O2008: Reducing Provider Burden While Facilitating Access to Patient-generated Health Data in the Early Intervention Program Referral Process by Using Emr-based Data Exchange and Task-shifting Models

Background: During well-child visits, healthcare providers apply various methods to elicit suspicion of developmental delay or disability that may warrant a referral to Early Intervention. NYC’s Early Intervention Program (EIP) assists and empowers families of young children by providing education and therapy services to those eligible. Explaining the Program, addressing parental concerns about potential developmental issues and need for an evaluation, completing the referral process, and documenting all components are challenges healthcare providers must navigate within the brief time window allotted.
In March 2021, the NYC Bureau of Early Intervention (BEI) and NYC Health + Hospitals (H+H) collaborated initially at three pilot sites and then across all pediatric centers to increase EI referrals, reduce the mean time from referral to evaluation completion, decrease the mean age at referral and reduce equity gaps by creating the EHR-EI initiative, which: 1) incorporates the EI referral form into EPIC, 2) implements bidirectional data exchange between BEI and H+H, and 3) allows active follow-up of children through the referral process. As well, the Robin Hood Foundation’s support has allowed its replication at three other healthcare systems and enabled evaluating the overall general model.

Methods: Electronic EI referral forms with mandatory fields were coded into EPIC. EI referral workflows were redesigned to incorporate the Pediatric Community Health Workers (CHWs) to assist families and incorporate EPIC builds such as obtaining written consent for interagency bidirectional information exchange. Pediatric Department-wide trainings were facilitated to educate healthcare providers on workflow changes.

Results: This initiative enables, for the first time in NYC, the use of an electronic EI referral process with bidirectional data exchange and follow-up at the healthcare system level. 75 pediatric CHWs were trained on follow-up of consented children using the referral status report developed by BEI. In 2021, 315 Electronic referrals were processed. Consent was obtained on 254 referrals, resulting in an 80% consent rate. During the first quarter of 2022, 479 referrals have been placed. 250 pediatric staff members have received training and are utilizing the new workflows. The electronic referral form is available for integration with minimal build into other EPIC Systems healthcare clients. A rigorous evaluation is underway to assess how this systems integration approach can reduce inequities in EI referral and retention and may contribute to population-level changes in access to care.

Conclusion: When providers deem the need for an EI referral, having task-shifting models that permit CHWs and EHR systems to facilitate functions enables effective patient-facing time towards other components of the well-child visit. Identifying and addressing barriers through improved communication and advocacy are additional achievements.