Getting the Patient Voice Into the EMR: Using Patient-Completed Pre-Visit Tools to Customize Care

Sunday, October 16, 2011: 11:15 AM
109 (Boston Convention and Exhibition Center)
Christina Bethell, PhD, MBA, MPH, Pediatrics, OHSU, Child & Adolescent Health Measurement Initiative, Portland, OR, Colleen Reuland, MS, Pediatrics, OHSU, Oregon Pediatric Improvement Partnership, Portland, OR and John E. Kilty, MD, PhD, The Children's Clinic, Portland, OR

Purpose: To assess the feasibility and validity of an online, patient-completed tool for which results are inserted into the Electronic Medical Record (EMR) to ensure adherence to Bright Futures recommendations and to customize care to meet the patient and family needs.

Methods: An online, pre-visit tool (the Plan Your Child’s Well-Visit tool) was developed based on the Bright Futures (BF) recommendations for well-child care for children 0-3. Visit-specific versions of the tool were created. The first section focuses on child and family health screening (e.g. general questions about parental concerns and questions, developmental surveillance and screening, family risk assessment, and environmental risk factors); and the second section focuses on parent’s priorities for anticipatory guidance and parental education.  The online tool also gives parents access to education and resources as they complete the tool. Upon completion, the parent is given a "Visit Guide" to use at their child’s visit and receives an email with educational materials for topics that he/she selected as priorities for the visit. The results are automatically incorporated into the pediatric provider’s EMR forms and used by the pediatric provider to customize the visit.  This was accomplished by modifying the EMR to support alignment with the BF recommendations. The tool was implemented in a private-practice comprised of 12 pediatricians. Use of the tool began in July 2009 and results shown are based on data through March 2011 (N=1,400 completed tools). A survey was conducted of 12 pediatricians about the tool in April 2011.

Results: A response rate of 41% was obtained for the online tool. The median time for parent completion of the tool was 9 minutes. The results from the tool were feasibly and reliably transferred into the EMR. The tool was effective in standardizing screening for key risk factors not previously screened for (e.g. 20.7% reported depression symptoms, 9.5% reported alcohol abuse). The tool was also effective in providing developmental surveillance to identify children for whom developmental screening or targeted developmental promotion was needed (5.3%). On average, parents picked 2.3 anticipatory guidance and parental education topics for discussion. The provider survey found high acceptability and support for the tool. All (100%) of the pediatricians plan to continue to use the tool and reported that it improved their ability to provide recommended well-child care. Providers also noted a positive impact on the quality of care for children whose parents did NOT complete the online, pre-visit tool due to the improvements made in the EMR forms.

Conclusion: Pre-visit online tools can be effectively inserted into the EMR in a way that maximizes collaboration with the parent and the ability to provide patient-centered care.