Dr. Kelly J. Kelleher, M.D., M.P.H. and Flipside Media, Inc.

Introduction

Injuries and behavior problems are among the most common and impairing conditions seen by pediatricians in primary care settings. Together, they cost society more than any other pediatric conditions, and consume a disproportionate share of pediatrician and staff time and effort. To assist in their identification and management, paper-based screening tools and parent information packets have been developed. However, the extensive investment of both time and money in the administration and processing of such forms precludes widespread adoption of these instruments. In the face of competing demands, clinicians simply do not have the time required to effectively implement programs of comprehensive safety and psychosocial screening, as they now exist. Investigators across the country have noted that physicians perform, on the average, only 20 to 60 percent of the tests and procedures recommended by major health organizations.

To improve the quality of anticipatory guidance around safety and behavioral issues, reliable and psychometrically sound screening instruments which can be seamlessly integrated into the existing structures of pediatric primary care are needed. EnterVue is a computerized screening and analysis tool that offers primary care clinicians a more efficient and effective way to screen, document and manage patient safety and psychosocial issues. EnterVue has the ability to benefit pediatricians by significantly reducing the costs of anticipatory guidance and psychosocial diagnosis and treatment, providing the ability to track and document the morbidity and longitudinal progress of a patient population, and fostering increased levels of patient and clinician satisfaction.

Overview

EnterVue utilizes an engaging multimedia application to supply a child's caregiver with questions that address safety and psychosocial areas of concern. The questions, which are answered via a user-friendly interface on a touch-screen computer, are phrased at a fourth-grade educational level in either English or Spanish, with headphone audio options for illiterate users. The program consists of various customizable question modules which are specific to different patient age groups and the seasons of the year. The 0-12 month and 1-4 year age group receive developmental and safety modules, while the 5-15 year age group receives behavioral and safety modules. Although the initial EnterVue modules are focused on the pediatric population, future System modules could easily be adapted to other age groups.

To begin a session, first-time users will log into the System via a brief registration module. After the user logs in, the EnterVue references the registration information and presents the user with the appropriate question modules. After the user completes the question modules, the EnterVue processes the response data and instantly prints two reports--one for the patient and one for the clinician. The patient report highlights potential hazard areas, if any, and provides information about appropriate courses of action.

The clinician report provides a longitudinal graphical representation of the patient's response data from the Pediatric Symptom Checklist (15), for quick identification of potential psychosocial issues. Any developmental or safety concerns, as identified by the EnterVue, are listed at the bottom of the report. The clinician report increases the anticipatory guidance capabilities of the clinician by making use of the waiting period between patient check-in and admission to an examination room. During the average waiting period, the EnterVue can solicit and compile an amount of information that would take a clinician an extra 15 to 30 minutes to acquire during the physical examination period. In addition to increasing efficiency, the System could also prove to be a more effective response acquisition alternative, as patients will generally provide more accurate responses (concerning sensitive issues) to a computer than to a clinician during a face-to-face contact. The EnterVue will also be a high-profile addition to any practice, serving not only to greatly increase the delivery of focused preventative care with little or no additional time investment, but also to attract new patients and increase levels of current patient satisfaction.

In addition to the prevention-centered core, EnterVue offers a suite of useful prospective documentation and administration features. Patient data files are stored locally on a secure drive within the hardware unit where they can be analyzed to document the status and progress of target constructs within the patient population. The System is also capable of generating documentation meeting NCQA standards, and is suitable for demonstrating compliance with other accountability standards. For more advanced analyses, the patient data files can be stripped of their personal identification information and securely uploaded to a central data repository where they can be compiled and converted into SAS files. These files can then be used to profile and benchmark patient populations, for marketing or severity/risk adjustment.

The intensive accountability of managed health care demands a better system for tracking patient psychosocial needs and documenting outcomes. Currently there are no systems available to address this need. The EnterVue is a first step in the attempt to bridge the gap between the medical and social sciences through the use of interactive technologies, computer science, and information science techniques. A properly implemented EnterVue can significantly reduce the lag time in identification of safety and psychosocial problems, thereby helping to reduce overall costs by aiding in the prevention of more expensive injuries and accidents.

As more than 65% of patient visits to primary care clinics involve psychosocial areas of concern, the biopsychosocial approach to family centered-care is becoming more accepted. The computerized EnterVue will give pediatricians the ability to use the this approach in their practice without being bogged down by the lengthy processing time and analytical constraints that are unavoidable with current paper-based safety and psychosocial screening tools. EnterVue has the ability to advance the biopsychosocial paradigm of health care in pediatrics and assist in the promotion of healthier choices, healthier lifestyles, and healthier families.

The Development Team

(Dr. Kelly J. Kelleher, M.D., M.P.H. and Flipside Media, Inc.)

Dr. Kelly J. Kelleher is a Staunton Professor of Pediatrics, Psychiatry, and Health Services at the University of Pittsburgh's Schools of Medicine and Public Health. Dr. Kelleher's research focuses on clinician practice patterns and the quality of primary care services, especially for children and adolescents. Flipside Media, Inc. is a Pittsburgh-based digital media company specializing in the development of interactive multimedia software systems for health promotion and preventative medicine. Flipside seeks out strategic partnerships with leading industry content providers to aid in the development of superior integrated computer-assisted learning and data management systems. Current Flipside projects involve the use of large amounts of high quality digital video, population-specific interfaces, and tracking/testing/reporting systems in user-friendly interactive applications.