Pediatric clinically integrated networks (CINs) continue to emerge in response to the move from fee-for-service to value based payments and as a mechanism to pull together disparate pediatric data across multiple hospital and provider practice EMRs for a complete longitudinal record to support the best care for children.
The inherent mission focus of children’s hospitals is to improve pediatric outcomes by taking a broad cross continuum role in managing the care delivery and overall quality of the care. The pediatric CIN is taking a leadership role in identifying and expanding evidence based pediatric models of care in the provider network, which are more successful with a solid technology foundation. In building the pediatric CIN, many information technology (IT) related factors are sometimes overlooked but must be considered including patient engagement of the child and family, beginning-of-life activities and transition to adult care.
Pediatric CIN leaders should focus on success in the following IT areas:
Metrics: Decide on metrics before a population health management (PHM) tool is implemented. IT implementation is successful when goals are in place with measurable milestones. There are few proven pathways including immunization schedules, high blood pressure and preventative cancer treatments for the pediatric population. One pediatric pathway is the Physician Asthma Care Education Program (PACE) and an available assessment tool is the Asthma Risk Score (ARS).
Enterprise Master Patient Index (EMPI): Prepare for a lack of aggregated data. Integrating CIN data from multiple EMRs and a payor is difficult, for example, matching the “Baby Boy Miller” data into one medical record with no SSN. Choose an enterprise master patient indexing algorithm with proven experience and success matching data when there are missing matching elements, such as: no SSN, multiple siblings at the same address with the same birth date and children born without a name.
Patient Engagement: Plan for marketing to and training of family members. When implementing a PHM tool for a pediatric CIN, implementing patient engagement tools requires more building, testing and family training because each state has an age whereby the patient can have access to the medical record without parent oversight, typically age 15 or 16. Portals, emails, text messages and other outreach are thoroughly tested to assure routing aligns with the child’s age and proxy.
Longitudinal Record: Plan for the continuation of the longitudinal record as the child matures to adulthood. The natural migration to internal medicine primary care requires pediatric CINs to team up with adult CINs for transitions when the patient is ready.
External Data Sources: Identify data sources to support a robust care coordination tool. The following plays a large role for children to make a difference in quality of care: data aggregation from hospitals, aligned but independent pediatric practice EMRs, aligned specialty practice EMRs such as pulmonary and ENT, payer(s), schools, the National Weather Service (i.e. pollen counts for asthma), state immunization records and public health offices.
Each of these success factors are planned for by an IT work group in parallel with network strategy leaders during the creation of the CIN. Data governance assures these key success areas are maintained through a PHM technology tool supporting operations with aggregated data, care management and analytics.
About the Author: Claudia Miller has directed healthcare IT projects for over 20 years. She has a deep appreciation for population health management, working with providers, and project management. She spoke at HIMSS14, HIMSS15 and HIMSS16 and her articles have been featured in JHIM, HIStalk, H&HN, CHIME and HIMSS C&BI. She earned a BS in Computer Science and an MBA at LSU.