21 Mar Implementing Your EHR: Does Practice Uniformity Matter?
As practices implement EHRs, many groups ask whether all physicians must or should use the same templates. The answer is more complex than it appears on the surface. One of the advantages of EHR technology is improve quality of care through clinical decision support. If there are recognized standards for care management, it is in the best interest of all involved that practices agree on how they will incorporate those standards.
For example, if a practice can agree that patients with a diagnosis of asthma should have an annual updated asthma action plan and spirometry, those items can be incorporated in templates and care plans. It then becomes easy to use the power of your system to recall patients who have not had their recommended care management performed.
One of the difficulties in Pediatrics is the lack of national recommendations of care for common conditions. There are well accepted standards for management of chest pain, heart disease and hypertension in adults. This is not as well standardized for pediatric otitis media, behavioral difficulties, or eczema. While general agreement regarding treatment may be helpful, having individual templates for each provider to use and the ability to customize according to style and preference is one of the hallmarks of a flexible Pediatric EHR.
Often physicians ask me about well child care. Here’s where I think uniformity matters most. Pediatric well care is one of the few places that there is a recognized, well-accepted standard of care: Bright Futures. Having well-visit templates that outline this standard of care to guide in management ultimately improves quality. We all know that it is impossible to discuss every recommended anticipatory guidance topic during the course of a visit. If well visit templates include patient education material to cover those topics, then each provider can decide what topics they like to highlight and patients still have access to the entirety of recommended information. If templates include recommended prompts to highlight exam elements such as hip exam or red reflex in an infant, and review of systems includes items such as dental care, then standardization improves both care and documentation for medical liability purposes.
Thoughtful well visit templates not only document review of systems and exam, but guide care. If one physician in a practice likes to administer an MCHAT at 18 and 24 months and another likes to do them at 18 and 30 months, it is more likely that this gets missed for any individual patient. If your practice routinely gives an MMR at age 15 months and you get a 10 PM call from a 15 month old patient with a rash and a fever, you will know to ask if they had an MMR in the past 2 weeks. Physicians should be able to personalize their note, but the framework for well visits should follow accepted guidelines.
To be most effective, a pediatric EHR should allow for flexibility in implementation of condition-specific templates, and at the same time should encourage harmonization to adopt well care templates based on Bright Futures standards.