Electronic Applications

A recent study at Harvard by Dr. Alison Schonwald, presented at the Pediatric Academic Societies meeting last May, showed that PEDS actually reduced visit length by about 2 minutes. Dr. Schonwald speculates that the time-savings is due to a reduction on "oh by the way" concerns combined with a more focused visit (since you know what parents' concerns are, and children's risk levels, you can walk into the exam room armed with information handouts, referral information, etc.). Explaining the need for a referral is straightforward because most parents have already expressed concerns. Online PEDS also by-passes all time needed for scoring, writing referral letters, etc. So, there's lots of time-savings there as well.
The information exchange between our site and your office is conducted like any other outsourced labwork. The site is HIPAA compliant. Although the child's first and last name enable customization of referral letters and parent summary reports, only a unique patient identifier (this does not need to be a patient i.d. or other meaningful number), the child's birthdate, and parents' answers are essential for scoring and returning results to your office. We can encrypt that information to add security.
Data is stored on the site under each licensed user's agreement and unique license number. We use this for usage counting, billing, and if requested, annual reporting of screens administered and results). We can make the data “disappear” after a specified period of time but only after the requested billing interval (and because of the inevitable, but usually immediate, need to have us retrieve lost records, i.e., if your office computers crash)!
We do not share pediatric encounter data with researchers. Anonymized data only from self-selected parents who come to the site outside of health care encounters, may be used for research and such parents are shown a privacy notice explaining this. Research studies with appropriate IRB approval can use the site for prospective data collection according to established protocols but may not use other site data.
Yes. We have a parent portal that allows parents to take our measures at home or on a waiting room computer. Parents will not see the results. Instead you are sent an email alerting you that a screen has been completed with a link to retrieve the records.
As part of our license agreement, we provide photocopiable files of the PEDS Response Forms (in 14 or so languages) in case these are needed in waiting/exam rooms. Staff can type answers onto our site (in English) and will receive immediate results. The site also enables you/staff to interview families while typing answers into the site, again you will receive immediate results.
Please submit a support ticket or contact us by email. We can correct the record and send it back to you within hours. If you need the parent to start over, that’s fine. Just let us know the date of testing and patient id number, and we’ll eliminate the duplicate record.
Usernames and passwords are case specific, meaning you have to use the exact combination of upper and lower case letters. Extra spaces before or after, will reject you so make sure you don’t have those.
You can request a password reminder by clicking on the "Get Login" menu item on the client administration logon page. Please explore these issues first: Usernames and passwords are case specific (meaning you have to use the exact combination of upper and lower case letters. Extra spaces before or after, will reject you so make sure you don’t have those. If that doesn’t work, please make sure your license is up to date. We send an email at least one month ahead to alert you that your license is about to expire so please stay on top of those.
Professional use of PEDS Online requires a license. All licenses are assigned with a unique username and password and allow the professional user to administer PEDS online for a specific number of times. Once we receive a signed license agreement, we’ll set up your account using your specified login information and you’ll be ready to go. If you would a trial, please <a href="mailto:angel.kennedy@forepath.org">Contact Us</a>
Yes! Online PEDS offers a parent-portal approach, which allows parents to take the measures at home, prior to office visits, or via in-office kiosks. Parents do not see the results, rather a notification email in sent to the provider alerting them that a screen has been completed.
This is true although with PEDS online there's a huge savings in terms of reporting writing, billing/coding and scoring. And... with either, lots of technical support and advice. The average reimbursement for using the -25 modifier with 96110 under Medicaid is $13.00 per screen so we still hope that screening is quite a profit center for primary care providers.
With research projects, we: a) want to know (delicately) if they are funded b) we then send our translation license agreement and see if that floats c) if they get balky, we offer a discount (I'm not sure if we have firm guidelines for this but for consistency's sake--50% off is pretty much we've done in the past (although much less so on the print side of things). Helen's got print discounts nailed down. We sort of do for electronic PEDS but should revisit this). d) if they haven't sought funding yet and are just costing things for a proposal, we suggest that they put us in their budget at the full price, an that when it comes to the inevitable budget negotiations, we can discount our prices but only if needed so e) send the translation license agreement so they include the costs in their proposal
The site is set up to accept dates in the European fomat of year-month-day (2009-01-21, for example). If you enter the date in a format other than this, the error is loaded.
1.Open your EMR to the patient record (progress notes or wherever you have space for notes on the visit) 2.Open Internet Explorer (or whatever browser you use), go to forepath.org and login 3.Administer PEDS/type in parents' answers from a printed form 4.Click submit 5.Use CTRL+A (both need to be held down) to highlight the entire page of PEDS results and parents' comments 6.Use CTRL+C to copy the results 7.Use your mouse or ALT+Tab to switch back to your EMR window 8. Paste text
There are quite a few options: a) At Home: Families take PEDS/M-CHAT from home before the appointment. They would need a take-home “script” (e.g., if they are given written appointment reminder cards, those could be reprinted to ask them to go to the parent portal site, login and complete the PEDS questions a day or so before their appointment). If easier, we can put a link on clinic or Nemours wide websites). Clinicians or staff would then access the records on the day of the appointment, view and place into EPIC. Pros: Time required for screening is almost exclusively shifted to parents. The website will halt them if literacy isn’t demonstrated (i.e., nothing in writing/skipped questions) Cons: A back up plan will still be needed in case parents forget or can’t continue due to literacy issues (however unlikely if they managed to get into the site). Providers working with low income families may not view this (relatively ideal) option favorably and may not recognize just how well their families can read and also have internet access, i.e., most do. Logistics: Reminder cards (or a leaflet put into the parent education package would be needed. Nemours could consider putting to put a link on clinic or the general website b) Waiting Room: The clinic receptionist asks the essential literacy prompt and then gives parents a copy of the PEDS Response Form and the M-CHAT? (we’ll provide photocopiable versions in various languages as part of the online license agreement), followed by Triage Area, Transcription: If PEDS/M-CHAT are completed in the waiting room in writing, the triage staff could access the site and enter parents’ comments. Clinicians would then access the site to view results, even before they enter the exam room. Pros: Time required for screening is mostly shifted to parents and back-up procedures are relatively minimal. Cons: 1. Triage staff will need training so that they know that if the parent has not written any words on the PEDS Response Form, an interview (including M-CHAT items, would be needed. 2. Parents are not as expressive in writing than in an interview and the triage area may not be conducive to optimal communication. 3. If the M-CHAT is also used at select visits, receptionists will be challenged (different procedures at different visits is a headache). 4. And, even if the workaround is age-specific well-visit packages that include the PEDS Response Form plus the M-CHAT at selected visits, there may not be space in the front office to store age-specific packages that receptionists could just hand over to parents. 5. If families aren’t sitting in waiting rooms for at least 10 minutes, they may not have time to complete PEDS+the occasional M-CHAT (especially when struggling with rambunctious toddlers—although really good distracting waiting room toys might help tons). 6. If staff time is absent, they could at least put the completed protocols next to providers work stations/offices and let clinicians enter and view results before entering exam rooms. But, that’s something of a waste of clinician though. Logistics: Directions to complete PEDS/M-CHAT would need to be put into the age-specific well-visit package, along with the PEDS Response Form and the M-CHAT. Receptionists could be asked to distribute the age-appropriate visit info and ask parents to fill out the forms within (thus sparing them from the challenges of providing different info/questionnaires at different ages). Depending on answers to #5 above, parents could be asked to come in 10 – 15 minutes ahead of time to complete the measures (Kaiser Permanente does this effectively and routinely) c) Triage Area, Orally: Once families are in the triage area, the med tech could administer the PEDS questions orally, plus the M-CHAT items when indicated. Pros: This method saves clinicians time (a good thing) since we’d really like them to spend more time on parent education, service selection, referrals, Cons: Staff are more burdened with this approach and the triage area may not be conducive to optimal communication, based on staff skills, privacy, etc. Logistics: Staff would need to be trained on how to open the site and then paste in brief results plus parents’ exact concerns into EPIC. d) Exam Room Independently. Parents, once escorted to the exam room, complete PEDS online through the parent portal. Pros: Time spent on administering PEDS (and the M-CHAT when indicated) is almost exclusively shifted to parents. Cons: Escort staff would need to probe for literacy and perhaps be prepared to sit down and interview parents (but staff rapport and personability needs to be considered carefully). The time needed for a staff interview when required (10% or so of the time but varying by clinic demographics) may not be workable in the current staffing patterns. Logistics: the exam room computer would need to be set to the parent portal, and/or when an interview administration is needed, staff or clinicians would need to know how to switch to the professional administration (in which case clinicians would see a screen of results, preferably turned away from the parents). If staff administer, clinicians would need skills to view records from the parent portal, ideally before they enter the exam room. f) Exam Room by Clinician Interview If clinicians prefer or need to interview parents in person, staff will need to make sure the exam room computer is set to the professional version and that PEDS questions are on the screen (or to a welcome prompt with language options). Pros: Parents will talk more—a good thing though. And, starting the encounter with PEDS is a great opener. It should, ideally be offered at the beginning so that clinicians can machinate about what exactly to do next (honing the decision support that PEDS offers them is essential) Cons: This approach takes providers more time than if parents can complete PEDS via the parent portal or in writing, especially when it comes to visits where the M-CHAT should be deployed. Logistics: Staff will need to set the exam room computer to PEDS online. Clinician speed at copying PEDS results and pasting those into the EPIC patient record is essential. Clinicians will need practice with the mechanics of this but also huge familiarity with PEDS results (seeing as how they need to just glance at the screen, absorb the info, all pretty much requiring reading at about E =MC2 so as to keep up a comfortable dialogue with families!


Implement

Note: <b>DELETED RECORDS CAN NOT BE RETRIEVED</b> If you have permission to Edit and Delete existing records, you will see a red X next to that record when looking at past records. Click on the X and you will be taken to a page asking you to confirm that you want to delete that specific record. If you need to delete records but do not have a default permission to delete them, please <a href="mailto: angel.kennedy@forepath.org">contact us</a> and we will make that feature available to your account.


Training

Asking families about concerns is a learning experience for them (and for providers/residents). Still I would consider these options for educating all: One is to use PEDS:Developmental Milestones (PEDS:DM) as needed (e.g., for PEDS Path B and D, and periodically for Path C). Encourage famiies to read the short stories on the left-hand pages since they illustrate age-appropriate parent-child interactions.The PEDS:DM Professionals Manual also has a detailed list of milestones for ages 0 – 8 that helps residents learn critical milestones needed to do well on the boards, and that can be photocopied and shared with parents. Another option is to make sure families (and residents) have copies of the AAP's pamphlet on child development (type “child development” as key words on www.aap.org’s bookstore and publication section). The pamphlet shows what's expected at different ages and it is cheap enough to get gobs to distribute to all. You can also put milestone charts on the waiting room walls. You can copy the one in the PEDS:DM Manual or order brochures to give to families from www.firstsigns.org.
Lots! On this site are training slide shows with case examples. Turn on the Notes Pages in Power Point and you’ll find a narrative for each slide. There are also downloadable case examples you can share with your audience and catalogues/brochures with product information information. If you give us enough advance notice, we can mail brochures to you (email us at EVPress@pedstest.com). Sharing these Q and A pages with trainees is also helpful. Finally, for the PEDS:DM, there’s a two-minute quick-time movie you can share with your audience. We are planning to add a “webinar” to the site soon. This will add video and audio to our slide shows and help trainers and trainees with both teaching and learning. We have an early detection discussion list on www.pedstest.com. Please join this (and encourage trainees to join as well). This daily digest offers a way to post questions to others interested in screening and surveillance and get lots of great suggestions. Finally, the AAP’s Section on Developmental and Behavioral Pediatrics has a great site: www.dbpeds.org that includes a tutorial on screening, self-assessment on needed background information (e.g. the impact of psychosocial risk), details on various disabilities, etc.
If working with trainees, Chapter 8 of the PEDS:DM Professionals' Manual has information on how to teach developmental-behavioral assessment. It explains how to offer a direct administration, build rapport, manage behavior during testing, compensate for existing disabilities, explain results, etc. For medical students, residents and fellows, independent learning opportunities are almost always needed (and a good skill for them to acquire). www.dbpeds.org has a "Screening Tutorial" that is quite helpful and trainees can start and stop, answer self-assessment questions, and acquire an excellent understanding of why it is best to use validated and accurate approaches to early detection. The site also has much information about disabilities, "the typical problems of typical children", parent education handouts, etc. Other thoughts: have trainees work through the slide shows on this website (www.pedstest.com), and practice administering PEDS and the PEDS:DM. The PEDS Brief Guide is something they'll need to read through and practice with. Chapter 8 of the PEDS:DM manual covers how to administer the PEDS:DM directly to children, build rapport, use non-committal praise, manage children's (and parents') behavior during testing, compensate for existing disabilities, explain results, etc. These activities will teach trainees the value of parent-professional collaboration and also help them learn important milestones in development. One of the best ways for trainees to learn about development is to send them on a half-day visit to a good day care or preschool program and let them observe children at various ages. There's nothing like seeing groups of 1 year olds, 2 year olds, 3 year olds, and so forth, for helping trainees grasp the enormous differences in skills by age levels. Trainees should go armed with observation tools (e.g., a PEDS:DM Assessment Level Booklet (to help identify red flags) and/or a copy the milestones chart in Chapter 8 (for a guide to average development). Another activity that's quite helpful is to send trainees to a public school, ideally to a classroom where one of their continuity patients is enrolled. Although parent and school/teacher permission is required, trainees can be asked to handle that on their own. If they can schedule their visit during a time when there is at least some opportunity for teachers to talk, that's invaluable, as is observing children in classrooms. During the visit, trainees might (with permission) obtain existing group achievement test scores and work through Chapter 7 of the PEDS:DM Professionals' Manual. This chapter contains an algorithm using existing test scores and clinical judgment to discern whether a likely explanation for children's difficulties involves language deficits, learning disabilities, intellectual disability, mental health issues, a range of challenging life circumstances, or (and only after the above), ADHD (since inattention is often a marker for other problems and not always the root cause). It might also be possible for trainees to administer the two measures in the back of the Family Book designed for older children, i.e., the Safety Word Inventory and Literacy Screener and the Pictorial Pediatric Symptoms Checklist-17 (Scoring for both is in Chapter 5). Also consider having trainees create (or update) a list of local referral resources. Trainees should ideally, visit them all (Head Start, Early Head Start, mental health clinics, day care, early intervention (going with the EI providers on a home visit is especially valuable), parenting programs, special education classrooms, etc.). Trainees could take responsibility for creating a laminated mini-poster to be attached to the wall of each continuity exam room (where parents can see it too!), thus easing the referral process and educating parents about services along the way. One of the (positive) side-effects of screening, especially when using PEDS to elicit and address parents' concerns, is that providers can readily see when parents need help promoting healthy development and behavior. This means an increase in the need for parent education materials. Consider having residents gather handouts (Chapter 6 of the PEDS:DM Professionals' Manual has ones that are photocopiable along with websites to other information resources. Trainees could be asked to download, customize and manage these (e.g., residents at Vanderbilt (all of whom had a required project) took the initiative to get plastic bins, grouped by age and topic, get them adhered to the back wall of the clinic for housing copies of parent education materials there (laminating the original so it wouldn't get lost)). One year, they even set up a parent training class (using an established effective curricula and a cohert of two year olds)! Impressive, although much like group well-visits, this requires tons of staff support, and preferably at least a small amount of external funding. One other helpful activity is the post-test on PEDS that trainees can use for self-assessment to ensure they have sufficient background information (e.g.,on the impact of psychosocial risk and parenting style), know how to administer the measure and avoid some of the pitfalls (like not exploring parents' literacy, not insisting that parents write something on the form), etc. This is downloadable on www.pedstest.com. We're creating a pre-post-test for the PEDS:DM so if you have suggestions for questions, please email me (frances.p.glascoe@pedstest.org). Finally, trainees and faculty are welcome to join our early detection discussion list. Sign up at www.pedstest.com! Please share your ideas and recommendations on training