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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Developmental Screening.

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Strategy. Enhanced Electronic Health Record Programs

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) https://www-sciencedirect-com.proxy.library.georgetown.edu/topics/medicine-and-dentistry/electronic-patient-record, many with an option to collect patient-recorded outcome measures. (PROMs) using tablets in the waiting room for 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 for during a visit and to obtain evidence of a completed screen for quality assurance for research purposes. Other enhancements include clinician reminders and adding referral options.[1]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

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. Here are sample ESMs to use as models 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?")

PROCESS MEASURES:

  • Number of pediatric clinics that implement EHR enhancements for developmental screening. (Measures the adoption and spread of the system-level intervention)
  • Number of clinic staff trained on using EHR-integrated developmental screening workflows and tools. (Measures the capacity building efforts to support effective EHR use)

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

PROCESS MEASURES:

  • Percent of developmental screening data entered into the EHR that is complete and accurate based on data quality audits. (Measures the reliability and integrity of EHR-based screening documentation)
  • Percent of abnormal developmental screening results automatically flagged and communicated to providers through the EHR. (Measures the effectiveness of EHR alert and messaging functions)

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

PROCESS MEASURES:

  • Number of pediatric clinics that establish interoperability between their EHR and regional early intervention and disability service data systems. (Measures the development of cross-sector EHR data exchange to support care coordination)
  • Number of quality improvement initiatives launched in pediatric clinics using EHR-based developmental screening data and analytics. (Assesses the use of EHR data to drive continuous practice improvement)

OUTCOME MEASURES:

  • Number of EHR-based developmental screening initiatives that demonstrate sustained improvements in screening rates and outcomes 6 and 12 months after implementation. (Measures the long-term impact and sustainability of the system change)
  • Number of children receiving early intervention and special education services who have a shared EHR-based care plan reachable to families and all providers. (Shows the impact of EHR tools on integrated, family-centered service delivery)

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

PROCESS MEASURES:

  • Percent of pediatric clinics implementing EHR-based developmental screening that serve Medicaid-insured families. (Assesses the reach and focus of the intervention)
  • Percent of EHR-based developmental screening data stratified by key characteristics for identification of gaps in care. (Measures the use of EHR data to uncover and address gaps in screening and outcomes)

OUTCOME MEASURES:

  • Percent reduction in gaps in developmental screening and referral rates after implementation of EHR-based tools and protocols. (Measures the intervention's impact on screening access and follow-up)
  • Percent of Medicaid-insured children in the community who receive recommended developmental screening and follow-up through EHR-enhanced pediatric clinics, compared to privately insured children. (Measures progress toward population health in early identification and intervention enabled by EHR systems)

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.
  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.

References

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.