State at a Glance: Pennsylvania
Pennsylvania is featured in the following reports from the National Evaluation:
- Evaluation Highlight No. 1: How are CHIPRA demonstration States approaching practice-level quality measurement and what are they learning?
- Evaluation Highlight No. 5: How are CHIPRA Quality Demonstration States encouraging health care providers to put quality measures to work?
- Evaluation Highlight No. 10: How are CHIPRA quality demonstration States testing the Children's Electronic Health Record Format?
Learn more about Pennsylvania's CHIPRA quality demonstration projects on this page:
As one of the 10 grantees, Pennsylvania is implementing projects in three of the five grant categories:
- Showing how a core set of children's quality measures can be used to improve quality of care for
- Promoting the use of health information technology (IT) to enhance service quality and care
- Demonstrating the impact of a model electronic health record (EHR) format for children.
Pennsylvania will partner with several medical centers and hospitals to collect, test, and report on the initial core set of children's quality measures and implement electronic linkages to promote early identification for children with developmental delay, behavioral health issues, and complex medical conditions. The State will test an electronic screening tool to enhance communication between providers and families and improve screening and referral rates for several clinical domains. Pennsylvania is one of two grantees that will test and evaluate the model EHR format for children.
Working with the Initial Core Set of Children's Quality Measures
Pennsylvania identified thirteen of the initial core set of children's quality measures to report directly from patients' electronic health records (EHRs):
- Childhood immunization status.
- Immunizations for adolescents.
- Weight assessment and counseling for nutrition and physical activity for children and adolescents: body mass index assessment.
- Developmental screening in the first 3 years of life.
- Well-child visits in the first 15 months of life.
- Well-child visits in the 3rd, 4th, 5th, and 6th years of life.
- Adolescent well-care visit.
- Percent of live births weighing less than 2,500 grams.
- Cesarean rate for nulliparous singleton vertex.
- Chlamydia screening.
- Appropriate testing for children with pharyngitis.
- Annual pediatric hemoglobin A1C testing.
- Child and adolescent access to primary care practitioners.
All seven of Pennsylvania's participating health systems1 are reporting from EHRs some or all of selected measures. While working to report the measures, all of the CHIPRA grantee health systems examined the availability of data in their EHRs. Often, they found that clinical processes (for example, developmental screening) are not captured in an area of the EHR, such as a discrete field, that can be queried for quality reporting. Instead, providers often recorded this information in the notes section of an EHR or in a scanned paper document, which cannot be queried. Work under the CHIPRA grant has brought these issues to light, thereby enabling the health systems to improve their EHR systems in preparation for future EHR quality reporting under the Meaningful Use Medicaid EHR Incentive Program.
In addition, all health systems are working to establish bi-directional linkage with the Pennsylvania Department of Health's Statewide Immunization Registry. As of February 2013, Geisinger Health System (Geisinger), Children's Hospital of Philadelphia (CHOP), Children's Hospital of Pittsburgh of UPMC, and Penn State Hershey Medical Center have achieved bi-directional linkage with the registry. Hamilton Health Center has achieved one-way linkage and is continuing to work on bi-directional connection. St. Christopher's Hospital for Children and Pocono Medical Center are continuing to work on linkage to the immunization registry.
Furthermore, Pennsylvania is reporting the following two dental measures using claims data since dental records are not part of the patient's EHR:
- Total eligibles who received dental treatment services.
- Total eligibles who received preventive dental services.
1 Children's Hospital of Philadelphia, Geisinger Health System, St. Christopher's Hospital for Children, Pocono Medical System, Hamilton Health Center, Penn State Hershey Medical Center, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center.
Using Health IT to Improve Child Health Care Quality
CHOP and Geisinger have implemented electronic screening tools for early identification of developmental disabilities prior to the clinic visit at their 23 pilot primary care clinic sites. The results of the electronic screens and any referrals to the Pennsylvania Early Intervention program are electronically placed in the patient's EHR. From July 2011 through December 2013, CHOP screened 38,300 patients; 19,904 of the screens were for developmental delay, 11,366 were for autism, and 5,688 were for maternal postpartum depression. From November 2012 through December 2013, Geisinger screened 10,039 patients; 6,320 were for developmental delay and 4,070 were for autism.
CHOP has had such positive feedback from physicians and patients that they are expanding the use of the developmental disability screeners to all primary care practice sites within their care network. This expansion will be a capital investment made by CHOP and will not involve CHIPRA grant funding. Geisinger is currently examining ways to expand screener use to all of their primary care sites and to continue using the screening tools after the CHIPRA grant ends.
Testing a Model EHR Format for Children
Five of Pennsylvania's grantee health systems (St. Christopher's Hospital for Children, Pocono Medical System, Hamilton Health Center, Penn State Hershey Medical Center, and Children's Hospital of Pittsburgh of UPMC) are participating in testing the model EHR format. Each health system has identified areas of the model format that are clinically relevant to their specific clinical goals and will focus on implementing those requirements into their existing EHRs. Of the 21 topic sets in the model format, 19 have been identified for some level of implementation. The health systems are working on specifics such as predictive modeling for re-admission risk using patient EHR data, setting up age- and gender-specific EHR alerts for well child preventive services, developing clinical decision support tools within the EHR, and the EHR flagging of children with special health care needs to facilitate care management and decision support.
The national evaluation team will gather information from Pennsylvania to address a wide range of
questions about the implementation and outcomes of its efforts, including:
- How did Pennsylvania report measures to practices and to what extent did the practices use this
information to improve quality of care?
- Did electronic linkages across child‐serving sites improve access to services for children with
developmental and behavioral concerns?
- What strategies did Pennsylvania use to test the model EHR format for children?
- What are the key lessons from Pennsylvania's experience that would be useful for other States?
This information is current as of February 2014, slightly more than 4 years after the grant award. To learn more about the projects being implemented in Pennsylvania under the CHIPRA Quality Demonstration Grant Program, please contact:
Kelli Sebastian, CHIPRA Project Manager
PA Department of Public Welfare
DGS Annex Complex-Willow Oak Bldg #43
1006 Hemlock Drive, Harrisburg, PA 17105