Peter S. Jensen, M.D., of the Department of Psychiatry and Psychology at Mayo Clinic, combines use of an ADHD rating scale and Mayo Clinic's electronic medical record (EMR) to track the progress of children diagnosed as having ADHD over time and across health care providers.
"The ADHD rating scale and side effects measures assess key aspects of the child's progress when used with consistency. The EMR pushes physicians to use the rating scale consistently and allows us to record its results, as completed by teachers and families, to track symptoms and progress over time," says Dr. Jensen.
The combination of the rating scale and the EMR creates a reliable tracking process that is also a safeguard for both patients and physicians. "Pediatric patients' needs change as they age," says Dr. Jensen. "The EMR, coupled with rating scales, allows us to note when patients are doing well—and when they are not. We can view a patient's evolving needs and modify treatment on the basis of a complete record of progress."
The system also provides information that allows health care providers to reassure the family about the need for medications. "Across the United States, families go through 11 different health care providers on average before they find one that they fully trust to advise them. If families don't trust medications—a huge issue—they don't use them. The markers and double-checks in the EMR provide information that allows physicians to help reassure the family that they're making an informed choice," says Dr. Jensen.
The rating scale in the EMR includes questions that help health care providers rule out abuse and vision problems for patients. "Research shows that we can have 95% diagnostic accuracy if we use this type of system properly," says Dr. Jensen.
The Division of Child and Adolescent Psychiatry and Psychology makes an effort to engage families fully in the health care process. "Input from the patient, family, and teachers is crucial," says Dr. Jensen. "Not just parents, but even kids can become experts at recognizing the symptoms, particularly as they grow older. The EMR tracking procedures become critical teaching and communication tools in that process."
For pediatricians, family medicine physicians, child psychiatrists, and psychologists (especially those trained long ago), incorporation of these kinds of assessment and treatment tools involves a learning process.
"In other areas of medicine, physicians learn by hands-on practice. They don't learn surgery by viewing slide shows. We are changing the way we are learning in our division and our continuing education courses," says Dr. Jensen.
Training includes role-playing, feedback from specialists, and 6 months of coaching with 8 to 10 physicians on weekly conference calls. Participants earn up to 30 hours of continuing medical education credits. More than 600 health care providers have completed the program.