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Frequently Asked Questions for Providers

1. What is the Well Visit Planner?

The Well Visit Planner^TM (WVP) is an online pre-visit planning website for parents to complete prior to their child's well-visit. It is a family-centered quality improvement method that guides parents to identify priorities and key issues prior to visits. It also includes access to educational materials and discussion tips for each of the Bright Futures defined visit-specific focus areas. The WVP enables customization and optimal use of visit time to address priorities, concerns and other issues specific to the child and family. A customized visit guide is generated for use by parents and their child's health care providers. Carefully anchored to national recommendations, the WVP Suite of Tools are currently available for the 4, 6, 9, 12, 15, 18, 24 and 36 month well visits and take an average of 10 minutes for parents to complete.

2. Why is it important to engage parents in well-child care?

Despite improvements in some areas, studies continue to show persistent gaps in the quality of well-child care and the nation's capacity to promote the healthy development of young children. Improving care means improving communication and partnerships with parents and meeting the unique priorities and needs of each child and family. The Child and Adolescent Health Measurement Initiative (CAHMI) designed the guideline-based, easy to use Well Visit Planner^TM (WVP) to help providers efficiently meet their well visit quality goals.

3. Why is the WVP valuable for my practice?

Well-child visits comprise a large portion of health care encounters for young children. Gaps in the quality of well-child care are well documented and engaging parents is an essential driver for improvement. Further, large national health policy directives have come from bodies such as the Office of the National Coordinator, and the American Board of Pediatrics which encourage and incentivize practices that use Health IT to engage their patients in quality improvement. The WVP is an evidence-based, easy-to-use tool that actively engages parents as partners in this process. National experts, families and pediatric providers all collaborated in the design, development and testing of the WVP to ensure feasibility and to optimize impact on the quality and efficiency of the well well-child visit for parents, children and provider teams alike. Initial testing documented improvements to provider office workflow as well as patient engagement, experience and quality of care. Requiring an average of 10 minutes to complete, 92% of parents reported they would recommend the use of the WVP online tool to other parents.

4. How was the Well Visit Planner Developed?

The WVP was developed and tested by the Child and Adolescent Health Measurement Initiative (CAHMI) for use in pediatric practices over four years through a grant from the federal Maternal and Child Health Bureau (R40 MC08959 03-00; 2008-2012).

National experts, families and pediatric providers all collaborated in the design, development and testing of the WVP to ensure feasibility and to optimize impact on the quality and efficiency of the well well-child visit for parents, children and provider teams alike.

The WVP is anchored to the American Academy of Pediatrics' and Maternal and Child Health Bureau's Bright Futures Guidelines and includes key age-specific developmental milestones for each of the 4, 6, 9, 12, 15, 18, 24 and 36 month well-visits. There are three steps of the WVP:

• Step 1: Answer a questionnaire about your child and family. Includes questions about positive observations of the child, child health and developmental surveillance, the child and family environment, identification of special health care needs.
• Step 2: Pick your priorities. Includes age-specific topics and embedded educational materials. General topics include family functioning, nutrition and feeding issues, establishing routines, behavior and development, language development, toilet training, TV and media use, guidance and discipline, sleep, domestic violence, oral health and safety concerns.
• Step 2: Visit Guide. Dynamically generated from steps one and two, the visit guide is a summary of responses that are important to discuss with the child’s health care provider, selected priorities with relevant example questions and space for notes.

See the WVP Guide to Topics and Questions for a comprehensive list of questions asked specific to each age group.

6. Who sponsors the WVP?

The Well Visit Planner (WVP) is a project of the Child and Adolescent Health Measurement Initiative (CAHMI). It was developed through support from the U.S. Department of Health & Human Services, Health Resources and Services Administration (HRSA), Maternal & Child Health Bureau (MCHB) under grants R40 MC08959 03-00 and Cooperative Agreement 1-U59-MC06980-01. The CAHMI and DRC are responsible for the information presented on this site. Please contact cahmi@ohsu.edu for further information.

7. Are there publications on the WVP tools?

Several papers are currently in progress on our work involving the Well Visit Planner. Links to these papers will be provided at Resources in the Provider portal as soon as they are published.

8. Is the WVP available in any other languages?

The WVP is currently available in English. We are currently working on developing and testing a Spanish language version.

9. Do you have to be at least 18 years old to use the WVP? Can teen parents use it?

Currently the public use version is only available to parents who are 18 years or older due to privacy and legal restrictions. We are interested in expanding the use of the public WVP website to include parents under the age of 18. If you are interested in this demographic group as well, please contact us for further consultation at cahmi@ohsu.edu.

1. Are there different versions of the Well Visit Planner?

Yes. First and foremost there is the Public Use Well Visit Planner. This is the free, publically available online tool, found at www.wellvisitplanner.org. This tool comes with materials, including handouts and trainings, to help providers implement the tool in their practice(s). This site also comes with an abbreviated paper-pencil version of the tool call the Shared Encounter Form (SEF). The content and features of this tool are not customizable.

Second, there are site-specific versions of the Well Visit Planner. Providers that partner with the CAHMI receive a custom WVP website that is essentially an expansion kit for the Public Use WVP. These custom sites have a number of modules/options/features to choose from that vary in cost and technical complexity. Here is a list of what’s currently available for site-specific development:

• Basic Site-Specific Options
• • Site specific URL (e.g. MyClinic.WellVisitPlanner.org)
  • Site Logo and contact information on website
  • Summary reports or full datasets containing WVP responses from your patient population.
  • Some tailored content where allowable; including links to external developmental screening tools
• Enhanced Site-Specific Option
• • Receive parent responses and visit guides automatically via secure email (as PDFs)
  • Integrate parent responses directly into electronic health records (may require additional investment)

The CAHMI is currently partnering with organizations interested in developing site-specific options of the Well Visit Planner. We suggest that you first read the Getting Started page and fill out the User Sign-Up Form found there in to let us know which feature(s) are of interest for your practice. Our capacity for work developing site-specific options is limited so please bear with us as we continue to scale-up and bring this important quality improvement tool into practice. We encourage interested providers to start with the Public Use WVP (www.wellvisitplanner.org). This tool stands on its own as a powerful quality improvement initiative and will expedite the development of site specific options. Scroll up to learn more.

2. What topics are covered in the WVP?

See General section question #5 in this document.

3. What are the age ranges for each age-specific version of the WVP?

The following table shows the age ranges in months for each age-specific version of the Well Visit Planner.

4. How were the questions in the WVP developed?

The WVP was developed and tested by the Child and Adolescent Health Measurement Initiative (CAHMI) for use in pediatric practices over four years and through a grant from the federal Maternal and Child Health Bureau (R40 MC08959 03-00; 2008-2012). The WVP was developed with an expert Advisory Group, including authors of the Bright Futures Guidelines. All content in the WVP is anchored to Bright Futures (BF) recommendations and specific items were written based on the expert input on item priority, assessment and intent. We would like to thank our team of advisors: Betsy Anderson, David Bergman, Emily Brophy , Dimitri Christakis, Kellena Collier, Paula Duncan, John Kilty, Amy Kurian, Cynthia Minkovitz, Tami Olson, Amy Perritti, Ed Schor, Judy Shaw, and Sara Slovin.

5. What is the reading level of the questions in the WVP?

The questions contained in the WVP were tested with parents of children under 40 months old to ensure readability and understandability. Most of the questions are written at or below an 8th grade reading level except in cases where doing so changed the meaning of the question or made it incomprehensible.

6. Does the WVP include any standardized screening tools? Does the WVP screen for ASD or other development disabilities?

The WVP is a general surveillance tool to which more specific screeners can be added. The public use WVP includes the Children with Special Health Care Needs (CSHCN) Screener (see http://cahmi.org/pages/Sections.aspx?section=10 for more information). It also links to publicly available versions of tools such as the Ages and Stages Questionnaire (ASQ), the Modified Checklist for Autism in Toddlers (M-CHAT), and the Promotion Health Development Survey (PHDS). Providers that have partnered with the CAHMI to build a site-specific version of the WVP (see the Customizing the WVP section of this FAQ) can link to other screening tools for which your practice has obtained the rights for use.

7. How does the WVP identify children for screening?

Sites we have worked with in the past have determined follow-up according to the percentage of children who are expected to meet a milestone by a certain age. For example, if a child has not met a milestone that is met by 75% or more of children of the same age, then pamphlets were provided during the office visit. If a child has not met a milestone that is met by 90% or more of children the same age, that child was given an appropriate specific screening tool during the visit. This is just one example of the many follow-up options for the WVP.

8. Can I make changes to the Well Visit Planner?

Parties interested in modifying content of the WVP are required to work closely with CAHMI personnel. Changes to the WVP need to be made with caution, and development of population-specific versions or translations into different languages must meet CAHMI’s validity and quality standards.

1. Is there a Mobile Application for the WVP?

Not yet. However, the CAHMI is interested in developing a mobile version of the public use website (www.wellvisitplanner.org). Business partners interested in this process should please contact cahmi@ohsu.edu. Parents can still complete the WVP from a mobile device at www.wellvisitplanner.org.

2. Can parent's responses to the WVP be integrated into the child’s electronic medical record (EMR)?

Yes, although not directly through the public use version of the WVP. EMR linkage is one of many customization options for the WVP. How this integration works depends upon the EMR system you use in your practice and the degree to which you are able to customize that system. Please read the Getting Started page for more details, and then contact us at cahmi@ohsu.edu for further information.

3. Does the WVP collect Protected Health Information (PHI)?

For the public use website parents are asked to provide a few pieces of personally identifiable information: child’s first name, and child’s date of birth. First name and birth date are NEVER stored in our database. Rather, they are used “on-the-fly” to calculate the appropriate upcoming well-child visit. That visit (e.g. 4 month, 6 month, 9 month etc.) is stored in our database rather than the date of birth.

Parents can, if they choose, email themselves or their provider the Visit Guide, but this takes place outside of our website. The CAHMI is not responsible for the transmission of any personally identifiable information sent via email through a parent or provider’s personal or professional email accounts.

Identifying information connected to your computer (IP address) will not be recorded by the CAHMI at any time.

Parents must consent and agree to the Terms & Conditions of the WVP before completing it.

If you choose to customize the WVP by integrating it with your EMR, some additional PHI may be required to enable this linkage. This requires informed consent, institutional oversight, and data security standards as required by Health Insurance Portability and Accountability Act (HIPAA) privacy rules. The informed consent procedure for each participant is built into the registration process for the WVP, and must be completed before any information is stored or transferred.

4. Who maintains the WVP and is technical assistance available?

The CAHMI team will respond to all questions and technical difficulties within a few business days. Please contact cahmi@ohsu.edu or call 503-494-1930 if you have any technical difficulties or comments or concerns about the WVP.

1. How do I get started with the WVP?

The public use WVP launched in January of 2013. The CAHMI has developed free guidelines and materials to help you ready your practice(s) and engage parents. All of this can be found in our Public Use WVP Implementation Toolkit. To request a free copy please consult the Getting Started page. On the last page of this toolkit you'll find the User Sign-Up Form. Please fill this out and return it to cahmi@ohsu.edu. Once your practice(s) are ready to use the WVP, simply direct your patients to www.wellvisitplanner.org prior to their next well-child visit and ask them to bring the visit guide into the office or, if you have a secure email server in place, prompt parents to send the visit guide through your system. There are also materials to help ensure successful integration of the WVP into office work-flow and to optimize the use of the tool. For more information please consult the Implementation Toolkit.

If you are interested in implementing a site-specific version of the WVP with data feeding into the electronic health record, secure email, tailored content, data reports, unique URL, or branding, please consult the Getting Started page to assess which option(s) are right for your practice. On the last page of this toolkit you’ll find the User Sign-Up Form. Please fill this out and return it to cahmi@ohsu.edu. We will get back to you shortly will more details.

Please note that while we have systems in place to develop site-specific options, we are in the early stages of scaling this process. In order for successful integration of advance WVP tools, a close partnership with the CAHMI is required. We are currently working with several groups to refine this process. As we continue to develop these advanced options across different platforms and at a growing number of locations, we will be able to take on more partnerships. Please bear with us in these early stages as we scale these tools in the most affordable, sustainable and accessible way possible.

2. How do I get my patients to use the WVP?

Getting patients to actively engage in their healthcare can be challenging. However, the WVP is specifically designed to ease this process. The Implementation Toolkit includes many resources that help teach your patients about the WVP and encourages them to use it. Included in the toolkit are posters, fliers and postcards that you can either use directly or customize for your practice. We also provide written and spoken scripts for inviting patients to participate. You can also consider using small incentives such as handing out special stickers to children whose parents completed the tool prior to their visit. Feel free to contact the CAHMI to get more ideas for engaging patients in the WVP that are specifically tailored to your practice.

3. How do parents know when and how to fill out the survey?

This is up to you, depending upon how you decide to integrate the WVP into your office workflow. We suggest that you consider hanging informational posters in exam and/or waiting rooms and calling, emailing or mailing a postcard to parents prior to their child’s well visit encouraging them to complete the WVP. You can find examples of these items in our Implementation Toolkit.

4. How do I smoothly integrate the WVP into my practice workflow?

We have developed an Implementation Toolkit to help you do just this. Read the Getting Started page and return the User Sign-Up Form found on the last page. We will get back to you within 3 business days with the Implementation Toolkit.

5. How much does the WVP cost?

The online tool at www.wellvisitplanner.org is free to the public. Providers, researchers and other parties interested in implementing a practice-specific website or integrating the tool into your EHR should contact cahmi@ohsu.edu for price estimates. Technical assistance and questions regarding the publicly available WVP tools are provided free of charge, simply contact cahmi@ohsu.edu.

6. Can the WVP be used for Maintenance of Certification (MOC)?

No, not at this time. However, we are in the application process with the American Board of Pediatrics (ABP) to have the WVP as an available option for fulfilling Part 4 of the ABP MOC requirements. It will be available as part of an integrated package with the CAHMI-developed Promoting Healthy Development Survey and as a standalone quality improvement project. Email cahmi@ohsu.edu to be notified when the WVP is available to be used for ABP MOC.

7. Does the WVP meet Meaningful Use Objectives?

The Office of the National Coordinator for Health Information Technology’s Meaningful Use objectives incentivizes providers to increase their patient engagement activities through health information technologies in order to improve quality care delivery. The WVP is a tool designed in line with Meaningful Use objectives to help providers meet these standards.

1. Are there different versions of the Well Visit Planner?

See the section of this FAQ on Content & Features.

2. How do I decide which type of WVP tool to implement in my practice?

The CAHMI has created the Getting Started page to help user decide which version or features of the WVP is right for their practice. It is an involved discussion that depends on your goals, overall quality measurement and improvement strategies, and the technology at your disposal.

Please fill out and return the User Sign-Up Form at the back of the toolkit on the Getting Started page so we can better help you decide.

3. Can the WVP be tailored for specific populations?

Yes. The CAHMI is interested finding partners to develop modules of the WVP for different populations. However, at this time we are focused on translating the Public Use WVP into custom websites with larger features set for our partner organizations. Note that while the content in the Public Use Well Visit Planner will not change there is the option to tailor some content in these site-specific versions of the Well Visit Planner. We require all site-specific partners interested in tailoring content of the WVP to work closely with the CAHMI in order to meet validity and quality standards and ensure successful implementation.

The CAHMI envisions future versions of the WVP tool that would allow condition or population specific modules. This being said, we are not actively developing these due to the need for a formal project and funding. While the WVP is currently designed for parents of children less than four years old, the CAHMI has a larger, more inclusive vision of developing many patient-center quality improvement tools that transform health outcomes by engaging patients. With support, we will identify a standard process and template to support rapid and high quality development of additional tools like the Well Visit Planner.

4. Can the WVP be used for work with adults?

The CAHMI is interested building partnerships to develop different versions of the tool. One such version for an adult population could be a pre-surgery engagement tool. However, our energies are currently focused on translating the Public Use WVP into a custom website with larger feature sets for our partner organizations. At this time, we will not be expanding into other populations without further funding or support.

1. How do I integrate the WVP into my EHR system? What are potential obstacles?

First, please use the figure 1 below to determine if EHR integration is the right option for your clinic. This figure and more can be found in our toolkit on the Getting Started page.

Figure 1. Is EHR Integration the option for you?

Once it has been established that it is technically feasible to integrate the WVP into your EHR system, the next step is deciding what data you’ll import and how you’ll import it.

When the content of the WVP that is transferred into the EHR has been established, the next step is to sort out the technology and infrastructure of the data transfer. The technical process of integrating the WVP into your EHR system can be involved and can be different for every EHR system.

1. Use a secure file transfer protocol (SFTP) connection to establish a data-copying process from the CAHMI’s secure data server to a secure computer at your site. The files sent via the WVP are stored in Health Level 7 (HL7) format.
2. Enabling your EHR system to import (via a scripted function or similar) from the files received via SFTP.
3. Specifying within your EHR, how to interpret the data from the imported HL7 file (this determines how the information from the WVP actually populates the data you see in specific forms, etc).

There are some challenges and obstacles involved in implementing the WVP-EHR connection. Some EHR systems are harder to rearrange than others and will provide you with fewer options in how you can change EHR content. In cases where EHR systems are less amenable to content that is customized by the user, the CAHMI can work with you to determine which content we can import into your EHR and how we can leverage the other materials that are part of the suite of WVP tools, to supplement the EHR data.

2. What EHRs have been tested with the WVP?

So far the WVP has only been integrated with Centricity. We are currently developing and testing integration with Office Ally and Epic systems.

1. How much does the WVP cost?

The Public Use WVP and the accompanying implementation materials are free. There may be some minor printing costs as well as cost associated with the time it takes to train staff to use this new tool.

The site-specific WVP is priced based on the modules, features and options requested. Some modules require more committed staff time and will therefore be more costly. The CAHMI works with the objective of keeping costs to a minimum. Starting from a non-profit/research mentality, our primary objective is to get tools into pediatric offices that will improve the quality of well-child care. We acknowledge the challenge of bringing innovative tools to the public with limited capital, thus we require support from our users. As we continue to work with our early partners, we will provide a better estimation of cost for the different options available. In the meantime we are looking for partners that share a common vision of improving quality of well child care through partnership with parents. We will not be charging for these early conversations and planning calls as there is mutual benefit in a shared learning experience. We will work with you over time to implement these tools with minimal cost and understanding that this is new territory that will require patience and learning as we move forward.

2. When can we start using the WVP?

The public use version is available now and the CAHMI is currently partnering with organizations interested in developing site-specific options of the Well Visit Planner. We suggest that you first read the Getting Started page and fill out the User Sign-Up Form found therein to let us know which feature(s) are of interest for your practice. Our capacity for work developing site-specific options is limited so please bear with us as we continue to scale-up and bring this important quality improvement tool into practice. We encourage interested providers to start with the Public Use WVP (www.wellvisitplanner.org). This tool stands on its own as a powerful quality improvement initiative and will expedite the development of site specific options.

3. How much work is it to integrate the WVP with the EHR?

This depends upon what EHR system you are using in your practice and to what degree you are able to alter and customize that system. It also depends upon how much and what types of information from the WVP you would like to send to the child’s EHR. We are happy to discuss more details about EHR integration specific to your practice. Please contact us at cahmi@ohsu.edu or 503-494-1930.

4. How do the paper documents get uploaded to the clinic and/or the EHR?

The PDF documents are generally transmitted to the clinic using the same method that is used to transmit the HL7 files (SFTP/FTP over SSH).

How the PDF documents are imported into the EHR (once they have been delivered to your server) may depend on how your EHR is set up to automatically import PDF documents. Some EHRs have required custom software development while other EHR systems might make use of automated scripting functions.

5. How often do the documents get uploaded to the clinic and/or EHR?

The frequency of data transfer to your system depends on several factors including technical components specific to your EHR. The sites we have worked with in the past have updates to their records occurring about every 15 minutes, but each site will be different. We will work with your clinic and technical staff to develop the most timely and practical system possible.

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