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MNAAP Newsletter

Member Profile: Claire Neely, MD, FAAP

 

ClaireNeely1. What do you like best about your role at ICSI?
I really appreciate the chance to work on difficult health care problems facing our state.  I believe the partnership of care delivery and health plans is vital to transforming our system to provide the care that our patients deserve.  Our work brings together health system leaders, practicing clinicians, patients and other stakeholders and provides the time and space to understand what is and isn’t working from all points of view, and consider actions to begin to close the gaps.

I also get to work with a great team at ICSI.  We have a staff of highly capable people, all driven to accomplish our mission of supporting the health system as it moves toward better care, smarter spending, healthier people and professional satisfaction for health care workers.

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Disaster Preparedness: Planning for the Unimaginable

PaulaKocken2By Paula Kocken, MD, FAAP

It seems that there are disasters happening every day and everywhere. Some occur very far away from us and others seem to be at our doorsteps. The AAP, recognizing the increase in disasters, has encouraged each state chapter to ask for pediatricians knowledgeable and interested in disaster preparedness to champion the efforts in their state to improve preparedness.  Dr. Kiragu asked if I could accept the challenge of improving the awareness of information and programs about disaster preparedness and move forward Minnesota’s pediatricians in their ability to respond to disasters.

I was very pleased to be asked to help Minnesota and the AAP in this complex and challenging topic. I have been working with disaster preparedness for over the past 15 years through many venues.  Beyond being a pediatric emergency medicine physician based at Children’s of Minnesota, I took additional training in the hospital response to disasters with the U.S. army.  As the medical director of Minnesota’s Emergency Medical Services for Children (EMSC), I have been working on “all hazards” readiness for pediatric disaster preparedness for EMS providers and emergency departments. I also participate with the MN Department of Health Advisory Committee for emergencies.

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AAP Legislative Conference 2017

 

nusheen ameenudinBy Nusheen Ameenuddin, MD, MPH, FAAP

“Hope is not a strategy…We will never, ever, ever stop advocating for kids!” said Mark Del Monte, senior vice president of advocacy and external affairs at AAP.

Those words energized the over 220 pediatricians who participated in the April 2017 AAP Legislative Conference in D.C and kicked off an intense, invigorating three days of nonstop advocacy training and application.

Now in its 26th year, with nearly double the prior year’s attendance plus a sizeable waiting list, this conference combined informative briefings, a Congressional staff simulation, skill-building workshops and culminated in actual meetings with attendees’ members of Congress or staff, followed by a group debriefing session.

As a first time #AAPLegCon attendee, who had also just participated in my first Minnesota Peds’ Day at the Capitol in March, I couldn’t wait to combine what I had learned about state-level advocacy with national work. Both events focused on protecting access to care for children, with Leg Con aiming for reauthorization of CHIP and ensuring that Medicaid remained strong, uncut and uncapped. At the state level, we also prepared to discuss access to mental health services and health equity.

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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

 

Pediatricians as Public Health Sentinels

Moline, Heidi (1)

By Heidi Moline, MD, MPH, pediatric resident, University of Minnesota

Microcephaly. Elevated lead levels. Acute respiratory distress. The past few years have reminded us that pediatricians are at the front line of public health emergencies in our communities and across the globe.

We find ourselves entrenched in outbreaks during their infancy, without case definitions, laboratory guidelines, or media coverage — only patients with curious symptoms.

Zika

In early 2015, Brazil experienced a recognized surge of both Zika virus and Dengue virus cases across the country. Several months later, pediatric neurologists Drs. Vanessa van der Linden Mota and Ana van der Linden noted an increase in the number of infants with microcephaly in their Northeastern Brazil clinics.

While in a normal month the might see one microcephalic infant, they were now seeing up to 5-7 per day. The Ministry of Health was notified, and by October, their province which usually has 10 cases of microcephaly per year, had registered 141 cases. Previously known only to cause rash and mild illness, with the aid of observant pediatricians, Zika virus was soon linked to microcephaly and other congenital malformations.

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