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2 Barbara Howard, MD President, TCH Inc. and Co-Creator of CHADIS Management Management LeadershipTeam Management Team Management Team Team Developmental-behavioral pediatrician trained at Harvard University Assistant Professor, The Johns Hopkins University School of Medicine Past president of the international Society for Developmental and Behavioral Pediatrics Contributing author for Bright Futures, DSM-PC and Bright Futures in Practice, key standards documents and American Academy of Pediatrics national committee member Raymond Sturner, MD Director, Non-profit Center Allen Traylor, MBA, MPH Chief Operating Officer Developmental-behavioral pediatrician trained at Yale University Associate Professor, The Johns Hopkins University School of Medicine Formerly Director of the Developmental and Behavioral Pediatrics Fellowship Training Program at Johns Hopkins and Director of the Child Development Unit at Duke University, Principal investigator or Co-PI of some 100 research grant years. Policy writer for the EHR Incentive Program - Meaningful Use Years of small business consulting MBA and MPH from Johns Hopkins Background in Health Education Business

3 CHADIS What is it? A unique web-based system for Clinical Process Support: 1. Online pre-visit screening, diagnosis and data collection 2. Point-of-care decision support and resources 3. Post visit patient engagement via individual MemoryBook Care Portals with alerts, notices and resources. 4. Clinician Education

4 Past and Present Support for CHADIS R & D Commonwealth, Cisco, Abell, Wilson, Erickson, State of Maryland, Doris Duke MCHB NIMH x 4 NICHD NHLBI CDC

5 Current Usage > 1 million parents enrolled >40,000 per month 49 states; 8 countries >7,000 pediatricians

6 How CHADIS Works Parent and teen separately take previsit online questionnaires Clinician reviews results, can consult linked textbook Clinician may exchange findings with school or mental health provider online Clinician finds relevant resources, handouts from links & prints for family Education materials automatically populate Memory Book & Care Portal How CHADIS Works

7 #1 Pre-visit Questionnaires Office sets up Visit Types once Patients use one simple office invitation code to register Autoassigned questionnaires are completed by respondents based on age, and visit type Over 200 questionnaires available to be assigned Many tools perfect for Behavioral Health

8 QUESTIONNAIRE VIEW

9 Select Questionnaires >200 to choose Select CHADIS Questionnaires (of >200) INFANT & YOUNG CHILD Ages & Stages Questionnaires Third Ed. (ASQ-3 ) Modified Checklist for Autism in Toddlers (M- CHAT) & Follow-up Infant Development Inventory (IDI) ASQ:SE SCHOOL AGE Pediatric Symptom Checklist (17 items) Vanderbilt Parent Revised Vanderbilt Follow-up, Parent Informant CHADIS - DSM 5 Strengths & Difficulties Questionnaires & FA SCARED: Parent and Child CBCL ADOLESCENT Pediatric Symptom Checklist - Youth Patient Health Questionnaire 2, 9, A CRAFFT Kutcher Adolescent Depression Scale CES-DC (depression) CHAMPS (Adolescent Risk Behaviors) TEACHER DATA Vanderbilt Teacher Revised & Follow Up School Intervention Questionnaire GENERAL HEALTH CHADIS Visit Priorities Early Periodic Screening Diagnosis and Treatment (EPSDT) Family Medical History Family Cardiac History Safety & Guidance Topics (Bright Futures) Brenner FIT (Obesity and Nutrition) PACCI, ACT and others (Asthma monitoring) FAMILY / ENVIRONMENT Edinburgh Postnatal Depression Scale Multidimensional Scale of Perceived Social Support (MSPSS) McMaster Family Assessment Device, General Functioning Scale Adverse Childhood Experiences (ACE) Partner Violence Screen Safe Environment for Every Kid (SEEK) QUALITY MONITORING Provider-level Promoting Healthy Development Survey

10 Teen Self-Administered Teens complete securely and privately online Parents cannot see teen results; teen cannot see parent results Multiple tools for teens: Pediatric Symptom Checklist - Youth Patient Health Questionnaire 9 & PHQ-A plus suicide questions CRAFFT Kutcher Adolescent Depression Scale CES-DC (depression) CHAMPS (Adolescent Risk Behaviors) Online Media Use Substance use risk factors

11 Patient Input Options Computer Phone Tablet Smartphone From: Home.or..Waiting Room Read or heard. English or Spanish 11

12 Tablet/Kiosk View View

13 #2 Clinician Decision Support Clinicians view scored results from their patients Shared results with consultants = Integrated Behavioral Health Results linked to: guidelines graphic displays echapters Hints local and national resources

14 Worksheet with Flagged Results for Clinician

15 View Details of Answers for Clinician

16 Decision Support: M-CHAT F/U

17 Evidence for Validity of F/U in Primary Care Can doctors do F/U as well as Trained RAs? 89% Agree; 4 positives classified differently each Kappa 0.76 AUC 0.67 = doctor; KKI = 0.61; No sig diff (p = 0.16)

18 Tracking Development- ASQ-3

19 CHADIS sends , get Teacher Vanderbilts

20 Advanced Decision Support: Patient Specific Templates Documentation Relevant questionnaire data pre-populates creating an auto-text report Clinician reviews and modifies and clicks to edit or add text Creates individualized parallel parent printable and secure webpage for child (MemoryBook CarePortal Point of care clinician education Teleprompters (patient barrier specific MI) Some videos Tips/hints E-chapter Access to guidelines Facilitates QI for MOC or Shared Savings

21 SEEK (Safe Environment for Every Kid) * 14 items covering: Food insecurity Parental depression Parental substance use Life Stress Harsh Punishment IPV Two positive randomized trials in primary care pediatrics by Dubowitz, et. al. top rating for strength of evidence in preventing child abuse from the California Evidence-Based Clearinghouse (CEBC) Dubowitz H., Feigelman S, Lane W, Prescott L, Blackman K, Grube L, Meyer W, Tracy JK. Screening for Depression in an Urban Pediatric Primary Care Clinic. Pediatrics. 2007;119(3): Lane, W., Dubowitz, H., Feigelman, S., Kim, J. Prescott, L., Meyer, W., Tracy, J.K. Screening for Parental Substance Abuse in an Urban Pediatric Primary Care Clinic. Ambulatory Pediatrics, 2007;7: Dubowitz, H., Prescott, L., Feigelman, S., Lane, W., Kim, J. Screening for Intimate Partner Violence in an Urban Pediatric Primary Care Clinic. Pediatrics. 2008;121(1):e Dubowitz H, Feigelman S, Lane W, Kim JW. Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model. Pediatrics. 2009;123: Feigelman S, Dubowitz H, Lane W, Kim J. Screening for Harsh Punishment in a Pediatric Primary Care Clinic. Child Abuse Neglect. 2009;33(5): Dubowitz H, Lane W, Semiatin J, Magder L, Venepally M, Jans M. The Safe Environment for Every Kid (SEEK) Model: Impact on Pediatric Primary Care Professionals. Pediatrics. 2011;127(4):e *Dubowitz, H., Prescott, L., Feigelman, S., Lane, W., Kim, J. Screening for Intimate Partner Violence in an Urban Pediatric Primary Care Clinic. Pediatrics. 2008;121(1):e85-91.

22 FAMILY STRESS PST Addressing Ambivalence

23 FAMILY STRESS PST Clinician Education

24 TOPIC SPECIFIC CME VIDEOS

25 SEEK PST E-CHAPTERS

26 SEEK PST: QI Report for MOC-4

27 Teleprompters for Problem Solving Counseling

28 Recommended Dosing

29 Asthma Treatment Plan appears in Care Portal

30 Asthma Treatment Plan Generated Prescribing: NHLBI suggested medications based on age, severity, URI. Asthma Action Plan: Pre-populated specific to clinician and patient.

31 Gameification of Education

32 Tracking Asthma

33 Tracking ADHD by Clinician

34 Tracking Reports

35 Registries- Your choice

36 #3 Patient Education and Engagement Setting the auspices for psychosocial care Each child gets individual webpage MemoryBook that celebrates milestones passed from ASQ Visit Notes and Asthma Treatment Plan from PST use by Clinician Alerts about safety items failed Resources sent by results, Clinician or free text search

37 Individual MemoryBook for Education & Alerts

38 Care Portal for Visit Notes & Alerts

39 Care Portal for Resources

40 #4 Clinician Education Maintenance of Certification Part 4 3 programs of 25 points each Autism, developmental screening, family risk Coming soon asthma, ADHD No chart reviews needed. 3 webinars. Free Monthly consultation webinars to discuss your cases with DBPs and Child Psychiatrist

41 CHADIS Benefits to the Practice Provide Enhanced Patient Care Improve Office Workflow Increase Practice Income Enhance Reputation for Evidence-based Care Maintenance of Certification Part -4 Practice Level Certification Assistance eg Meaningful Use, ACO

42 Added Income: 96110, 96127, & higher level codes 96110, & coding is supported with all the necessary scoring, interpretation & documentation CHADIS offers over 15 screens that have been paid and often multiple codings can be billed for the visit Though payment by private insurers varies by state, is paid by Medicaid in almost every state Potential Annual income from greater than $15,000 per clinician Low Scenario Moderate Scenario 3 extra screens paid per wk 30 extra screens paid per wk $10 payment $10 payment 50 weeks per year 50 weeks per year = $1,500 = $15, & 99215: Added income from Review of Systems and Family & Social Histories verify complexity and document to bill for or visits

43 CHADIS Integrated with EHRS or Stand Alone Now available integrated with: Allscripts Touchworks Office Practicum eclinical Works Integrations agreed to: Athena Integrations ready to provide: Centricity EPIC CHADIS has HL-7 interface and custom API CHADIS results can be copy-pasted into your EHR

44 CHADIS Pricing: An Annual Fee Practice Size Single Multi Group # OF CLINICIANS PER CLINICIAN RATE $995 $850 TBA RESIDENT RATE $59 $59 $59 Part 4 MOC: (per clinician) $150 per activity $250 for two activities

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46 CHADIS ADHD PST* Patient pre-visit questionnaires prepopulate template Template presents results and interview result options within guidelines Decision support presents from links Vanderbilt graphic shows results from all respondents with med. dose Autotext report is created and can be edited Patient Specific Education appears in each child s Care Portal or can be printed Custom reports can be run at your request Forms a research database

47 CHADIS ADHD PST*

48 Pop up choices produce autotext

49 CHADIS Care Portal content automatically created*

50 CHADIS Care Portal notes*

51 CHADIS Online Comprehensive Clinical Process Support TOTAL CHILD HEALTH INC Altamont Place Baltimore, MD (888) 4-CHADIS