from release	“We have specific notes that are flagged that need permission to be printed.” (pediatrician) “We had put a [flag] not only on the social work notes but on the entire visit … meaning this person, dad and anybody legally representing dad as an attorney, is unable to get these records.” (IPV advocate) “And so, at our hospital, we review – anyone that gets … referred [for IPV], we review their chart and addend the note so it gets protected.” (pediatrician)
Careful attention to documentation	“If it has nothing to do with why the child came in, we actually have coded language that we use here at [hospital] … It’s a very basic phrase that means something to us but doesn’t mean anything to the parent or other caregiver.” (IPV advocate) “If someone says, ‘I need you to not put this address in my child’s record,’ we really emphasize and teach providers to listen to them. Don’t just shirk that off. There’s a reason for that.” (IPV advocate) “Say, a five-year-old is on their bike and they fall and break their arm. That’s why they come into the emergency department. While they’re in the emergency department, their mom is screened and says I do want services for [IPV]. That should not go into the chart. It has absolutely nothing to do with why the child is there … In putting that in there, you’re not doing any good for that caregiver. You’re compromising their safety. Say the partner choosing to abuse does come in, does request the record … That could potentially really make a safety risk for that caregiver and potentially even that child.” (IPV advocate) “Which was completely eye-opening to me, coming from the adult world. It never occurred to me that that would be an issue. We asked screening questions freely, put it in the chart, never thought about it because our patients were adults. So, no one was going to have access to their chart. And now there’s this shared chart.” (IPV advocate) “If I partner with our advocates, our [IPV} advocates, through the safety and support team, I won’t document the plan they come up with the patient, where the patient’s going, or anything like that. I’ll keep it very vague, and they don’t document in [the EHR].” (social worker) “– making our words clinically related to the child and the impact on the child. And even if we are talking about the victim, within that to be able to make sure that we’re always tying it back to, ‘So, how does this impact the child?’” (social worker) “… if a child comes in as a direct result of an injury where something like that due to DV, we recognize that’s going to go in the chart. That is the direct cause for the reason the child is there.” (IPV advocate) “I actually think one of the biggest concerns I have is nursing typically tracks patients’ movements within the [IPV]. Like, ‘boyfriend at bedside,’ ‘social work to see,’ that kind of thing, ‘patient didn’t provide X, Y, Z,’ whatever little info. They do little status updates. I just wonder about the impact of some of those … I think there should be more research and attention to that.” (social worker)
Educate the healthcare team	“I don’t think social workers have really, as a discipline, as the National Association of Social Workers – I don’t think they have made sure that there’s training enough and dissemination of information enough to ensure that if notes were transparent, that social work was documenting in a way that was safe for everyone in the family.” (social worker)

Theme 1: Potential risk of the EHR

Subtheme 1a: Abusive partners may access the pediatric EHR.

Participants noted that the pediatric EHR creates risk for IPV survivors and their children because the abusive partner may access the child’s record. Abusers may access this information using both legal and duplicitous ways. A social worker shared about a particularly persistent abuser who as the biologic parent had legal access to the child’s EHR: “He requested the medical record over five times.” An advocate noted that abusive partners may access the EHR duplicitously through the “backdoor” when they are employed by the healthcare institution: “We’ve had situations where abusers were actually [working] within our systems … they can stalk and figure out where people are.”

Subtheme 1b: Multiple types of information in the EHR may facilitate varied abusive behaviors.

Information that creates risk is found in clinical documentation, as well as demographic and scheduling information in both the medical chart and online patient portal. Participants described varied abusive behaviors this information may result in, including stalking, discrediting the survivor, or increasingly severe abuse.

Access to demographic information in the EHR may compromise safety plans or be used to harass IPV survivors. A pediatrician shared that an abusive partner used the pediatric EHR to find out where the IPV survivor was living: “It wasn’t even about the medical record itself … It was specifically because [the abuser] didn’t know where the non-offending parent was. And so, they were able to get [the address] from the [child’s] record.” Participants described how the online portal component of an EHR create risks. An advocate noted that “[an abusive partner] having access to the [online] portal … You can see when the next appointment is … We had a situation where that happened, where the mom brought the child in. Dad showed up at the hospital.” A social worker described how an abusive partner used access to the online portal to harass his partner in multiple ways: “What he ended up doing was getting access to her [online portal] passwords, so he could see when all her appointments were, and he was showing up to the hospital and kind of stalking her … What he ended up doing was like changing the email address to being another one that he had made. So anytime you would try and reset the password, you couldn’t.”

Information in clinicians’ documentation may alert the abuser to disclosure of IPV. An IPV advocate cautioned, “If you have two parents who have access to the medical record and one of the parents disclosed intimate partner violence, and that’s, you know, documented in the chart, and the other parent requests a copy of it or has access to it, somehow pulls it up and sees that disclosure was made. That could potentially escalate violence or abuse.” Another advocate felt that risk due to healthcare provider documentation was sufficient to warrant routinely cautioning IPV survivors to be mindful of what they disclose to the pediatric healthcare team: “I always make sure to inform [IPV survivors] that they have to be careful to an extent to what they share with their children’s pediatric provider.”

Participants noted that information in the EHR may be used by an abuser to discredit the survivor. A pediatrician shared, “I’ve heard this a couple times. ‘I have proof that every time they come back from mom’s house, they always got something going on.’ And they do have proof. I mean, it’s very clear, and if you are a non-medical professional, you would notice a pattern … Oh, interesting. Every Sunday night this kid comes to the ER with a new illness, bed bugs, ringworm, all these things. These are signs of neglect and abuse.’” An advocate noted that EHR documentation “can often be flipped the other way or sort of made to look like they’re the exact opposite of what they are or in some way can hurt the client. Maybe they told their provider that something happened on the 24^th of last month, but it was really a week before that and they just didn’t remember because of trauma.”

Theme 2: Potential benefits of the EHR

Sub-theme 2a: Trauma-informed continuity of care.

Potential benefits of the EHR for IPV survivors included ensuring continuity of care between providers and between visits: “You want to put the information in because you don’t want things to get lost or fall off” (social worker). A pediatrician noted how IPV documentation may help provide trauma-informed care by decreasing the need for a survivor to recount their IPV: “You want to … not make parents who are experiencing [IPV] re-tell their story every time.”

Subtheme 2b: Communicate processes for safety.

Documentation in the pediatric EHR may also help ensure safety for the IPV survivor, their children, and the healthcare team. A security officer described how their notes may alert clinicians to potential issues related to IPV: “[Security] is the one who puts those notes in … [Clinicians will] see these notes and be more proactive than reactive that this is a potential problem, that the person may have an abusive partner.” A social worker shared how the EHR was used to communicate a plan for contacting the IPV survivor safely: “We had a patient who was in a pretty significant, very dangerous relationship … We put her [phone] number in place that had a note that said, ‘please only call on these days,’ when the partner was at work.”

Subtheme 2c: Repository for legal documents.

Including legal documents such as custody arrangements or orders of protection in the EHR may enable the healthcare team to consistently limit access to the healthcare campus or medical records. Documentation may also be used to provide evidence of child injury due to IPV, other impacts of IPV on the child’s health, or evidence of child abuse.

Subtheme 2d: Documentation as advocacy.

A social worker shared that she used EHR documentation as a mechanism for advocacy: “In that case, I actually documented more than I would usually because I looked at it as an advocacy opportunity. So, I used terms like, ‘Due to the dad’s withholding of the baby from the mother, she was unable to seek medical care after [the baby] being hit in the head.’ So, I did try to use that language that always tied the accountability back to the [abusive partner].”

Theme 3: Challenges to Addressing IPV-related EHR Risks

Subtheme 3a: Information may confer both benefit and risk.

Participants noted that at times the same information useful for continuity of care and safety also carries risk: “It’s very tricky, because you want to make sure that you’re putting something in the medical record that’s accurate and helping to keep both providers safe and children and the other partner safe, but also not putting too much information that it could potentially be used against them” (social worker).

Subtheme 3b: Medicolegal aspects of documentation.

Medicolegal concerns may complicate documentation when IPV is a concern. A social worker noted, “I think oftentimes providers document in essence not only for that footprint for patients’ ongoing care but also for protection for themselves and what they did and what information they know and that kind of thing … because there’s liability to the work we do and especially when safety is at the forefront of the concern, and especially with pediatrics … I think sometimes putting it all down can just be like an insurance policy for providers” (social worker).

Theme 4: Recommendations to Mitigate Risks

Subtheme 4a: Protect records from release.

Participants recommended mechanisms to protect the EHR from release, including flagging all/part of a chart as “confidential” and use of protected documentation templates that are not released when records are requested. A pediatrician shared, “We have tried to create … social work notes that are shadowed [not released with medical record requests] and then there are notes that can be redacted.” For online health portals, participants recommended note types that are not uploaded automatically into the portal and deactivating portal access if safety concerns exist about information contained in the portal. Participants also noted the need for formal processes to ensure records are released appropriately and safely.

Subtheme 4b: Careful attention to documentation.

Multiple participants commented on the need to be careful that documentation does not increase risk. Participants recommended use of non-specific or coded language, although also noted the need for more detailed documentation when IPV directly impacted a child’s health (e.g., child injured during physical IPV). Providers should consider risk vs. benefit when documenting information. A physician noted, “I think there just has to be more attention, for all of us, as to why am I putting this in the chart … How does this benefit anyone? Why would people need to know this? Will it cause substantial harm or risk to the child or parent … Could it cause substantial risk or safety concerns?” An advocate cautioned specifically against putting shelter information, such as name or address, in the EHR.

Subtheme 4c: Confer with the IPV survivor.

A social worker shared how she talks with IPV survivors about what is in the EHR: “She gave me her address and it was a safe address now. And I said, ‘Is it OK for that address to be in the chart?’ And she said, ‘Yes, … he knows that I’m living there … But I’ve worked very hard to find a daycare that he couldn’t find out.’ So, part of our documentation includes, ‘Does the child attend daycare? Include address and phone number.’ And, so, I didn’t.”

Subtheme 4d: Educate the healthcare team.

To ensure that available risk mitigation strategies are used effectively and consistently, participants recommended education about IPV-associated EHR risk and means to mitigate this risk, specifically for health information staff, social workers, and medical providers. Current knowledge and education were felt to be inadequate: “There needs to be more understanding of the impact of all that and how documentation should really look, a review of the literature, and then dissemination of what best practices should be” (social worker).

Discussion

Although professional consensus guidelines have addressed risk related to the pediatric medical record and IPV, to our knowledge, this is the first study to assess EHR risks in the context of supporting IPV survivors and their children in pediatric healthcare settings. It is critical to better understand this risk given the increased ease with which patients and their caregivers may access the medical record via the EHR, including online patient portals, compared to a paper medical record. In this qualitative study, we identified both risks and benefits of the pediatric EHR for IPV survivors and strategies to mitigate these risks.

IPV includes a wide array of abusive behaviors that enable an abusive partner to maintain power and control over their partner.^{24, 25} Prior studies describe abusive partners’ use of controlling behaviors in home, work, legal, and healthcare settings.^{19, 26–29} Our previous work highlighted how power and control behaviors may be used in pediatric healthcare settings; this included limiting healthcare access, manipulating the perceptions of the healthcare team, and controlling medical decision-making.¹⁹ Each of these behaviors may result in decreased quality of the care provided to children. This study broadens our understanding of the use of pediatric healthcare settings to facilitate IPV power and control by describing how abusive partners may gain and use information from the EHR to perpetrate abuse. Figure 1 summarizes our findings to highlight the ways in which abusers may misuse the EHR and strategies to mitigate pediatric EHR-related risks for IPV survivors and their children.

Figure:

Pediatric electronic health records and intimate partner violence: Access, consequences, and risk mitigation

The advent of the EHR, particularly the use of online patient portals, has significantly increased ease of medical record access and types of accessible information, compared to paper health records. Although the increased access afforded by online health portals may improve communication and empower patients and their caregivers, it also brings potential harms. This study identified information in online health portals that may create risk for caregivers experiencing IPV, including clinical notes, appointment schedules, and caregiver contact information. Previous work has highlighted challenges around documentation of sensitive information disclosed by caregivers in the context of open access to clinical notes.³⁰ Although such disclosures may be relevant to the child’s health status and treatment plan, documenting these disclosures could result in harm. For example, documentation may reveal sensitive information that the caregiver prefers to keep private, should either caregiver’s partner have legal access to the child’s EHR or upon such time that the child may access their own online health portal.³⁰ Our study affirms prior concerns that documenting IPV disclosure in a child’s health record may pose a safety risk for caregivers^{16, 17} and highlights the changing nature of this risk with the advent of online health portals. Further, this work expands our understanding of IPV-related EHR risk to include the potential for abusive partners without legal right to the health record to access the online health portal through tactics such as coerced password sharing.^{31, 32}

There are several clinical implications of our work. Studies have shown that when survivors seek help and accept referral to an IPV advocate, these may be signs of escalating abuse with a high degree of potential lethality.^{15, 33} Thus, when IPV disclosures occur in the pediatric health setting, providers and institutions should use utmost caution around EHR documentation, including use of confidential or sensitive note functions and input from the IPV survivor. Further, caregiver disclosure of IPV in a pediatric practice should prompt connection to victim service advocates who are experts in harm reduction and options for safety. Providers may consider embedding IPV-related resources with other social service information in the after-visit summary provided to families as a means of universal provision of resource information. Additionally, EHR documentation templates may serve as reminders to use an institution’s coded language for IPV. Institutions may also consider incorporating IPV-related EHR risks as part of new-hire training, commensurate with job role. Periodic ongoing education may enable healthcare team members who encounter IPV disclosures less frequently to adhere consistently to safe documentation practices. Ongoing education may also facilitate more nuanced practices, such as shared decision-making with caregivers around IPV documentation or the intentional use of documentation as a means of advocacy. Further, our findings suggest that considerations for EHR-related risk in the context of IPV should be expanded beyond clinical provider documentation. For example, access to demographic information or appointment schedules may facilitate intimate partner stalking.

Study findings are particularly relevant given the 21^st Century Cures Act.³⁴ The Cures Act aims to improve patient and family access to health records, with full access to the EHR slated for implementation in 2022. The Cures Act does, however, recognize eight exceptions for which denying EHR access would not constitute information blocking.³⁵ Denying EHR access due to IPV-related risks would fall under the preventing harm exception, which recognizes that withholding electronic health information may be necessary to prevent harm to a patient or another person. The Office of the National Coordinator for Health Information Technology provides additional clarification around exceptions to information blocking.³⁵ Multiple mechanisms may facilitate increased use of practices to safeguard information within the pediatric EHR in the context of IPV. As noted above, institutions could translate mechanisms currently used to ensure pediatric EHR confidentiality for other types of confidential and/or sensitive documentation to safeguard IPV documentation. EHR companies may facilitate increased use of such protections specifically for IPV documentation by including them in standard product packages. Further, creation of standard compliance policy to address IPV and the pediatric EHR, perhaps through an entity such as the Joint Commission, may also foster implementation of such practices. IPV documentation could also be included among criteria for voluntary certification of health information technology for pediatric clinical use as part of the 21^st Century Cure Act.³⁶ Although current EHR policy and recommendations do address the need for the pediatric EHR to facilitate documentation of complex family relationships as a component of family-centered care, the challenges of such documentation for families experiencing IPV have not specifically been addressed.^{5, 6, 37} Further, to our knowledge, commentary to date on the potential negative implications of the Cures Act within pediatric healthcare settings has not addressed the unique circumstance of IPV.^{38, 39} Professional policy statements and consensus recommendations on pediatric EHR functionality and implementation of the Cures Act should consider inclusion of IPV as a specific privacy concern scenario, as many have done for adolescent health records.^{5, 8, 9, 36, 40}

We recognize several limitations to this study that set the stage for future research. Our study population provided unique insights on EHR-related risks and benefits, but was limited to IPV advocates, clinical health team members, and hospital security. Future work should examine perspectives among IPV survivors, as well as professionals with legal, health information technology, and health policy expertise. We reached data saturation among our sample as a whole but may not have identified all themes among participant subgroups. As an initial study on IPV-related EHR risks, our findings are exploratory. Additionally, this study was conducted before institutions implemented changes in EHR access in 2021 to comply with the Cures Act. Further research is needed to identify best practices regarding pediatric EHR functionality in the context of IPV, particularly in the context of the Cures Act.^{5, 36}

Conclusion

Our findings suggest that the pediatric EHR may carry both benefits and risks for caregivers who have experienced IPV and for the medical teams providing their care. Future efforts should focus on developing pediatric EHR best practices in the context of IPV as well as inclusion of these as standard functionalities of the pediatric EHR and a standard component of education for members of the healthcare team.

What’s New:

The pediatric electronic health record, including clinical documentation, contact information, and online health portals, may be a source of both risk and benefit for intimate partner violence survivors and their children. Protected, minimal, and survivor-informed documentation may mitigate this risk.