AAP News •
www.aapnews.org • September 2015 37
Health IT Trends
A multidisciplinary group of emergency and
critical care physicians, transport team members,
pharmacists and paramedics from Children’s
National Health System in Washington, D.C.,
has created an app for all providers to reference
during pediatric emergencies.
Called Pediatric Quick Reference, the app
helps a provider dose emergency medicine and
equipment based on patient age and weight.
Content also is organized by clinical situation
or alphabetical list.
The app is free and available for Apple and
Android devices. For more information, visit
If you would like to share a first-hand experience
using technology, such as software, program, app,
widget, etc., to improve patient care or practice
management, email submissions of 250 words or
less to Cathleen Guch at firstname.lastname@example.org.
Use app to dose medications
during pediatric emergencies
from the AAP Division of Quality
by Sogol Pahlavan, M.D., FAAP
Editor’s note: This is the first of a two-part series on
increasing patient engagement.
Many pediatric practices are struggling with
patient engagement via patient portals. A recent
study found that portal uptake among eight primary
care practices ranged from 22.1% to 27.9% (http://
When our seven-provider practice in Houston
began implementing our patient portal, our goal
was to meet the minimum standards required to
receive meaningful use incentive payments. We
quickly realized, however, that the portal offered
many benefits not only to our patients but also to
Convenience for families, improved workflow
Portals seem simple and straightforward: The
family provides its email address, the electronic
health record (EHR) assigns a unique password, and
the family uses that email account and password to
log into the patient portal and get full access to the
child’s comprehensive medical record 24/7.
Our patient portal allows families to easily view
and print immunization records, school forms,
growth charts and diagnostic test results. Families
can request medication refills, referrals and forms.
They also can message the office with non-urgent
questions, which is more convenient for them than
While exploring the portal features in-depth, we
realized it could help streamline our office workflow
Overcoming barriers to use
So why is it so difficult for patients to embrace
We discovered what many other practices also
identified as the biggest obstacles — access and
Some of our families do not readily have Internet
access. Some have limited data, which they prefer
to use to check their Facebook or Twitter accounts
rather than their patient portal. Others do not have
hardware to print documents and therefore see
Don’t assume, however, that your low economic
patient population lacks access to the Internet. More
than 60% of our patients are on Medicaid, but only a
handful have no Internet access and we accommodate
them accordingly. Many access the Internet through
The second and often bigger obstacle is changing
behavior. To initiate and implement a new process
that involves your patient population, you must have
the support of your office staff at all levels — from
clerical to providers to administrators. Teamwork is
essential. In our office, we created a motto for 2015:
It is important to remember that the process is
ongoing and should be done in phases. First, we
focused on establishing portal accounts for families
and then moved to incremental use of portal features.
Timing should be a consideration (we implemented
the portal during the summer, which is a slower time
for our office).
It also is essential to make sure someone in the
office “owns” the project. When choosing someone
for this key role as portal administrator, consider an
employee who is well-versed with the clinical aspects
of your EHR, is tech-savvy, is patient and provides
great customer service (as there likely will be some
resistance from families).
Fortunately, we faced hesitance but not significant
resistance from our patients. Resistance implies “we
understand what it is, we don’t like it and we refuse
to do it.” Hesitance implies “we are willing to learn
if you are willing to teach.” Hesitance evolves into
success with the right approach. It requires support,
education and ultimately accountability.
A patient portal changes your practice culture. You
must know your audience well. Inspire families to
embrace the change and include ample support and
reassurance. To lead is not to force an idea but to
educate, empower and allow the audience to embrace
Change is inevitable in the world of medicine.
Pediatricians have a choice: You can stomp your feet
and pound your fist, or you can embrace change and
move your thriving practice into the 21st century.
Dr. Pahlavan is a member
of the AAP Section on
Susan J. Kressly, M.D.,
FAAP, a member of the
section and the Council
on Clinical Information
Technology, contributed to this article.
Embrace change: Take the leap and set up a patient portal
A patient portal may offer many benefits to a practice
and its patients, but a new launch requires staff
support, proper timing, a designated administrator
and exceptional customer service.
Dr. Pahlavan Dr. Kressly