Transitioning from pediatric care to women’s health

When and how to build a seamless transition workflow from pediatric care to women’s health

Adolescence is a transitional period with rising preventive and reproductive care needs, particularly for patients who may need gynecologic or reproductive care. Supporting a smooth transition from pediatric care to women’s healthcare can help prevent gaps in care, improve patient experiences, and reduce administrative burden.

It’s critical for practices to build a standardized process for the handoff — one that incorporates technology-enabled workflows to automate patient outreach, record sharing, and follow-ups. This process should also address key questions, such as: When do patients age out of pediatric care? How do we configure portal access for patient transitions? What will our electronic health record workflow look like?

This guide provides a step-by-step framework for building an adolescent care transition workflow that could help improve operational efficiency and patient outcomes.

The importance of managing the transition from pediatric to women’s health

Adolescence and young adulthood can be vulnerable points for care fragmentation for patients who need gynecologic, reproductive, or sexual health care. During this time, patients may begin to address reproductive care needs, schedule their first Ob-Gyn appointments, and undergo sexually transmitted infection (STI) screenings. Yet many practices struggle to properly manage and anticipate this transition. A large Texas health system identified three common gaps in the transition from pediatric to adult care: unclear workflows, inconsistent documentation structures, and limited data visibility.

By standardizing processes and tools used around the pediatric patient handoff, practices can effectively:

Prevent care gaps

Practices can help patients avoid missing critical opportunities for care during this high-risk life stage. STI screenings and reproductive care, for example, can support prevention, early detection, and timely treatment for health concerns that may affect long-term health. Adolescents can also connect with adult care practitioners where appropriate to manage chronic conditions as they age.

Reduce administrative burden

Coordinating care transitions comes with administrative hurdles, such as securely transferring records, changing portal access, providing referrals, and setting up billing. Creating a comprehensive, standardized process for these tasks can improve throughput and minimize errors.

Protect patient privacy

Some states have recently passed laws where adolescents may be able to independently consent to care services and manage their own medical information when it comes to certain types of care. Where permissible under federal and state laws, practices can protect adolescent patient privacy by building workflows to document consent status, share records, and update portal access permissions. Practices should work separately with their own legal counsel to determine permissible workflows applicable to their practice and can then work to establish such workflows through policies, procedures, and relevant tools and technology that comply with applicable law.

Improve patient experiences

Practices can make it easier for patients to schedule appointments and access the timely care they need. This can, in turn, improve patient satisfaction and referrals.

A step-by-step framework for building a standardized transition workflow

Practices can follow this step-by-step framework to build a standardized and reproducible transition workflow that reduces administrative burden and improves patient experiences.

1. Identify eligible patients for transition

Practices can establish clinical triggers that prompt referral or transition conversations. Per the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC), these triggers might include first sexual activity, contraception counseling, pregnancy, persistent menstrual issues, pelvic pain, STI treatment, or chronic conditions needing adult gynecologic care.

Practices might also consider age-based milestones to assist in identifying eligible patients for adolescent women’s healthcare where appropriate and consistent with applicable law. For example:

• The CDC recommends routine human papillomavirus (HPV) vaccination at ages 11 or 12; vaccination can start at age 9, and catch-up vaccinations are recommended through age 26 if patients are not adequately vaccinated earlier.¹
• ACOG recommends that adolescents have an initial reproductive health visit between ages 13 and 15. That visit should focus on education, prevention, and relationship-building and does not necessarily require a pelvic exam.²
• CDC guidance on STIs recommends routine chlamydia and gonorrhea screening for sexually active adult women aged 18–25.³

Practices should also be aware that there are some exceptions to these thresholds referenced above. Each patient's needs and health journey are different. For instance, some patients may continue routine preventive visits with their pediatric primary care team while receiving gynecologic or reproductive care from a women's health clinician, depending on their needs, preferences, and the practice's care model. Practices should also consider the relevant applicable laws for patients and their business, as these thresholds may also be governed differently across different states.

2. Automate patient outreach

Once practices have identified patients who may be ready to switch to women’s healthcare, they should initiate conversations via automated or targeted messages. For example, they can build an EHR workflow that includes transition checklist templates, visit reason codes, referral order sets, and templated secure-message scripts. This can help ensure timely transitions and prevent care gaps, giving patients time to receive referrals and research their options.

3. Configure portal access to support privacy

Practices can make it easy for patients to securely access their portal and manage this next phase of care. To do so, they should:

• Review state consent and privacy laws. Understand which services adolescents can consent to on their own and which information can be (or is required to be) shared with a parent or healthcare proxy.
• Establish new access permissions. Create templates to document consent status and patient confidentiality. Implement portal settings for proxy access, change requests, and secure record-sharing.
• Involve front-desk staff. Work with staff to verify patient portal access and insurance before the patient's first women's health appointment.

4. Provide referrals for first women's health visits

Practices can create referral templates for women's health practitioners based on each patient's clinical triggers, medical history, and care needs. Templates can include contact information, guidance on how to schedule appointments, and educational resources about what to expect during the visit.  

5. Establish billing processes

Practices' billing and coding teams should:

• Capture the appropriate Current Procedural Terminology (CPT) codes for preventative visits. Make sure the corresponding CPT codes are used when billing for preventive care services, such as contraception counseling and STI screenings.
• Watch for insurance Explanation of Benefits (EOB) privacy leaks. Practices should align EOB disclosures with patient consent and proxy settings to protect patient confidentiality in a manner that is consistent with applicable law.
• Account for billing differences. Understand the unique billing and coding processes for both pediatric and women's health visits; ensure consistent and accurate documentation during the transition.

6. Confirm attendance to close the loop

Practices should set up automated tracking to ensure patients schedule and attend their women’s health appointments. Practices can also trigger follow-up messages to provide more information or reminders for those who may need guidance on making this transition.  

After the appointment, practices should confirm patient satisfaction to ensure the handoff is complete.

Automate transition workflows with athenaOne®

Practices can  automate components of these nuanced transition processes and better manage preventive care for adolescents with athenaOne, which combines EHR, practice management software and services, and patient engagement tools into a single platform.  

For example, here's what an automated workflow might look like for managing the transition from pediatric care to gynecology:

• Use population search to easily identify aging cohorts. Set up an automated campaign that emails patients at certain age thresholds, consistent with clinical best practices and applicable law, about transitioning to women's healthcare services.
• Implement a women's health referral workflow for Ob-Gyns and prompt patients to schedule their first appointment by age 18 (or earlier, depending on care needs and applicable law). Allow patients to access their health information and resources at any time through the athenaPatient™ App.
• Securely transfer pediatric records to the Ob-Gyn chart.
• Check each patient's reporting dashboard to ensure the transition is complete and preventive care is underway.

These steps help standardize the process from start to finish, supporting value-based care and giving patients a clearer path through the transition.

Streamline your pediatric patient handoff

The transition from pediatric to women's healthcare can be complex — and it varies for every patient. Without a clear workflow, these transitions can lead to gaps in preventive care, missed follow-up opportunities, and avoidable administrative or financial strain. Practices should implement a standardized, technology-enabled workflow to improve care continuity, quality measures, and patient experiences.  

Ready to optimize this process for your practice? Start by piloting a transition protocol for a defined cohort (for example, relevant patients in a specific age range), and learn how athenaOne supports connected care across specialties.