The first generation of Neonatal EMRs (Electronic Medical Records) appeared in the 1990s as stand-alone programs and enabled providers to electronically generate patient documentation and track patient outcomes more efficiently. As hospitals have moved to a single software platform for all providers, neonatal caregivers have been pressured to adopt a hospital’s single platform, which may not necessarily focus on neonates. With the advancement of technology, there are now opportunities to harness interoperability to integrate a neonatology-designed EMR with a hospital EMR. Interoperability is defined as the ability of two or more systems or components to exchange information and to use the information that has been exchanged.1 In this win-win situation, both sides stand to benefit; hospitals are able to meet criteria for meaningful use, as well as having access to clinical data previously housed in a stand-alone neonatal EMR, and neonatal providers can use software designed specifically around how they care for their patients.
PediNotesTM (www.PediNotes.com) is an EMR developed for neonatal and pediatric care; designed to work how a clinician works. It uses HL7 interoperability to combine data from multiple sources, and presents this data to the end-user in real time, while providing mechanisms for generating outputs (patient documentation, Computerized Provider Order Entry (CPOE)) to hospital EMRs. HL7 provides a standard for software development which vendors can adhere to for healthcare information exchange.2 PediNotesTM has evolved from initially consisting of several add-on software enhancements to other EMRs, into a complete EMR for neonatologists, pediatricians, pediatric subspecialists and ancillary providers in the NICU (Neonatal Intensive Care Unit) and Well Newborn Nursery. PediNotesTM received its first certification as a modular inpatient EMR in 2013.3
A brief review of the neonatal literature reveals a consensus list of functionalities that an ideal neonatal EMR would contain.4-6 This list includes:
1. Integration with existing hospital EMRs 2. Neonatologist-designed in order to focus
on neonatal providers’ workflow in the NICU
3. Software functions that capture the spectrum of neonatal disease, including those based on chronological and postmenstrual age
4. Document generation and billing integration
5. Sharing of data with clinicians, hospital administration and electronic databases
PediNotesTM aims to usher in the next generation of Neonatal EMRs with a focus on interoperability to enhance existing hospital EMRs and assist the neonatal provider in the provision of care to their patient.
Integration with Existing Hospital EMRs
The American Recovery and Reinvestment Act (ARRA) of 2009 provides for incentive payments beginning in federal fiscal year (FY) 2011 for eligible hospitals (including eligible small, rural hospitals) and Critical Access Hospitals (CAHs) that adopt a certified Electronic Health Record (EHR) system and are meaningful users of certified EHR technology.7 This helped spur the rapid adoption of EHRs in hospitals. With payments ending in FY 2016, eligible hospitals and CAHs that do not successfully demonstrate meaningful use of certified ER technology are subject to Medicare payment adjustments.8
The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted as part of ARRA and stimulated significant health information technology (Health IT) adoption and exchange of electronic health information with the goal of every American having access to their electronic health information, and where providers have a seamless ability to securely access and use health information from different sources. The Office of the National Coordinator for Health IT’s overarching goal for electronic health information exchange is for information to follow a patient where and when it is needed, across organizational, health IT developer and geographic boundaries.8
PediNotesTM incorporates interoperability both in clinical data exchange, as well as CPOE. This has allowed PediNotesTM users to work in a single neonatal-focused software platform in the NICU, while integrating with the hospital’s EMR. On a day-to-day basis, PediNotesTM interoperability provides many advantages:
• Patients can be pre-admitted into PediNotesTM using the hospital ADT information.