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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. NPM 6: Developmental Screening

MCHbest Logo toddler and doctor playing with their noses

Strategy. Enhanced Medical Records

Approach. Support additions to the electronic health record system in pediatric clinics.

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Overview. The widespread implementation of electronic medical records (EMRs), many with an option to collect patient-recorded outcome measures (PROMs) using tablets in the waiting room or online pre-visit, represents a significant advance over previous paper-based approaches. It is now possible to upload scores to the patient's EMR for the clinician to review prior to or during a visit and to obtain evidence of a completed screen for quality assurance or research purposes. Other enhancements include clinician reminders and adding referral options.1

Evidence. Moderate. Programs based on this strategy are likely to work, but further research is needed to confirm effects. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Health Care Practices.

Outcomes. Enhanced medical record systems improve rates of developmental screening and referrals in pediatric clinics.

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Support multicomponent interventions led by nurse practitioners to improve access to preventive services for women in health care settings,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

QUADRANT 1:
Measuring Quantity of Effort ("What/how much did we do?")

  • Number of pediatric clinics participating in enhanced medical record programs.

QUADRANT 2:
Measuring Quality of Effort ("How well did we do it?")

  • Percent of pediatric clinics participating in enhanced medical record programs.

QUADRANT 3:
Measuring Quantity of Effect ("Is anyone better off?")

  • Number of children referred and receiving services.

QUADRANT 4:
Measuring Quality of Effect ("How are they better off?")

  • Percent of children referred and receiving services.

Note. When looking at your ESMs, SPMs, or other strategies: (1) move from measuring quantity to quality; (2) move from measuring effort to effect; (3) Quadrant 1 strategies should be used sparingly, when no other data exists; and (4) the most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

Reference:

1 Murphy, J. M., Stepanian, S., Riobueno-Naylor, A., Holcomb, J. M., Haile, H., Dutta, A., ... & Jellinek, M. S. (2021). Implementation of an electronic approach to psychosocial screening in a network of pediatric practices. Academic Pediatrics, 21(4), 702-709.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.