Modifying electronic health record software can help catch early signs of childhood obesity, problems with oral health, vision, and hearing, and the risk of developing autism, expert says.
Electronic health record software has not met some pressing needs of pediatricians.
After years of federally funded studies of the problem, and few meaningful actions as part of meaningful use, it's time for a change.
One healthcare organization has identified pediatricians' biggest EHR pain points and is working to improve the situation.
"The biggest gaps that we found were largely around developmental screening and follow-up," says Kern Eason, pediatric EHR consultant at Community Care of North Carolina, a group of 14 physician practice networks in the state of North Carolina.
"A lot of what pediatrics is about is not so much dealing with acute episodes of care. Especially in the ambulatory setting, it's [about] preventative [measures]."
Modifying EHR software and its decision-support elements, would help catch early signs of childhood obesity, problems with oral health, vision, and hearing, and the risk of developing autism, Eason says.
"The idea is to catch it early," he says. "Adults come in for one visit a year, whereas very young kids have two or three visits with their primary care physician a year."
And systems designed for adults, aren't entirely suitable for children. EHR-prompted adult screening questions such as smoking status need to be deemphasized before patients reach their teenage years, he says.
Instead, EHR prompts for topics such as nutrition and car seat safety can make a big difference, developmentally, he says.
In addition, pediatricians calculate childhood body mass index very differently than they would calculate adult BMI. "A system that measures body mass index using adult metrics is going to be completely off for a child," Eason says.
"The same [is true] for blood pressure percentiles, [which are] completely measured differently in the pediatric world."
Even a task as simple as calculating the appropriate dose of medication for a child can necessitate a pocket calculator. "It's just not real safe, so we're working on making sure that some of those core things that improve care and make care consistent are built into EHRs," Eason says.
Funded by a Federal Grant
This work predates meaningful use, and CCNC was working on it as early as 2010. Stage 1 of meaningful use contained almost no pediatrician-specific quality measures, and stage 2 and stage 3 added just a few, Eason says.
Under a grant from the federal program administering the Children's Health Insurance Program Reauthorization Act (CHIPRA), a program that provides health insurance to children enrolled in Medicaid and the Children's Health Insurance Program program, CCNC worked with pediatricians, EHR vendors, and practice staff to define what it calls a "Model EHR Format" for pediatrics.
North Carolina was one of 18 states awarded this CHIPRA federal grant. CCNC manages care for all Medicaid beneficiaries in the state.
As its starting point, the CHIPRA grant work done by CCNC and other grant-recipient researchers in Pennsylvania took a pediatric EHR gap analysis done in 2009 by Duke University and Intermountain Health and began to look for a subset which addressed the major pain points of pediatricians.
The early work did not give much guidance for what specific improvements could be made in EHRs, Eason says.
Next Steps
Over the course of 2010 to 2015, the grant from CHIPRA allowed CCNC to interact with physicians, hospitals and EHR vendors.
Due to the differing provider mixes in the two states, hospital feedback came primarily from Pennsylvania, and small physician practice feedback came more from North Carolina, Eason says.
The final report, released last November by AHRQ, is spurring efforts on two fronts:
- It is informing pediatric workflows for EHRs being scoped out by a workgroup involving the American Academy of Pediatrics, as well as HL7, Eason says.
- More importantly, it will give all providers something to lobby their EHR software companies to follow through on and implement.
"The biggest driver is rules for pay-for-performance, and the payment system is really going to incentivize practices to say, 'this is what we must have to be viable and to succeed in the new world,'" Eason says.
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.