3 Key EHR Considerations for Neonatologists

Neonatologists care for the most vulnerable of patients, and a growing number of neonatologists are turning to electronic health records to improve recordkeeping and treatment of these newborns. Under the Patient Protection and Affordable Care Act, physicians will be liable for financial penalties for not adopting an EHR system. However, even without such a mandate, EHRs can provide neonatologists with opportunities to improve care, provided that the system chosen is one that is easily adopted by the intended end users.

The treatment of patients in neonatology differs from that of adults and older pediatric patients. Treatment usually begins before the baby is born, during the prenatal period. It continues through delivery – which can result in unexpected complications that require immediate treatment – and through admission to either the regular nursery or, in the case of complications, to the neonatal intensive care unit. In both the nursery and the NICU, progress notes, transfer notes, discharge summaries and reports can differ greatly from those used in other departments. Therefore, neonatologists need to consider EHR systems that can handle the specialty’s nuances. Three critical features are integral in making an EHR work best for neonatology.

1. Designed specifically for neonatology. Standard EHRs capture patient data, but because of the unique way neonatologists treat their patients, using EHRs designed for other specialties can mean spending an hour or more per patient to enter data. An EHR that is specifically designed for neonatologists, by neonatologists, follows the natural flow of how these physicians care for babies and reduces the time spent on recordkeeping. It would include all the initial screenings given to newborns, fluid and electrolyte levels, diagnoses and laboratory results. For example, EHR systems that allow for decision support, such as excluding certain diagnoses for patients that meet certain criteria, have been shown to increase efficiency in the NICU[1].011014chandler

While some recommendations for all-inclusive, “standardized” EHRs include creating templates specific for neonatology, this requires a significant time and personnel investment to both build the templates and to maintain them[2]. Use of a system that is already built for neonatology, designed by neonatologists, represents a better use of resources. Ideally, the EHR provider would examine data from hospitals related to neonatal care and implement care bundles into the software that assist with treating and preventing conditions such as chronic lung disease. This allows the integration of best practices into the software, allowing neonatologists to benefit from a large database of information gathered directly from clinical settings.

Automatic alerts are also critical to a neonatology-specific EHR. Options such as drug alerts, timing of procedures such as hearing screenings and eye exams and feeding and nutrition information, as well as CPT coding assistance, help practitioners avoid gaps in documentation – thereby helping to prevent medical errors, aid in proper medical billing and avoid unnecessary testing.

2. Integrates into existing hospital EHRs. The best neonatology-specific EHRs must integrate completely into existing hospital-wide EHRs and have received CCHIT or similar federally mandated accreditation. Neonatology EHRs are niche programs, and in order to use them within the confines of a hospital that utilizes a larger EHR, the neonatology EHR needs to be able to safely and securely transfer data to and from the hospital’s larger program. This requires the approval of the hospital’s IT department as well as the vendor of the hospital’s EHR software.

Integration of neonatology-specific EHRs into hospital-wide EHRs requires the incorporation of mappable, discrete fields within the record, corresponding to fields in the larger EHR system. Additionally, the data collected should be mineable, allowing for neonatologists to abstract and transfer the data to reports for both internal and external use, including reporting on quality issues to the Vermont Oxford Network, the National Association of Children’s Hospitals and Related Institutions (NACHRI), and other national or international reporting groups.

3. Internet-based with backup and redundancy. Internet-based software alleviates much of the burden on hospital IT departments because it allows system administrators to access workstations remotely. For example, if the EHR software develops problems locally, a central IT department does not need to retrieve the physician’s tablet or laptop to troubleshoot. Similarly, routine upgrades, bug fixes and local changes do not require the collection of devices. Instead, Web-based EHRs allow an IT department to instantaneously transmit changes to all machines at all facilities simultaneously. If there are issues across several facilities, the hospital IT department can provide repairs at convenient times without disrupting physicians’ workflow. Finally, should a remote machine malfunction, an Internet-based system allows for replacement without the need to reinstall software or add a license.

An Internet-based system also requires backup and redundancy to ensure data is not lost. Data backups need to happen in real time at multiple secure sites.

EHRs with these capabilities will not only help neonatologists better treat their patients but, by virtue of better care, will also help reduce costs. In a medical environment that is increasingly shifting to a pay-for-performance model, any NICU which can demonstrate provision of better patient care through quality initiatives, developed in conjunction with an EHR capable of abstracting and using direct patient information, will benefit patients, hospitals and physicians.

Barry D. Chandler, MD, joined Sheridan Healthcare as Senior Vice President of Children`s Services in 1996, when his group practice merged with Sheridan Healthcare to create the Neonatology and Pediatric Division of the company. Dr. Chandler currently serves as Executive Director of the Southeastern Association of Neonatologists, the Emeritus Director of the Division of Neonatology at Miami Children`s Hospital, and the Co-Director of the Level III NICU at Plantation General Hospital in Plantation, Florida.

Dr. Chandler graduated from Bowdoin College and completed his medical education at Tufts University School of Medicine, with a fellowship in Neonatal-Perinatal Medicine at Brown University.

Pallotto, E. K., Hunt, P. G., Dykes, F. D., Durand, D. J., & Murthy, K. (2013). Topics in Neonatal Informatics: Infants and Data in the Electronic Health Record Era. NeoReviews, 14(2), e57-e62.

Pallotto, et al., 2013

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