Child Health Informatics Center stands up for pediatricians
Christoph U.Lehmann, M.D., FAAP
Health IT Trends
Over the last seven years, the AAP Child Health Informatics Center (CHIC) has played
a major role in improving the landscape for pediatricians and other health care providers
who use health information technology (HIT) as they care for children and families.
The CHIC monitors legislation and regulations related to the meaningful use of electronic
health records (EHRs) and HIT; works with government agencies; advocates for HIT that
benefits children and pediatricians; and provides technical assistance.
The Academy launched the CHIC in 2009 to prepare pediatricians for anticipated changes
regarding HIT and to support the following goals:
build awareness of the importance of HIT as it relates to improved quality and efficiency
of pediatric care;
advocate for pediatricians’ HIT needs by coordinating and communicating issues at
the national level, including with federal policymakers, the Office of the National
Coordinator (ONC), the Centers for Medicare & Medicaid Services (CMS) and HIT vendors;
provide resources and education to members about EHR adoption and implementation;
support the translation and spread of knowledge for integration into electronic formats.
Most recently, the CHIC facilitated a major win for a solo New Jersey pediatrician
who had received meaningful use incentive monies and was being audited. In 2016, the
practitioner received a notice from the New Jersey Medicaid office claiming the practice
owed almost $6,000 from meaningful use incentives paid incorrectly. The Medicaid office
threatened to forward the matter to a collection agency within 30 days and directed
participating managed care organizations to forward any payments for the pediatrician
to it instead.
The practice had testified that it met the measure requiring provision of electronic
copies of medical records within three business days to 50% or more of patients or
caregivers who requested an electronic copy. Unfortunately, the practice failed to
maintain copies of the reports it sent to Medicaid. At audit, it reran the report
which had been designed (based on ONC guidance) to report the measure over the whole
life of the EHR and not for the reporting period. The auditor failed the practice,
which triggered Medicaid’s recoupment attempt.
The pediatrician turned to her EHR vendor, which sought assistance from the CHIC.
The CHIC reached out to ONC and CMS, which contacted New Jersey Medicaid officials
and educated them that CMS guidance did not support the auditor’s view. The pediatrician
subsequently was informed that she did not have to pay back the meaningful use incentive.
The CHIC has had several other major achievements, including
Development of survey questions and analysis of office-based pediatricians’ use and
perceptions of EHRs in practice. In 2009, 2012 and 2016, CHIC developed questions
for the AAP Periodic Survey of Fellows, and survey data have informed AAP advocacy,
lobbying and educational efforts.
Lobbying for reinstated payments for meaningful use of EHRs. In 2014, Florida stopped
payments to providers participating in the Medicaid EHR Incentive Program (meaningful
use). Florida Medicaid decided not to request additional spending authority for meaningful
use after 2013, which meant eligible pediatricians and children’s hospitals were going
to miss out on $70 million in reimbursements to support their use of EHRs to care
for children. The CHIC, in collaboration with the Florida Chapter, worked with CMS
on a plan to reinstate meaningful use payments through Florida Medicaid.
Safer e-prescribing for children. In 2016, the National Council for Prescription Drug
Programs approved a proposal from the Academy to include patient weight as a standard
feature of electronic prescriptions for pediatric patients. The CHIC and AAP Council
on Clinical Information Technology led this effort (see AAP News article “Standards group approves AAP proposal to include weight on e-prescriptions,”
From federal and state advocacy successes to supporting individual pediatricians,
the CHIC has been a “boots on the ground” force for the application of technology
to make pediatric care more efficient, effective and safer.
Dr. Lehmann is medical director of the AAP Child Health Informatics Center.