Implementing electronic health record-based quality measures for developmental screening

The goal was to examine the current abilities and future potential of electronic health record (EHR) systems to measure childhood developmental screening and follow-up rates in primary care settings.

A group of pediatric clinicians and health informatics experts was convened to develop quality indicators reflecting different aspects of the developmental screening process. These indicators included the administration of a standardized, validated instrument to screen children for developmental delays, the documentation of abnormal screening results, and the provision of follow-up care. Six integrated provider systems across the United States, with fully implemented EHR systems, were evaluated to determine the feasibility of implementing these measures within each system. Barriers related to measure implementation were identified.

The EHR systems of all 6 health care organizations could implement measures examining developmental screening rates and could identify and track children with abnormal screening results. However, most of the systems did not have the ability to capture data for more-complex EHR-based measures. In particular, data elements based on workflow actions could not be captured with current EHR system designs.

This study identified 2 main barriers to the implementation of developmental quality measures: concerns about data reliability and the tracking of care coordination within patient records. Potential solutions to these problems, including terminology standardization, patient portal use, and use of a single developmental screening instrument, are discussed.