Is a Pediatric electronic medical record system most appropriate for your office?
An EHR / EMR that has been designed specifically for Pediatricians will have a variety of Pediatric specific content as well as Pediatric specific work flow included within the product. Be sure to look for this when evaluating Pediatric EMRs.
It is beneficial during the initial steps of selecting and throughout the eventual implementation of an EHR/EMR product to gather any forms, communication tools, and educational material. This set of forms will assist in assuring a similar tool will be available and/or developed either by template or reporting. There will be many changes that are required during the implementation of an EHR, including in a Pediatric office, and minimizing the disruption can be very helpful.
The EMR / EHR has the potential to streamline work processes and have a positive impact upon office efficiency and quality. To gain the most with the implementation of the EMR / EHR it is important to look at work flow redesign. Look at potential bottlenecks or inefficient processes in the paper chart environment and rather than duplicate these inefficient processes look for the opportunity to complete a work redesign. It may be tempting to put the work redesign on a to do list but closely consider work redesign to be a part of the implementation phase. This method is usually less costly and does not require another implementation phase going forward. You should very carefully question your prospective EMR vendor to determine if they have incorporated a variety of Pediatric specific workflows into their system. For instance, are ages only in years, or do you have the ability to determine ages in hours, days, weeks and months in addition to years? Are dosing models consistent with taking care of a pediatric patient population?
Pediatric Specific EMR/EHR features:
- Intake forms
- Demographics that support various family structures
- Well child / Preventative
- Immunization administration and management
- Growth Charts
- Genetic information, maintenance, and reporting
- School Physical
- Sports Physical
- Camp Physical
- Daycare Physical
- Reportable Communicable Disease management
- Child abuse reporting forms
- Referral entry and tracking
- Medication orders, tracking, and maintenance
- VIS (Vaccine Information Sheet)
- CDC link
- Flack Pain scale
- Behavioral tools
- ADD/HD tools
- Age Specific
- Birth Data
- Instrumentation integration (vital signs, EKG, spirometry, etc
- Pediatric protocols for pediatric triage
- Patient Portals
- Pediatric Specific templates
Patient intake forms should be developed to flow nicely with the template work flows. The system should be set up to allow for preloading of the patient intake form prior to the visit to enhance physician schedule efficiency.
Demographics That Support Various Family Structures
Demographics that support various family structures including adoption, step-children, foster care, child abuse, and single parent homes is valuable with a diverse population. It is highly recommended the Pediatric EMR//EHR capture and protect sensitive childcare information.
Birth data sections should contain appropriate fields for birth weight, complications at birth, time and date of birth provided to facilitate documentation. All components of the EMR should address appropriate age specific criteria.
Immunization administration and management is a necessary component of the Pediatric EMR / EHR. The recommended immunization schedule should be a component of the EMR enabling alerts for vaccinations due at the time of a visit and an automation of reminder letters. A direct link to CDC allows easy access to the recommended vaccination schedule and ability to print VIS (vaccine information sheets) at the time of vaccine administration or prior to scheduling immunizations.
Printing the VIS form should automatically document the fact the VIS for a particular immunization was printed for specific patient as required. The most efficient systems will accommodate obtaining any parental authorizations required in the exam room preferably electronically. If electronic signature is not available the minimal acceptable method would be obtaining a paper authorization and then scanning to the visit. Immunization orders or templates should include all data required for administration of the immunization including lot number, site given, and documentation of any reaction.
Growth charts that accommodate preterm, infant, and child growth records should be available for the EMR. Height, weight and other parameters to be measured should be easy to enter and then automatically plotted on the growth charts.
Genetic Information, Management and Reporting
A method to document genetic information that facilitates updating and maintenance can prove very beneficial. Reporting capability from the established data fields is recommended.
School, Sports, Camp, and Day care Physicals
Templates to capture the needed information for the school, sports, camp and daycare physical visit should be available for customization. Producing a form using the data in the template fields and/or information stored in various sections of the EMR is highly recommended. This will save valuable pediatrician time by not having to fill out forms manually. Contact your local schools and/or state educational offices to obtain approval of any computer generated form prior to use. The process to get the automated form approved by the proper school and/or state officials can take a considerable amount of time.
Reportable Communicable Diseases Management
Identification of reportable communicable diseases can be facilitated with a link to state health departments and the CDC.
Referral request Management
Referral request order entry allows for tracking of all referrals from order to consult or result received. This is a liability limiting process and can result in liability insurance cost savings to the provider.
Medications prescribing information offering dosing assistance to the pediatrician that is age and weight based can save time and reduce risk of medication errors. A system that facilitates tracking of refills enhances care and alerts to the pediatrician to allergies, reactions, and medication conflicts in general. E-prescription is of importance to meet compliance with state and federal regulations.
Laboratory fields, data and work flows that allows for easy entry of orders, results and tracking ability are vital to meeting liability concerns and maintaining compliance and quality care. Ability to scan results, consults, performed outside of the facility would be necessary to capture all data in the EMR.
Pain Scale Management
Inclusion of a standard pain scale for pediatrics assures compliance with regulations laws and patient rights. There are various pain scales including those for children under age 1 and those over age 1. These include NIPS, PPP, Riley, FLACC, Cries, Faces, Oucher, and others.
Behavioral Health, ADHD, AUTISM management
Data fields complementing behavioral assessments for ADHD, Autism, and other behavioral conditions should be included the EMR/EHR system.
Pediatric Triage Management
To enhance and facilitate established standards of care appropriate knowledge based pediatric triage material should be built into the system or accessed via a link to the appropriate website. This will improve the phone call conduct within the office.
Report, Form, Questionnaire Generator
Patient data is all in the Pediatric EMR and you need the information out for various reporting and submission purposes. A report, form and questionnaire generator will accomplish this necessary task for you. Capture the necessary information at the time of the visits and then request the appropriate report, form or questionnaire to automate this process without double entry and/or handwriting the forms. This includes school physical, sports physical, camp physical, and other forms needed for a specific visit.
Document Manager and Photo Manager
There is a growing trend to capture photos of patients for inclusion in the patient record. The photo manager can provide for capture of retention of these images.
The document manager would accommodate any forms needed for the Pediatric practice, HEDIS reporting forms, etc.
Pediatric EMR / EHR Templates
Pediatric specific templates developed with the Pediatricians most efficient work flow will prove to be cost efficient. A partial list of suggested EMR templates for the Pediatric Practice EMR is noted below.
- Food Allergy
- Chest Pain
- Correspondence (food allergy letters, metered dose inhaler note, school excuse)
- Ears – Drainage, infection, ear pain, ear pressure, recurrent ear infections, and many more
- Infant Fever
- Abdominal Pain
- Voice/Speech Disorder
- Throat Infections
- Miscellaneous – anaphylaxis, adverse drug reaction, child abuse, juvenile dermatomyositis, sports physical, and more
- Musculoskeletal – ankle sprain, elbow injury, foot pain, knee injury, shoulder injury, low back pain, and more
- Postnasal drainage
- Nasal Foreign Body
- Nasal Obstruction
- Newborn Visit
- Cystic Fibrosis
- Upper Respiratory
- Allergic Rhinitis
- Sinus Infection, Sinusitis
- Skin – acne, atopic dermatitis, burns, insect bites, impetigo, rash, and more
- Viral Infections – Chicken pox, fifth’s disease, influenza, roseola, mononucleosis, and more
Patient portals allow providers to grant patient access using a secure username and password to information in the EMR through a web connection. Access often is granted for the following:
- Check appointment schedules
- Request an appointment
- Review lab results
- Review statements
- Pay bills
- Request a prescription refill
- Complete new patient intake forms.
All templates should be customizable. This can include making links available to CDC and state agencies. Reporting should also be customized that meets requirements for HIPAA reporting, immunization reporting, and various administrative reporting.
An EMR that allows for multiple methods of entry into the EMR is optimal to facilitate various work flows. Methods could include templates, down drop list, expandable text, voice recognition, transcription, handwritten electronic pen/pad, abstraction, and scanning.
In summary, selecting an EMR product for the Pediatric office which addresses the specific work flow and care components unique for the Pediatric patient demographics will provide the most efficiency for the Pediatric office. A Pediatric EMR specific feature check list would be a beneficial tool during the Pediatric office EMR selection process.
Do you need help selecting a Pediatric Electronic Medical Record?