How can we improve child health through quality improvement and innovation when pediatrics is the smallest budget line item and the lowest priority? I left a thriving community practice in Silicon Valley after 12 years to answer this question. Game-changing health technology is being funded at record valuations, and just a small percentage of it is designed for children. As an enthusiastic early adopter, I have seen the transformative power of technology and the data it can harness for health improvement. Technology can enable thinly stretched pediatric practices to deliver higher quality care to more children for less money. But only if these tools provide data that is meaningful, timely, accessible, and actionable.
The right tools lower the cost of care and improve outcomes. But they can also improve patient-provider interactions and enhance communication through thoughtful design and integration into individual practice workflows. Indeed, this is where technology shines - not by interrupting or replacing the clinical encounter, but by empowering the provider and the patient to get the most from their clinical interaction.
Health technology companies need to understand physician workflows and the value of every second with our patients. One second, we may be charming a toddler through an ear check, and another, we are listening for the sound of adolescent depression. We want, and children deserve, tools that build our capacity to listen and care. Pediatrics attracts mission-driven problem-solvers interested in improving the lives of children and families. We want to hit a home run for every family - to make their visit worthwhile, allay their fears, deliver the highest quality care and build capacity to raise thriving children. We need tools that help us hit home runs.
Jam-packed well-child visits
Pediatrician interactions have become powerhouses of outcomes. Like other primary care physicians, pediatricians are highly trusted. Because of that, important population health initiatives that need to get in front of parents get added to pediatric visits. The result is an overwhelming and impossible list of topics to cover in one well-child visit:
- Disease management
- Disease screening
- Infection control (vaccines)
- Developmental screening
- Mental health screening
- Health promotion/prevention
- Social determinants of health
- Mandated reporting
- Medical home
- Care navigation/coordination
- Utilization management (referrals)
The reality is that neither pediatricians nor parents can accomplish all they want at each visit. While pediatricians focus on critical tasks, such as performing an exam, addressing any recent issues, and taking care of needed vaccines, the parents are focused on wrangling the patient and other siblings who may be along for the visit. There’s little time to talk about longer-term plans for care or current and anticipated worries the parents may have.
It's not hard to understand why when the reported average time for a well-child visit is 10-20 minutes according to the 2019-2020 Nation Survey of Children’s Health from the Child and Adolescent Health Measurement Initiative. The statistics below can spur a number of discussions from providers. Most importantly, I think they showcase the friction between time with the patient, quality of care, continuity of care, and capacity for care.
- 47% report receiving care in a "medical home"
- 25% report receiving care in a "well-functioning system"
- 37% report receiving recommended developmental screening
- 31% report being asked about their developmental concerns
- 62% report receiving vision screening
Ease provider burden, don't increase it
Our current system makes it hard for us to hit that home run for children and families. We want to do our job and do it well, but are not given the tools or the time. The moral injury resulting from systemic barriers to delivering optimal patient care is driving provider burnout, causing even the most idealistic providers to question their purpose.
Back to my original question about innovation… Can technology help? There is a place, in fact, a desperate need, for tools that work - both for patients and for providers. Health technology designed to unclutter, elevate and optimize human-facing encounters can make us all better.
Sabrina Braham MD FAAP is a Clinical Assistant Professor of Pediatrics and a CERC Design, Innovation, and Clinical Entrepreneurship Fellow at Stanford University School of Medicine.
