Feeding is often difficult for breastfed newborns, and feeding difficulty can lead to hyperbilirubinemia and dehydration. Together, these three interrelated diagnoses (feeding difficulty, hyperbilirubinemia, and dehydration) are the most frequent barriers to a healthy first month of life and cause the large majority of neonatal readmissions. Further, monitoring and treating these diagnoses is a common cause of both extended length of stay during the birth hospitalization and of increased outpatient utilization after the birth hospitalization.
Earlier identification of infants with feeding difficulty might allow effective interventions to address this problem and prevent hyperbilirubinemia and dehydration, improving the length of stay during the birth hospitalization, readmission following discharge from the birth hospitalization, and the number of outpatient visits in the first month. In order to accomplish this, we have implemented a SMART on FHIR integration of the Newborn Weight Tool (NEWT).
The NEWT web-based application was developed by Dr. Ian Paul, M.D., M.Sc. at Penn State Hershey Children’s Hospital and Drs. Valerie Flaherman, MD, MPH and Michael Kuzniewicz, MD, MPH, at University of California San Francisco, Pediatrics. Funded by the Children’s Miracle Network, it is publicly available and provides clinicians with hour-by-hour newborn weight loss nomograms to assist in early identification of those on a trajectory for adverse outcomes. However, clinicians wishing to use the nomogram for patient management must either exit the electronic medical record to use a browser for manual data entry, or must engage IT support at their institution for a complex EHR-specific build. This barrier to use greatly reduces the impact such an innovative tool can have on neonatal morbidity, especially in underserved populations and community hospitals.
By integrating NEWT directly into the EHR and automating data collection using an external integration platform, we have significantly simplified the implementation and usage of NEWT. Our process innovates on existing FHIR and parameter based solutions by FHIR-enabling a non-FHIR tool, allowing for the simple dissemination of the technology to any health care entity that has implemented the required FHIR resources and thus greatly expanding the potential for wide dissemination. We are seeing a very high level of interest in the NEWT app and are excited in its potential level of adoption due to the SMART on FHIR standard.