You are proud of the care you are providing for your patients, but you wish there were a simpler and more efficient way to manage their records and information. You wish there were a more efficient way to manage your practice so that you could focus more time and attention on patient care and less on practice care.
Pediatric healthcare professionals today must focus not only on the health of children, but their entire well-being. This includes all aspects of a child’s health: cognitive health, immunizations, relationships, behavior, and emotional health. This is the core purpose of team-based care:
Team-based care is a health care model that endorses the partnership of children and families working together with one or more health care providers and other team members across multiple settings to identify, coordinate, and address shared goals that meet the needs of the whole child. Team-based care is considered a foundational element of the patient-centered medical home. The AAP conceptualized the medical home in 1967 and first defined it in a policy statement in 1992. The medical home focuses on building a team of professionals responsible for coordinating a patient’s care across the health care continuum and through the changing health care needs that occur from early infancy to adulthood.1
It may well be that the reason your practice is not doing as well as you think it could, (and why you are feeling overwhelmed with practice care) is that you are not using the best tool for the job.
Unfortunately, many pediatric practices that adopted an adult-centric EHR solution (for a myriad of reasons) have found that those solutions simply do not work for pediatric practices. As their practices evolve and they become more familiar with EHR solutions, many have begun the transition and have discovered the numerous benefits of a pediatric-specific EHR.1
Figure 1 presents some of the high-level functionality that a pediatric-specific EHR solution offers. But what do those features mean in the real world, to real workflows, and for real pediatric practices? Let’s take a closer look at some of those features and the more salient benefits they have for pediatric practices.
The features listed in Figure 1 can be grouped into four functional benefits that have an immediate and direct impact on pediatric practices:
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Decision Support is what puts the right information in front of the user at the right time to do what’s best, based on evidence-based guidelines. Most adult-centric EHRs do not remind the provider, for example, to perform a lead test at the 12-month appointment as part of routine care. The adult-centric EHR will likely provide no warning when entering a blood pressure of 120/80 for an adult patient since that is considered normal, but that is considered high for a 10-year old patient. Failure to display a warning when entering those vitals could be dangerous to that child.
Some adult-centric EHRs round off a patient’s weight to the nearest pound. This type of calculation would indicate a baby with a birth weight of 8.6 pounds who lost 2 ounces on the first day (a normal occurrence) as dropping from 9lbs to 8lbs, which could inaccurately flag a medical concern. A pediatric-specific EHR uses precise measurements for vitals and only issues warnings based upon pediatric-centric standards.
Under normal circumstances, Well Visit forecasting and scheduling in adult-centric EHR solutions indicate Well Visits on a yearly or perhaps biannual basis. Pediatric-specific EHR solutions use templates such as Bright Futures to forecast and schedule Well Visits consistent with Bright Futures periodicity guidelines.
Immunizations are one of the most important elements of pediatric care. Having immunization decision support that considers the full complexity of the ACIP immunization schedule minimizes missed opportunities to give appropriate vaccinations and keeps children healthy.
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Unlike adult-centric EHR solutions, pediatric-specific EHRs provide screening tools and questionnaires specifically designed for pediatric patients and their families. These include screening tools for Maternal and Adolescent Depression and Oral Health Risk Assessment. Full integration with CHADIS allows providers to use a large selection of pediatric-centric CHADIS surveys including: Family/Environment, ADHD, Development and Autism, Adolescent Self-Administered, Child Mental Health, and Medicaid/AAP Recommendations.
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Perhaps one of the most overlooked aspects of a pediatric-specific EHR solution is its ability to support complex family relationships. In essence, a pediatric patient has three “families”:
For some patients, all three of their families are composed of the same people. For others, they have distinct Social, Genetic, and Financial families. Adult-centric EHR solutions were built on the premise that each patient has one family that gave birth to them, cares for them, and is financially responsible for them.
Unfortunately, in pediatrics, family relationships are not always this cut and dry. A robust pediatric-EHR solution is not only able to handle all family types, but also capable of easily associating these family types with the patient and other family members at the practice. For example, if the biological parent has just been diagnosed with skin cancer, updating that information on one biological child’s chart will automatically update the charts of the other genetically related children. Pediatricians and their staff do not have to go in and update each chart separately as they would with an adult-centric solution.
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Another area where adult-centric EHR solutions are letting down pediatric practices is the support for a particularly sensitive area of pediatrics: adolescent care.
Adult-centric EHR solutions often not only do not provide specific functionality for adolescent care, many actually disable some of that functionality for adolescents. For example, some adult-centric EHR solutions disable patient-portal access for patients when they reach 13 years of age. They do so because the pediatric records of adolescents may contain privacy-protected information such as STD and pregnancy tests and results. Adult-centric EHR solutions do not have a way of keeping end-users other than the patient (such as parents and guardians) from accessing this information, so they simply disable access.
Pediatric-specific EHR solutions allow practices to identify entire classes of labs and medications as confidential. In addition, specific counseling, notes, or sections of the patient chart can be protected from global visibility. This means that only those that are given permission to access specific information, both inside the office and from without, are able to see it, ensuring sensitive information remains protected.
These clinical and patient-centric functionalities in a pediatric-specific EHR lead to better healthcare and a better experience for providers and staff, for the overall practice, and especially for patients and their parents and guardians. But what about the financial health of your practice?
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If you own a pediatric practice, you are not only a pediatrician, you are also an entrepreneur. However, most medical schools do not cover the business aspect of running a practice. As many pediatricians know, pediatricians, unfortunately, are among the lowest paid specialties. While many practice owners are profitable and make a good living, most are not optimized for financial success. It is critical that you take the financial health of your practice seriously and, like all entrepreneurs who want to be successful and to remain independent, do all that you can to maximize the revenue and reduce overhead.
Robust financial health for your pediatric practice begins with a pediatric-specific EHR. “Well-rounded,” adult-centric EHR solutions are not customized for pediatric practices. As a result, the “soft costs” associated with creating and following complicated workarounds and not having pediatric-specific functionality deprive practices of the time they could spend attending to other concerns and by not having the payment and billing functionality that they need to maximize efficiencies while reducing overhead.
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One of the most important features to look for when considering a pediatric-specific EHR is adopting a solution that combines EHR data and Electronic Practice Management (EPM) data – including clinical information, provider orders, billing and payment data — in the same database. Having combined EHR and billing information in a single database allows for linked clinical and financial information and makes it possible for a pediatrician to perform detailed searches quickly, such as: “List all patients that had in-house labs that I did not bill for.”
Being able to perform cross-searches between EHR and EPM data allows practices to catch those instances where the practice did not add a CPT to the visit, or pass the CPT code along to the superbill. Even if your practice fails to bill only 1 percent of the time, that 1 percent can add up to a substantial loss of revenue. Unfortunately, the failure-to-bill rate is often higher than 1 percent for many practices. Without a combined EHR/EPM pediatric-specific solution, the only way for practices to cross-search this type of information is to download the data from both databases into a spreadsheet and to compare the datasets externally in that spreadsheet. This is time-consuming, tedious, and prone to errors and oversight and places an excessive burden on providers and staff.
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Your practice may have opportunities for significant additional payments related to reporting. You may receive reimbursements for submitting data to state and federal agencies (for example, immunizations and lead tests). However, many practices find that the time and cost of generating and submitting those reports removes any profit margin.
A pediatric-specific EHR usually includes automated and customizable reports for exactly this type of state and other data submissions. For example, the pediatric EHR solution allows you to run a report from the EHR with the parameters such as lead testing for Medicaid patients, newborn screening to the state or quality metrics to other outside entities.
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Another option that some vendors of pediatric-specific EHR solutions offer is outsourced billing. Pediatricians provide a high volume of services at low costs, resulting in razor-thin profit margins. Pediatric billing services have teams of billing experts who understand this and other nuances of pediatric billing, including the complexities of Medicaid regulations and reporting. This enables the pediatricians they work with to collect more of what they’ve rightfully earned. In addition, outsourcing billing frees staff to focus on improving the practice experience and bottom line. Individuals who were once focused on billing can now concentrate on recalling patients for vaccines, which is an important revenue stream for practices.
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If mismanaged, vaccines can quickly turn from a source of revenue to a money-losing proposition. Having just in time inventory allows the practice the opportunity to forecast and purchase what they will need to serve their patients in the upcoming weeks. Running out of vaccine and missing opportunities for immunizations while the patient is in the office is not optimal care and requires an inconvenience for the family and the patient. On the other hand, having significant monies tied up in inventory in the refrigerator that is not being administered to patients ties up cash flow that can be better used for other purposes.
Pediatric EHR solutions that integrate lot management for Vaccines for Children (VFC) eligibility reduce the paperwork and eliminate the workaround methods that practices using a “well-rounded” EHR struggle with in order to maintain VFC-eligibility data. This EHR-centric functionality also reduces errors – errors which are costly in terms of time and revenue to correct – and thus reduces the strain on Providers and Staff.
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If you are trying to make do with a “well-rounded” EHR solution developed for practices that focus on adult patients, not only are you contending with a lack of critical functionality, ease-of-use, and lost revenue, you are also missing out on being a part of the pediatric community. The top five adult-centric EHR vendors pay little attention to the pediatrics market share and therefore offer neither pediatric support nor access to the pediatric community. It is difficult enough to thrive in pediatrics. Going at it alone sets the odds against you and your practice.
By adopting a pediatric-specific EHR solution, especially one that is created by pediatricians, for pediatricians, you deploy not only the best tool for the job, but you also engage the entire community of pediatricians. This includes a network that ranges from online forums to annual user conferences. At these user conferences, vendors and hundreds of practices and pediatricians collaborate to share tips and tricks and help to establish and communicate best practices to ensure the most successful and healthy practices possible.
EHRs are largely the result of physicians pursuing the Triple Aim for optimizing health system performance: enhancing patient experience, improving population health, and reducing costs. However, a fourth aim has been added to the original three: “improving the work life of healthcare providers, including clinicians and staff.”3
Nothing gives you a better chance of success – and nothing helps to nurture a healthy practice pursuing their mission — quite like a community of thousands of like-minded practitioners working together to improve pediatrics.
Today’s pediatricians provide more than medical diagnosis and treatment. They provide a complete array of services to ensure the overall physical, mental, and emotional health of their pediatric patients. Like any business that plans to thrive and to remain independent, this requires providing your parents/guardians with the best service possible.
In the past, patients were hesitant to change from one physician/practice to another. It was not uncommon for the same physician to treat two to three generations of the same family. However, recent studies suggest that millennials are changing doctors and practices with increasing frequency.
Adopting the best technology and improving the overall wellbeing of your practice simplifies your daily workflows, improves your financial health, and improves the climate of your practice. These healthy changes help to create a high-quality and caring experience that parents/guardians value and therefore increase patient retention.
This paper has discussed just a few of the practical, real-world, real workflow reasons why pediatric practices should consider adopting a pediatric-specific EHR solution. In discussing both the clinical and financial advantages to such a solution, this paper has mentioned reducing the strain on the providers and Staff at your practice and improving the overall wellbeing of your practice. As today’s pediatricians address the overall wellbeing of their patients (including their physical, cognitive, and emotional health), so they must also focus on the financial strength of the practice and on reducing the stress and strain put on their staff by not employing an EHR-specific solution.
In short, you didn’t go into pediatrics because you expected to make a lot of money. You did this for your love of children. You deserve a tool that allows you to love what you do and serve your patients and their families well.
Office Practicum is a leading provider of pediatric-specific solutions. Our EHR, PM system, and billing services help pediatric practices improve clinical and financial outcomes. Contact us today to learn more.
Endnotes
1 Julie P. Katkin, Susan J. Kressly, Anne R. Edwards, James M. Perrin, Colleen A. Kraft, Julia E. Richerson, Joel S. Tieder, Liz Wall. August, 2017. Guiding Principles for Team-Based Pediatric Care. Task Force on Pediatric Practice Change. Available at: http://pediatrics.aappublications.org/content/pediatrics/early/2017/07/19/peds.2017-1489.full.pdf
2 Agency for Healthcare Research and Quality, Effective Healthcare Program. August 2014. Core Functionality for Pediatric Electronic Health Records. Available at: https://effectivehealthcare.ahrq.gov/topics/pediatric-ehr/research-protocol.
3 Thomas Bodenheimer and Christine Sinsky. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine.Available at: http://www.annfammed.org/content/12/6/573.full.
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