Quality improvement in pediatric well care with an electronic record.

For the past 4 years the pediatric office of Children's Health Specialists has used an electronic medical record (EMR). The EMR has forms for the routine well child visits recommended by the American Academy of Pediatrics (AAP) [1] and instruction sheets with key information on development and safety as recommended by "Bright Futures" [2]. In this study the completeness of well visits, instruction distribution, immunizations and lead testing were examined for all children in our practice with birthdays in 1998. When children did get to the office they did get their instruction sheets on child development and safety and were well immunized. Children who had insurance coverage to pay for in-office lead testing were 42.6 times more likely to have blood lead testing done: Risk Ratio 42.6, lower limit 10.6, upper limit 171.3. Insurance coverage and regulatory changes would likely increase lead screening markedly in high risk populations. Our implementation of our EMR has helped us to deliver high quality pediatric well child care but external obstacles limit the completeness of the care.