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MNAAP Newsletter

Using the EMR to Streamline Care for Children in Foster Care

By Amelia Burgess, MD

A nine-year-old boy comes in to your clinic with a foster parent. It is his second placement, after his 6-week “shelter” placement. He has an undescended testis, vision impairment, caries, and asthma. His school record has been spotty – he has moved several times since kindergarten, and has missed many days each school year. His permanency plan is not yet clear. His father lives in another state, he has a relative two counties over, and his younger siblings live in yet another county in a pre-adoptive home. He does not have a primary care physician.
You know that you need to “hook him in,” and quickly, to the services he needs. But you also know that he may move to a new home before you get his records, and before his evaluations and treatment are complete. Children in foster care often get the same evaluations several times, but never get a treatment plan.

Since January 1, 2015, we have all been practicing with electronic health records. Electronic tools embedded in these systems can be used to:
Access outside health records. Allina, CentraCare, Essentia, Fairview, HealthEast, HealthPartners, Hennepin County Medical Center, North Memorial, and Park Nicollet are all connected through Care Everywhere. This means that, with appropriate consent, we can access medical records from other institutions immediately, and that our records will be accessible to others.

Create checklists for common orders and considerations. If your electronic health record allows you to, you can create an order set based on the American Academy of Pediatrics recommendations for the comprehensive evaluation of children placed in foster care. If you can’t create an order set, you can create a note template that triggers you to plan for the necessary evaluations. A prototype may be found at the Healthy Foster Care America website. (https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Documents/Health_Form.pdf)

Write efficient, thorough reports and letters. Medical, surgical, birth, medication and social histories can usually be pulled in to any document. Epic has a problem list function that allows you to describe the problem and update it at each visit, and pull the problem and the current plan. I have a standard template for foster care reports that can be used to create a health report for use by caseworkers, judges, and family members.

Foster parents, adoptive parents, caseworkers, and judges are very grateful to get a comprehensive health summary to help make decisions for children. Using tools within our electronic health records can help us advocate for children by providing accurate historical information along with our best pediatric recommendations.

Sample visit summary:

This is an after visit summary for the use of parents (birth, foster, and adoptive) and caseworkers.
Please fax to ***.
Reason for visit: @dx@
Accompanied by: ***
@probl@
@cmed@
@alg@
Other concerns (home, school, community):***
@probvisitnotes@
Next appointment: *** with ***
Children in foster care should be seen for well-child care every month for the first 6 months, every 3 months thereafter until 2 years old, and every 6 months after age 2.
It has been my pleasure to meet with @fname@. Please call with any questions. You can reach our department assistant [name] at [phone number]. Our care coordinator can be reached at [phone number].
@me@
*** Triggers typed input
@dx@ pulls in the visit diagnoses
@probl@ pulls in the existing problem list. I keep entries for educational, developmental, oral, and mental health so that I will be reminded to address them at each visit.
@cmed@ pulls in current medications.
@alg@ pulls in allergies.
@probvisitnotes@ pulls in plans related to problems addressed at the visit

 

Creating a Health Care Home for Children in Foster Care

By Amelia Burgess, MD, MPH, FAAP, pediatrician at Park Nicollet

Foster care and the conditions of abuse or neglect that lead to foster care are seen in both rural and urban settings throughout Minnesota. Twenty six percent of all Minnesota’s children in out-of-home care come from counties with fewer than 10,000 children, and they are removed from their homes at rates higher than we see in our most populous counties.

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