Emphasizing the importance of children's healthcare is essential for promoting a healthy population. Evidence demonstrates that preventive healthcare and proactive screening interventions from infancy to early childhood enhance the wellbeing of children and reduce long-term health hazards. To ensure a healthy childhood, regular preventive assessments, encompassing early identification and intervention for developmental disorders, are crucial. Based on the same concept, the Qatar National Health Strategy is a comprehensive plan aimed at improving healthcare, including addressing infant health challenges. Key features include strengthening maternal and child health services, prioritizing vaccination coverage, and focusing on best infant and young children feeding practices for children under the age of five. The strategy also emphasizes early detection and intervention for developmental disorders and disabilities. Overall, the aim is to create a healthy and supportive environment for every child to grow and develop.

PHCC's Well Baby Program

The Primary Health Care Corporation (PHCC) supports these broader goals of the National Health Strategy in creating a healthy and supportive environment for children in Qatar. The Well Baby Program aligns with the National Health Strategy by prioritizing children’s health. The program focuses on preventive care, routine assessments, vaccinations, and management of mild health problems to support the child’s proper growth, development, and wellbeing. The Well Baby Program also educates parents about proper nutrition, developmental milestones, and healthy parenting practices.

To implement the Well Baby Program in a systematic way, PHCC leveraged its existing Cerner Millennium electronic health record (EHR), which seamlessly integrates primary, secondary, and tertiary care processes in Qatar. While focusing specifically on early childhood, Cerner Millennium supports immunization management,¹ ensuring all children maintain up-to-date status with the national immunization schedule. Additionally, the system facilitates early identification of developmental issues and prompt intervention, as indicated by Bailey et al,² who emphasized the role of EHRs in tracking developmental milestones and referring children for specialized care.

Enhancing childcare with integrated EHR workflows

Manual paper-based workflows contribute to disconnected and episodic childcare, which can have several negative consequences for the overall health and wellbeing of young children. Some disadvantages include missed opportunities for early intervention, incomplete vaccination coverage, inconsistent tracking of growth and development, inadequate parent education, and fragmented medical records. On the contrary, integrated processes optimized by the EHR regularly promote consistent healthcare visits, enabling healthcare providers to identify potential issues early on, leading to better clinical decision-making and contributing to optimal care. Additionally, electronic workflows help effectively monitor healthcare providers' compliance with the Well Baby Program and ensure continuity of care for the intended population.

Recognizing these benefits, PHCC upgraded its existing Well Baby Program on the Cerner Millennium EHR platform under an optimization project. After an initial phase of requirement gathering, building, testing, and end user training, the project went live in November 2021.

Enhancing care and efficiency: Project optimization

Through optimization, interventions were introduced to assist healthcare providers attend to children and support their parents. This approach enables the maintenance and retrieval of a continuous patient chart, which not only manages historical information but also facilitates accurate clinical decision-making and the implementation of essential interventions for the wellbeing of both the baby and its family.

Under the Well Baby optimization project:

• Interventions were introduced to help providers serve children and support their parents, and to retrieve and record information as a continuous patient chart that could manage historical information as well. This enables clinicians to make the right clinical decisions and make the necessary interventions for wellbeing of both babies and their families.
• Furthermore, customizing the standardized Well Baby package based on age allows for practitioner-friendly use, ultimately improving adherence in delivering care to the target population.
• The project also helped translate national clinical guidelines into executable assessments and tasks that were grouped as age-based forms. Furthermore, all grouped tasks were integrated into a broader patient chart view under dedicated workflow MPages, thus facilitating easy access.
• To facilitate focused documentation, templates were designed in a manner that supports faster filter-based retrieval during future visits, thus saving time wasted earlier in searching inefficiencies.

Recognizing the benefits

By leveraging the capabilities of Cerner Lights On Network and Cerner Advance, the optimization team was able to analyze data, track solution performance, and identify trends or areas for improvement. This information aided in decision-making and improved overall clinic operations.

• Using this solution, Well Baby clinic has managed more than 6,700 children between the ages of two months and five years old between June 2022 and February 2023.
• With more than 8,000 new babies coming for their first visit, the use of this solution was used to record the baby’s and parents’ demographic information, contact details, and any relevant family medical history. This information was used to track patients and coordinate care until the child reached five years old. Appointment scheduling was utilized to manage clinic visits, vaccinations, and follow-up appointments. This helped ensure timely care and reduced the chances of missed appointments for more than 89% of the visiting children between the age of two months and six years.
• For all registered babies, growth was monitored by recording the baby’s weight, height, and head circumference during each visit. This helped track the baby’s growth and development over time and aided in identifying any potential health concerns.
• With an integrated vaccination history and questionnaire for parents about vaccination records, full compliance was observed. We also noticed that adherence to the vaccination schedule played a significant role in ensuring regular Well Baby visits when due. The consistent attendance from one visit to the next further validated this observation.
• All babies were monitored for developmental milestones, such as sitting, crawling, walking, and talking. This information was helpful to assess the baby’s progress and identify any potential developmental delays early on.
• Integrated screening and assessments for hearing, vision, and autism helped maintain a comprehensive health record for each child and coordinate any necessary follow-up care.
• By tracking the topics discussed during parent education sessions, such as breastfeeding, nutrition, sleep patterns, and safety, parents could tailor the information provided to each family’s unique needs, concerns, and further referrals.

Backed by the Cerner Lights On Network, this design bolsters monitoring and assessment of the program, facilitating quality assurance and fostering continuous improvement. In addition to the benefits discussed above, the solution helped standardize clinical notes, observations, and diagnoses. This facilitated seamless communication among healthcare providers and helped ensure everyone had access to the most up-to-date patient information when needed by providers.

To summarize, by leveraging on the capabilities of PowerChart—Oracle Cerner’s go-to solution for all the information that clinicians require—Well Baby clinics provided more efficient, personalized, and comprehensive care to children while also improving communication among healthcare providers and streamlining administrative tasks.

Reference:

¹Biondich, P. G., Grannis, S. J., & Overhage, J. M. (2005). A modern optical character recognition system in a real-world clinical setting: some accuracy and feasibility observations. In Proceedings of the AMIA Symposium (p. 56). American Medical Informatics Association.

²Bailey, L. C., Forrest, C. B., Zhang, P., Richards, T. M., Livshits, A., & DeRusso, P. A. (2013). Association of antibiotics in infancy with early childhood obesity. JAMA pediatrics, 168(11), 1063-1069.