Is a Pediatric Electronic Medical Record System Right for Your Practice?
An EHR/EMR that has been designed specifically for pediatricians will have a variety of pediatric-specific content, as well as a pediatric-specific workflow included in the product.
It is beneficial during the initial selection steps and during the eventual implementation of an EHR/EMR product to collect any forms, communication tools, and educational materials. This set of forms will help ensure that a similar tool is available and/or developed either by template or reports.
The EMR/EHR has the potential to streamline work processes and have a positive impact on office efficiency and quality. To get the most out of your EMR/EHR implementation, it is important to consider workflow redesign. Look for potential bottlenecks or inefficient processes in the paper graphics environment, and instead of duplicating these inefficient processes, look for an opportunity to complete a job redesign. It can be tempting to put job redesign on a to-do list, but carefully consider job redesign as part of the implementation phase. This method is usually less expensive and does not require another implementation phase in the future. Specific Pediatric EMR/EHR Features:
* Admission forms
* Demographics supporting various family structures
* Healthy child / Preventive
* Administration and management of vaccines
* Growth charts
* Genetic information, maintenance and reporting.
* School physical exam
* Physical Sport
* Physical Camp
* Physical Nursery
* Management of Reportable Communicable Diseases
* Child Abuse Reporting Forms
* Entry and tracking of referrals
* Orders, monitoring and maintenance of medications
* VIS (Vaccine Information Sheet)
* CDC link
* Flack pain scale
* Behavior tools
* ADD / HD Tools
* Age specific
* Birth Data
* Integration of instrumentation (vital signs, EKG, spirometry, etc.)
* Pediatric protocols for pediatric triage
* Patient Portals
* Pediatric specific templates
intake forms
Patient intake forms should be developed to flow well with template workflows. The system should be configured to allow pre-loading of the patient’s intake form prior to the visit to improve physician scheduling efficiency. Demographics Supporting Various Family Structures
The demographics that support various family structures, including adoption, stepchildren, foster care, child abuse, and single-parent homes, are valuable with a diverse population. It is strongly recommended that Pediatric EMR//EHR capture and protect sensitive child care information. Birth data
Birth data sections should contain appropriate fields for birth weight, birth complications, time and date of birth provided for ease of documentation. All components of the EMR must address specific age appropriate criteria. Immunization Management
The administration and management of immunizations is a necessary component of the pediatric EMR/EHR. The recommended immunization schedule should be a component of the EMR that allows alerts for immunizations due at the time of a visit and automation of reminder letters. A direct link to the CDC allows easy access to the recommended vaccination schedule and the ability to print VIS (Vaccine Information Sheets) at the time of vaccine administration or prior to scheduling vaccinations.
The printing of the VIS form should automatically document the fact that the VIS was printed for a particular immunization for a specific patient as required. The most efficient systems will accommodate obtaining the required parental authorizations in the exam room, preferably electronically. If electronic signature is not available, the minimum acceptable method would be to obtain a paper authorization and then scan the visitor. Immunization orders or templates must include all data necessary for administration of the immunization, including lot number, indicated site, and documentation of any reactions.
growth charts
Growth charts that accommodate preterm, infant, and child growth records should be available to the EMR. Height, weight, and other parameters to be measured should be easy to enter and are then automatically plotted on growth charts. Genetic information, management and reporting
A method for documenting genetic information that facilitates updating and maintenance can be highly beneficial. Reporting capability of set data fields is recommended. Physical Exams for Schools, Sports, Camps, and Daycares
Templates to capture the information needed for the physical visit to school, sports, camp, and daycare should be available for customization. It is strongly recommended to produce a form using the data in the template fields and/or the information stored in various sections of the EMR. This will save valuable time for the pediatrician by not having to fill out forms manually. Please contact local schools and/or state education offices for approval of any computer generated forms prior to use. The process to get the automated form approved by the appropriate school and/or state officials can take a considerable amount of time. Management of Reportable Communicable Diseases
Identification of reportable communicable diseases can be facilitated with a link to state health departments and the CDC. Management of reference requests
Reference request order entry allows tracking of all references from order to inquiry or result received. This is a limitation of liability process and can result in liability insurance cost savings for the provider. medication management
Drug prescribing information that offers dosing assistance to the pediatrician based on age and weight can save time and reduce the risk of medication errors. A system that facilitates the monitoring of refills improves care and alerts the pediatrician about allergies, reactions and drug conflicts in general. Electronic prescribing is important to comply with state and federal regulations. laboratory management
Laboratory fields, data, and workflows that enable easy order entry, results, and traceability are vital to satisfying liability concerns and maintaining compliance and quality of care. The ability to scan results, queries made off-site to capture all the data in the EMR, would be required. pain scale management
The inclusion of a standard pediatric pain scale ensures compliance with regulatory laws and patient rights. There are several pain scales, including those for children under 1 year of age and those for children over 1 year of age. These include NIPS, PPP, Riley, FLACC, Cries, Faces, Oucher, and others. Behavioral Health, ADHD, AUTISM Management
Data fields that supplement behavioral assessments for ADHD, autism, and other behavioral conditions should be included in the EMR/EHR system. Pediatric triage management
To enhance and facilitate established standards of care, appropriate knowledge-based pediatric triage material should be incorporated into the system or accessed via a link to the appropriate website. This will improve the conduct of phone calls within the office. Report generator, forms and questionnaires
All patient data is in the pediatric EMR and you need the information for various reporting and shipping purposes. A report, form and questionnaire generator will perform this necessary task for you. Capture the necessary information at the time of visits and then request the appropriate report, form or questionnaire to automate this process without double entry and/or manual writing of the forms. This includes the school physical, sports physical, camp physical, and other forms required for a specific visit. Document manager and photo manager
There is a growing trend to capture photographs of patients for inclusion in the patient record. The photo manager can provide for the capture or retention of these images.
The document manager would accommodate any forms needed for pediatric practice, HEDIS reporting forms, etc. Pediatric EMR/EHR Insoles
Pediatric-specific templates developed with the most efficient workflow of pediatricians will prove cost-effective. Below is a partial list of suggested EMR templates for the pediatric practice EMR.
* Food allergy
* Chest pain
* Correspondence (food allergy letters, metered dose inhaler note, school excuse)
* Ears: drainage, infection, ear pain, pressure in the ear, recurring ear infections and many more
* Conjunctivitis
* Fever
* Childhood fever
* Abdominal pain
* Appendicitis
* Constipation
* Reflux
* Vomiting/Diarrhea
* circumcision
* ITU
*Voice/speech disorder
* Throat infections
* Miscellaneous: anaphylaxis, adverse drug reaction, child abuse, juvenile dermatomyositis, physical sports 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
* ADD/ADHD
* Headaches
* Newborn visit
* asthma
* Cystic fibrosis
* rump
* upper respiratory
* Allergic rhinitis
* Sinus Infection, Sinusitis
* Skin: acne, atopic dermatitis, burns, insect bites, impetigo, rashes and more
* Viral infections: chickenpox, fifth disease, influenza, roseola, mononucleosis and more
patient portals
Patient portals allow providers to grant secure username and password patient access to information in the EMR via a web connection. Access is often granted for the following:
* Check appointment times
* Ask for a date
* Review laboratory results
* Review statements
* Request a prescription refill
* Complete new patient intake forms.
General considerations
All templates must be customizable. This may include making the links available to CDC and state agencies. Reports must also be customized to meet HIPAA reporting requirements, immunization reports, and various administrative reports.
An EMR that allows multiple methods of EMR input is optimal for facilitating various workflows. Methods could include templates, dropdown list, expandable text, speech recognition, transcription, handwritten electronic pen/pad, abstraction, and scanning.
In summary, selecting an EMR product for the pediatric office that addresses the specific workflow and components of care unique to the pediatric patient demographic will provide the greatest efficiency for the pediatric office. A checklist of features specific to pediatric EMRs would be a beneficial tool during the pediatric office’s EMR selection process.
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