Breastfeeding Promotion and the Electronic Medical Record
By now, most physicians have come to acknowledge that the electronic health record (EHR) is an idea whose day has come. Until recently, each physician (or group of physicians) had hoped to move at his or her own pace in making the necessary accomodations. With the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH Act), however, there is some measure of urgency in making the conversion to the EHR.
Under HITECH, the Centers for Medicare and Medicaid Services (CMS) have been directed to implement incentive payment programs for the “meaningful use” of EHR technology. In order to qualify as meaningful users, hospitals and providers must meet three requirements. The first is to utilize certified EHR technology in a manner condducive to appropriate care (for example, electronic prescribing). Second, the adopted technology must be capable of exchanging information with other IT systems so as to enhance the quality of care.
Finally, by means of such technology, the user must be able to provide to the government information related to clinical quality measures. An integral part of this process is to be able to capture data relevant to the prevention and treatment of disease, and to the optimization of health. Equally important is the collection of health-related data for research purposes.
The incentives are substantial. Those who qualify as meaningful users are eligible to receive anywhere from forty to sixty thousand dollars. The catch, of course, is that the window of opportunity for taking advantage of these incentives closes after 2016. So there is a certain measure of urgency in getting the conversion work done.
The implications with respect to the practice of breastfeeding medicine are not insignificant. For example, what kind of data should be collected? The usual suspects for EHR implementation are such things as demographics, vital signs, growth charts, problem lists, allergies, immunizations, medications (with special attention to generics), lab results, and lifestyle issues (smoking, alcohol consumption, etc). In pediatrics, it will be of paramount importance to include breastfeeding metrics in the mix. At each well baby visit, it will be important to record not only whether, but also how exclusively, the infant is being breastfed.
Mention should be made of any concerns the mother voices with respect to breastfeeding at the time of the visit, and a place (and code number) provided in the problem list for any obstacles encountered with respect to achieving an optimal breastfeeding outcome. In the medication list, there should be a way of reminding the provider that Vitamin D supplementation should be considered if the infant is breastfeeding. With respect to the physical examination, a place in the EHR should be provided for any observations pertaining to the quality of the position, latch and suckle of the breastfeeding infant. All of the above considerations should be included in the template of the EHR, and should not simply be regarded as optional features that the provider may or may not wish to attach to his note.
Interpretation of data in light of the feeding status of the infant will also be important. For example, how will the growth charts be interpreted? What growth charts will be used? Will a certified “EHR technology” utilize the WHO charts? If not, should such an oversight be regarded as acceptable?
The collection of breatfeeding data will be of enormous importance from the perspectives of both clinical practice and medical research. One of the most valuable features of the EHR is that it will greatly enhance efforts currently under way to link reimbursement to provider performance. Breastfeeding assessments and interventions must be included in the metrics for these reimbursement plans. With regard to research, we will soon have at our disposal the means to more accurately link breastfeeding practices with clinical outcomes. Not only will we be able to match such outcomes to breastfeeding duration, but to the degree of breastfeeding exclusivity, as well. With the collection of such data, the benefits of breastfeeding should become more compelling than ever.
It is now up to our professional health organizations to see to it that hospitals, providers, EHR vendors, and the CMS prioritize breastfeeding management in the provision of primary care to newborns and infants. The payoff should be substantial.
Jerry Calnen, MD, is a pediatrician and is president of the Academy of Breastfeeding Medicine.
Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.