P3.C054: Optimizing Well Child Care Using EHR Tools to ease provider documentation burden and automate evidence-based patient reminders

Background: The Texas Health and Human Services Commission recommends 27 well-child checks (WCCs) before the age of 18. WCC rates are suboptimal with Texas ranking 44 out of 50 states in completion rates. WCCs allow pediatricians to close care gaps in immunizations and complete recommended tests. However, it is often difficult to keep track of the evolving recommendations from multiple sources, and their completion is not consistent. Electronic health record systems offer tools related to provider reminder and recall, client reminders and provider order sets that can simplify provider documentation and assist in closure of these care gaps. Prior studies have shown that strong provider recommendation as well as patient reminders increase rates of WCC completion. To ease provider documentation, help with clinical decision making, and patient reminders, we leveraged EHR tools to improve WCC completion rates and reduce manual labor resources.

Methods: This project leveraged technology tools to improve the delivery of WCCs. The target population was all primary care pediatric patients within our large multi-site organization. Patient-facing technical enhancements included actionable electronic outreach messages, electronic scheduling of WCC, and notification via portal of incomplete preventative care tasks. The outreach messages targeted patients aged 3-17 and included provider recommendations for a WCC and any open care gaps. Provider utilized tools, including 20 age-specific note templates, 4 order sets, and several trackable data elements. These tools were automatically suggested to all providers who complete WCCs.

Results: Throughout implementation, we have reached out to 24,361 patients with actionable portal messages. Of those messages 6.58% scheduled preventative care. A total of 1,911 patients completed a WCC after an outreach receiving an electronic reminder. This has saved us over 812 hours in pre-visit call time.

The WCC note templates have been used on average 2,333 times per month. The physical activity and nutrition counseling discrete data elements within these templates helped us to meet reporting metrics required by several insurance payors. In addition, the reporting elements with the Well-Child HEADDS note template allowed us to improve our completion of the TIPPS metric requirement for tobacco counseling and sexual activity documentation. Over the previous year, the order sets have been used 23,372 times, allowing us to complete more comprehensive preventative care.

Conclusion: Technology is a valuable tool to improve the delivery of preventative well-child care. Automating actionable patient outreach messages can benefit both patients and organizations by increasing completed WCCs and decreasing staff input time. Provider facing clinical decision support comes in many varieties and can be easily used as a reminder to standardize routine care. Multi-stakeholder buy-in is critical to implementation of a program that influences so many aspects of the patient and provider experience.