title: EMR-Based Intervention Improves Lead Screening at an Urban Family Medicine Practice.
abstract: OBJECTIVE
  Elevated blood lead levels have well-described detrimental effects to growth and development in children, yet screening rates remain low. We sought to determine if a reminder within the electronic health record (EHR) could change provider behavior and improve blood lead level (BLL) screening test ordering rates in an urban academic family medicine practice.
  
  
  METHODS
  Baseline BLL test ordering rates were calculated for children ages 9-72 months. An update adding reminders to screen was made to the electronic note template used during pediatric well and sick visits at the practice. Data from the 10-week periods both before and after the change was made were compared through a retrospective chart review.
  
  
  RESULTS
  A total of 210 children were seen during the pre-intervention period. Forty-eight percent (n=101) had already been screened. Of the 109 eligible for screening, 23 had tests ordered, and 18 of those had tests completed. Eighty-four children were eligible for screening in the post-intervention period. Forty-one of those children had tests ordered, and 15 had tests completed. Provider ordering rates increased from 21% of eligible patients to 49%. Test completion rates only increased from 17% to 18%.
  
  
  CONCLUSIONS
  An electronic note-based reminder system significantly improves provider ordering rates of BLL tests. Researchers are currently investigating how the use of point-of-care BLL sample collection can improve test completion rates and therefore increase the frequency of successful screening.
authors.affiliation: Department of Family and Community Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: McGrath
authors.forename: Krys
authors.initials: K
authors.lastname: Foster
authors.forename: Patrick
authors.initials: P
authors.lastname: Doggett
authors.forename: Marc
authors.initials: M
authors.lastname: Altshuler
authors.forename: Jewel
authors.initials: J
authors.lastname: Osborne-Wu
authors.forename: Christine
authors.initials: C
authors.lastname: Castellan
authors.forename: Kelly
authors.initials: K
authors.lastname: Lopez
authors.forename: Pheobe
authors.initials: P
authors.lastname: Askie
authors.forename: Daniel
authors.initials: D
authors.lastname: Chung
authors.forename: Laura
authors.initials: L
authors.lastname: Parente
authors.forename: Yury
authors.initials: Y
authors.lastname: Parra
mesh_terms: D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005194:Family Practice; D006801:Humans; D007223:Infant; D007854:Lead / Q000633:toxicity*; D008403:Mass Screening; D011320:Primary Health Care; D012189:Retrospective Studies; D014505:Urban Population
chemical_list: D007854:Lead