Next-generation tools for the next generation

Dan Finkelstein, MD, FAAP , Capitol Medical Group Pediatrics

This column is part of a series of firsthand physician accounts that detail how AMA medical group partners are moving medicine to support patient health and the medical profession.

As a practicing pediatrician for more than 20 years, I’ve seen not only generations of patients, but new generations of technology. Children I once treated are now the parents who bring their children into my practice. Similarly, I’ve seen technology grow—or rather, shrink—to the point where a patient’s entire, lifelong medical history is available in the palm of my hand.

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Electronic health records (EHRs) are a major part of a physician’s daily workflow. Whether they’re a major help or a major obstacle depends on many factors. However, I’ve found that many EHRs are not designed for or by pediatricians. Too often we’re left out of discussions of clinical informatics, which has consequences for our ability to efficiently care for our patients and their families. In order to most effectively care for our patients and manage relationships with parents, pediatricians should look for the following features in their EHR:

  • Patient portal integration: Parents can utilize a patient portal to securely message physicians and providers, pay bills, review test and lab results, schedule appointments, receive reminders for well-child visits and vaccinations. Housing these capabilities within the EHR helps centralize information so that it is complete and easily accessible.
  • Telehealth synchronization: As telehealth booms in the wake of the COVID-19 pandemic, we’ve seen firsthand how effective this technology is in medicine. For pediatricians, some of the primary applications include behavioral health, nutrition counseling, chronic care management and more.
  • Social determinants of health and family dynamics: Factors such as housing security, access to food, education, social support and more have a profound impact on children’s development. According to the Children’s Hospital Association, “The consequences of these issues limits the impact of the medical care being provided, affecting the family’s engagement and the child’s overall health.” An EHR should have inbuilt capabilities to monitor these factors for both children and parents/guardians as well as the ability to duplicate this data for siblings to streamline physician workflows.
  • Specialty-specific interfaces: Interfaces and templates, including the Bright Futures Guidelines by the American Academy of Pediatrics (AAP), may include support for measuring vital signs, weight-based drug dosage computations and “biometric-specific norms for growth curves and support growth charts for children.”
  • Vaccination assistance and recording: EHRs that are optimized for pediatrics should include robust features related to vaccinations. Research highlights the need for:
    • Vaccine data recording
    • Immunization status tracking
    • Flexible and efficient data sharing
    • Clinical decision-making support that “focuses on immunization forecasting”
    Data sharing is increasingly important as patients now receive care in various locations, such as getting a flu shot at a pharmacy. Therefore, an EHR should ideally incorporate data from all sources, syncing with state and national registries to ensure all vaccination information is accurate and accessible.

EHR usage shouldn’t be limited to the features coded into the software. Another component that is critical to success is reviewing the massive amounts of data and analytics these powerhouse EHRs generate. As a member of a medical group, I routinely meet with fellow pediatricians to review metrics and take turns sharing insights about ways to optimize our EHR usage and more. Nele Jessel, MD, vice president, Clinical Informatics, Privia Health, noted on The Break Room podcast, this crucial aspect “includes improving documentation efficiency, decreasing the use of paper and improving clinical workflows.” These meetings include dedicated performance consultants, who help turn big data into meaningful insights for us to incorporate into our practice.

What I value about this approach, which combines technology and face-to-face meetings with peers, is how it includes both the science and art of medicine. Together we can help each other better care for patients in a way that is data- and technology-driven while remaining deeply personal.

Dr. Finkelstein is a family physician with Capitol Medical Group Pediatrics in Chevy Chase, Maryland. He is affiliated with Privia Medical Group, an AMA Health System Program partner.