**PCC+ Well Child Module**

**PCC+ version 2.6**

**Introduction**

The PCC+ v2.6 Well Child Module (WCM) will become an "add-on module" to
the current version of PCC+. The objective of the Well Child Module is
to use information technology to standardize well child care throughout
the Indian Health Service and to lay the groundwork for the inclusion of
age-specific guidelines and reminders for well child care into the
Electronic Health Record (EHR). The well child module is designed to be
in compliance with a set of national guidelines and standards that were
provided by a group of senior pediatricians in the IHS. As a rule,
guidelines and standards are taken from nationally recognized sources
such as Bright Futures, the American Academy of Pediatricians, the Ages
and Stages Child Monitoring Program, and the IHS Patient Education
advisory group.

**Background**

Well Child care is one of the most common yet clinically complex
services. Typically, the well child "record" is captured on a series of
special encounter forms with each form corresponding to a specific age
from birth through adolescence. Each form contains age-specific
guidelines for developmental screening, anticipatory guidance,
examinations, immunizations, nutritional counseling, and patient
education. The ideal situation is that children are scheduled for well
child appointments and the forms correspond to the age(s) of the child
being seen however; experience tells us that this type of precision is
rarely, if ever achieved.

The objectives of the PCC+ Well Child Module are to:

1.  Standardize well child care throughout the IHS,

2.  Present the correct age-specific guidelines to the provider at the
    time of encounter using current nationally recognized guidelines,

3.  Enable the components of the Well Child Module to be incorporated
    and presented in a multi-modal format so that it can be used by the
    Electronic Health Record (EHR), PCC+ and Health Summary.

In addition to objective 3 above, hybrid components will be available
that will enable providers to enter well child information (i.e. ASQ
scores) directly into the RPMS system via a desktop module.

**Features of the new Well Child Module (WCM)**

1.  Knowledgebase and Knowledgebase Manipulator

> From the moment a child is born until age 21, there are thousands of
> age-specific guidelines and reminders that apply to well child care.
> The PCC+ WCM contains a knowledgebase in RPMS that serves as a
> repository for age-specific guidelines and reminders. The
> Knowledgebase Manipulator is a tool used by WCM that will enable
> providers to edit the knowledgebase and to determine exactly which
> age-specific guidelines and reminders will be displayed on PCC+
> encounter forms and in the near future, the EHR application.

2.  ASQ Screening

> The Ages and Stages questionnaire is a commercial instrument for
> monitoring childhood development. The ASQ contains a set of 19
> age-specific questionnaires for the child's parent to answer. The
> questionnaire is then scored by well child care personnel and results
> are entered into the RPMS system, either by data entry personnel or
> via a WCM GUI application at the point of care. ASQ results are stored
> as "measurements" in RPMS and are displayed on the new Well Child
> Health Summary.

3.  Informal Development Screening

> For sites that are not able to conduct ASQ screening on every visit,
> the WCM can be configured to display representative milestones from
> the Denver Developmental Screening Test (DDST) and these milestones
> will display on the PCC+ encounter form. The child's age determines
> exactly which milestones will display as well as the percentage of
> children at that age who are expected to pass a particular milestone.

4.  Intervention Reminders

> Special exams and interventions are due throughout childhood. The WCM
> will provide the following age-specific exams and reminders:

-   Special risk exams, such as TB screening.

-   Age-specific exams, such as strabismus and scoliosis.

-   General screening exams such as lead levels.

-   Autism screening questions.

-   Immunizations. Past immunizations given (history) and forecasting
    lists will be automatically generated by WCM and displayed on the
    encounter form.

5.  Anticipatory guidance

> Anticipatory guidance is a cornerstone of well child care. There are
> literally thousands of age-specific topics, general patient education
> topics, and nutrition counseling topics available for display. Using
> the Knowledgebase Manipulator the WCM will enable providers to display
> only topics and standards they choose to display on encounter forms.
> Topics include substance abuse, behavioral health, community
> interaction, oral health, etc...

6.  PCC+ Growth Grids

> Users of traditional PCC+ have been able to display growth grids and
> immunization lists. PCC+ 2.6 will continue to print the grids and
> lists to be used as patient handouts.

7.  Data Entry Mnemonic

> Since the new WCM captures new data elements, it will increase the
> workload of data entry personnel. To compensate, the new WCM includes
> a new "intelligent" mnemonic that will be synchronized with the actual
> patient visit. Using the new "WCE" mnemonic, only information that is
> specifically associated with a well child visit will present to the
> data entry clerk, thus increasing the efficiency of data entry
> personnel.

8.  New Well Child Health Summary component

> The new Well Child Health Summary component will display age-specific
> guidelines and reminders specific to Well Child care.

**Summary of the new Well Child Module (SCM)**

The new version of PCC+ will include a Well Child Module that is
intended to standardize well child care in the IHS and lay the
groundwork for inclusion of well child care age-specific guidelines and
reminders into the EHR application. The WCM leverages the power of
information technology and automated decision support in two specific
ways to:

-   Capture and encapsulate data gathered during well child care
    encounters that previously was only collected piecemeal over an
    extended amount of time.

-   Customize and present age-specific guidelines and reminders to the
    pediatrician at the time of encounter.

Several other validated screening tools exist such as the Arizona PEDS®
instruments used by pediatricians in Arizona. New autism screening tools
(i.e. mCHAT®) are also becoming available. We intend to add these
screening options to future versions of the WCM.

For more information on the WCM, please contact Clarence Smiley at
<clarence.smiley@ihs.gov>