Information Bulletin
Ministry of Health, NSW
73 Miller Street North Sydney NSW 2060
Locked Mail Bag 961 North Sydney NSW 2059
Telephone (02) 9391 9000 Fax (02) 9391 9101
http://www.health.nsw.gov.au/policies/
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Child Personal Health Record (Blue Book) Release of Revised
Version 2012/2013
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Document Number IB2013_028
Publication date 23-Jul-2013
Functional Sub group Clinical/ Patient Services - Baby and child
Clinical/ Patient Services - Maternity
Summary The information bulletin sets out the main changes to the Personal Health
Record in 2013. It provides guidance for health professionals in
implementing the new resource.
Replaces Doc. No. Personal Health Record (The Blue Book) - Release of the revised version
[IB2007_008]
Author Branch NSW Kids and Families
Branch contact April Deering 9424 5828
Applies to Local Health Districts, Specialty Network Governed Statutory Health
Corporations, Affiliated Health Organisations, Community Health Centres,
Dental Schools and Clinics, Divisions of General Practice, Government
Medical Officers, Private Hospitals and Day Procedure Centres, Public
Health Units, Public Hospitals
Audience Maternity, Child and Family Health Services, Dental Schools and Clinics
Distributed to Public Health System, Health Associations Unions, Ministry of Health,
Private Hospitals and Day Procedure Centres, Tertiary Education
Institutes
Review date 23-Jul-2018
Policy Manual Not applicable
File No. H12/98432
Status Active
Director-General
INFORMATION BULLETIN
CHILD PERSONAL HEALTH RECORD (Blue Book)
Release of Revised Version 2012/13
PURPOSE
The information bulletin sets out the main changes to the Personal Health Record in 2013.
It provides guidance for health professionals in implementing the new resource.
KEY INFORMATION
Since 1988, NSW Health has presented a child Personal Health Record (Blue Book) to
newborns. In 2012/2013, a major review of the NSW blue book was conducted. Over
3,000 health professionals and parents provided written feedback to inform the review. A
reference group with presentation from a range of stakeholder groups oversaw the review.
Local Health Districts are responsible for ensuring that relevant staff have access to
appropriate training to undertake assessment and monitoring of children’s health, and
have completed this training.
ATTACHMENTS
1. NSW Kids and Families Information Bulletin regarding the revised Child Personal
Health Record (Blue Book) 2012/2013.
IB2013_028
Issue date: July-2013
Page 1 of 1
Child Personal Health Record
(Blue Book)
Release of Revised Version 2012/2013
Information Bulletin
Table of contents
1 Introduction ........................................................................................................................... 1 2 Key Changes ......................................................................................................................... 1 3 The PHR and Electronic Personal Health Records ............................................................ 2 4 Guidelines for implementation ............................................................................................ 3 4.1 Working in Partnership – parents and professionals....................................................... 3 4.2 Clinical use – ensuring appropriate documentation. ....................................................... 3 4.3 Assessing Growth – Growth Charts ................................................................................ 4 4.4 Assessing Development – Parent Evaluation of Developmental Status (PEDS) ............ 4 4.5 Providing families with education and support on safe sleeping ..................................... 5 4.6 Families who have difficulty reading English................................................................... 5 5 Contact information .............................................................................................................. 6 APPENDIX A: List of changes to this version of the PHR....................................................... 7
APPENDIX B: Model pathway for child health and development assessment and
referral............. ....................................................................................................................... 7 Contents page
1 Introduction
Since 1988, NSW Health has presented a child Personal Health Record (PHR) to parents
of newborn babies in the state. Regular reviews have been part of the PHR development
and in 2012, a major review of the PHR was undertaken.
Changes in the PHR were made in consultation with leading clinicians and researchers
with expertise in the field, to ensure that the PHR was informed by the best available
evidence. The review was overseen by an Advisory Group comprised of key childhood
health and development professionals and consumer representation. A Screening and
Surveillance Subcommittee provided expertise and made recommendations to the
Advisory Group on key issues such as growth (weight, height, body mass index (BMI)),
hearing, vision and child development. Wherever possible, the PHR is designed to align
with relevant State, national and international guidelines and evidence.
The PHR review was also informed by an online survey of over 3000 clinicians and
parents that examined how effectively the PHR was fulfilling its intended functions, making
it the most consultative review undertaken so far.
Consistent with the feedback provided in the consultation, the NSW PHR remains blue,
and is still an A5 ringbinder with the capacity for parents to easily add additional pages
throughout the book. The plastic pocket remains in the back for other items. The white
space for recording the child’s name remains on the front and spine of the book, and
parents should be encouraged to use a permanent marker to identify their child’s PHR.
The structure of the book is similar to the previous version, although it has been
streamlined. The routine recommended minimum schedule of health checks remains at 9
checks at the same times: birth, 1-4 weeks, 6-8 weeks, 6 months, 12 months, 18 months,
2 years, 3 years and 4 years. The Immunisation section remains at the back of the book
for ease of reference.
2 Key Changes
The review resulted in a number of changes that clinicians should note. These are listed in
the order of appearance in the PHR at Appendix A.
Changes with the greatest clinical impact will be:
 The inclusion of information about developmental milestones at the beginning of
each scheduled health check
 Updated growth references, with the World Health Organisation (WHO) growth
standards now included for children up to two years of age, and the Centres for
Disease Control growth references for children 2-18 years
 The immunisation schedule no longer appears in the Immunisation section, and has
been replaced by a link that leads parents to the most current advice.
Page 1 of 12
3 The PHR and Electronic Personal Health Records
A ‘soft’ copy of the revised PHR (without the Parent Evaluation of Developmental Status)
will be available on the NSW Health website for viewing and downloading.
In 2010, Commonwealth, State and Territory Governments approved and funded the
development of a Personally Controlled Electronic Health Record (National eHealth
Record) system that was launched in 2012. The National eHealth Record aims to provide
a secure, electronic record of a person’s medical history which can be shared with health
care providers with consent of the patient.
There has been a recent release of a child health, growth and development component of
the National eHealth Record which allows parents/carers in NSW to record information
about their child’s health, growth and development including measurements (e.g height
and weight) and milestones (e.g. first words). Parent/carers can enter information via a
web based portal and as from June 2013 via a Smartphone App. At the time of release of
this Information Bulletin, the child health, growth and development component of the
National eHealth Record is for use by parents/carers only.
The content of the child health, growth and development component of the National
eHealth Record is based on the NSW Personal Health Record (“Blue Book”) which is
given to all parents on the birth of their child.
Since September 2012 an electronic version of the Blue Book (“eBlue Book”) has been
implemented in parts of western Sydney involving the Western Sydney and Nepean Blue
Mountains Local Health Districts and Medicare Locals.
The eBlue Book enables child health, growth and development information to be entered
and viewed on-line by public hospitals, participating GPs and child and family health staff
with the consent of parents/carers.
Parents/carers taking part in the trial in western Sydney can also view and enter
information into their child’s eBlue Book record through the eBlue Book Consumer Portal
(website) and the eBlue Book mobile phone application for Smartphones.
In those parts of western Sydney where the eBlue Book is available, participating health
care providers and consumers are advised to continue using the eBlue Book. NSW Health
is looking to expand the availability of the eBlue Book in the near future.
As the National eHealth Record does not currently support entry of child health, growth
and development information by health care providers it is not a replacement for the NSW
Health electronic Blue Book at this time.
NSW will continue working with the Commonwealth Government to further develop the
child health, growth and development component of the National eHealth Record. NSW
also continues to support the use of the NSW Personal Health Record (hard copy Blue
Book) which allows both parents/carers and health care providers to enter information into
the record.
Page 2 of 12
4 Guidelines for implementation
4.1 Working in Partnership – parents and professionals
The PHR is intended to be a key resource for parents and health professionals, to help
them to more effectively work together to achieve the best health and development
outcomes for children. Evidence shows that the best assessments incorporate parents’
expert knowledge of their child with clinicians’ knowledge and experience. Parental
concerns about their children can be an excellent indicator of possible health or
development issues, and both parents and clinicians should use the PHR as a starting
point for discussing children’s health, growth and development, and any concerns that a
parent may hold.
4.2 Clinical use – ensuring appropriate documentation.
The Birth Details and the Newborn Check must be completed by the appropriate
clinician(s) before the child is discharged from hospital. The triplicate (green) form is for
the use of the hospital, and should be included in the hospital file. The duplicate (yellow)
form should be left in the PHR for the child and family health nurse to remove at the first
health home visit, for the child’s community health file. If other electronic record keeping is
in place that ensures the information is properly recorded in the electronic file, the
duplicate and triplicate forms can simply be left in the PHR. The clinician must still ensure
that there is an accurate, legible and complete record of the Birth Details and Newborn
Check in the PHR.
An appropriate standard of clinical practice includes a review of parent questions and
concerns, discussion of the ‘topics for discussion’ for the scheduled health check, and a
full clinical check up as indicated by the age of the child.
The new PHR has a list of parent completed questions about health risk factors on page
3.2 that apply each time the child has a check, as well as specific questions for each
health check that parents should be encouraged to complete prior to the health check. If
these questions have not been completed, the health professional should ensure the
questions are asked during the health check. The answers must be reviewed by the
clinician at each check, and the responses considered in clinical decisions resulting from
the check.
Where centres are equipped to move to electronic record keeping and away from
maintaining paper based records, it is still essential for clinicians to ensure that they have
reviewed parent responses to the risk factor questions, have incorporated the information
into their assessment, and have documented the encounter appropriately in their system.
The answers to the questions on feeding, along with “Is your baby/child exposed to
smoking in the home or car?” (environmental tobacco smoke) and “Is your baby placed on
his/her back for sleeping?” (safe sleeping) are important triggers for health promotion
messages to be discussed with parents. The responses to these questions must be
recorded in the child’s file (paper or electronic), as these are the basis of key child health
data collections. Negotiations are underway to ensure that this is incorporated into the
development of new versions of community health electronic health records (CERNER
and CHIME).
Page 3 of 12
Clinicians should also note that when they complete the Health Check template and
answer ‘yes’ to “Parent questions completed?” they are indicating that they have checked
(or asked) the questionnaire for that check and the health risk factor questions on page
3.2, have discussed any potential risk factors identified with the parent or carer, and have
incorporated this information into their assessment of the child.
4.3 Assessing Growth – Growth Charts
A major innovation in this version of the PHR is the inclusion of the WHO Growth Standard
for 0-2 year olds.
In April 2006, the World Health Organization (WHO) released a new international growth
standard for young children aged birth to 5 years. This standard describes the growth of
healthy children living in well-supported environments in six countries.
The WHO standard charts use growth of the breastfed infant as the norm for growth, and
are based on high-quality data collected for children younger than aged 2 years.
The WHO and the CDC growth charts differ in their overall conceptual approach to
describing growth. The WHO growth charts represent growth standards that describe how
healthy infants and young children should grow under optimal environmental and health
conditions. The CDC growth charts are a growth reference. They describe the growth of
children in the United States in a specific time period.
Using the WHO growth chart percentile cutoff values indicates a change in clinical
protocol. When transitioning from the WHO growth standard charts to the CDC growth
reference charts at aged 2 years, a change in growth classification may occur. During this
transition, caution should be used in interpreting any changes in classification.
For the growth assessment to be an effective screening tool, accurate measurements are
critical. A series of measurements will assist in appropriate interpretation of growth
patterns.
Before using the charts, clinicians should complete the online training funded by the
Department of Health and Ageing for Australian clinicians, available at
http://www.rch.org.au/childgrowth/. Local Health Districts are responsible for ensuring that
their staff have access to the training and have completed it.
4.4 Assessing Development – Parent Evaluation of Developmental Status
(PEDS)
The PEDS is a validated parent completed developmental screening and assessment tool.
It remains an integral part of the health checks at 6 months, 12 months, 18 months, 2
years, 3 years and 4 years.
This tool should be completed by parents and scored by the examining health
professional. Train the Trainer courses were provided in 2007, and training in using the
PEDS has continued statewide since that time. All Local Health Districts are reminded that
they are responsible for ensuring that their staff members are trained in administering and
scoring the PEDS as the primary developmental screening tool at routine health checks.
The recommended secondary screening tool, which has been supplied statewide, is the
Ages and Stages Questionnaire third edition (ASQ-3) and the Ages and Stages
Questionnaire: Social & Emotional (ASQ:SE).
Page 4 of 12
The developmental information included at the beginning of each check in this version of
the PHR should be reviewed by parents prior to completing the PEDS. Access to
information about normal development has been shown to elicit more accurate information
from parents regarding their child’s development. Health professionals should ensure that
parents are aware of the information in the PHR, and have reviewed it.
Each LHD should have developed a local pathway for the assessment of child health and
development, responding to concerns, and referring children and families to other services
when indicated. A model pathway, endorsed by the PHR Review Advisory Group to assist
LHDs in the development of local pathways, is at Appendix B.
NSW Health’s choice of the PEDS as the primary developmental screen and the ASQ as
the secondary screen is based on compelling evidence, and is consistent with the current
recommendation of all key authorities that parents should be actively involved as partners
with health professionals in the developmental surveillance and assessment of their
children. The ability of health professionals to involve parents of young children in
developmental surveillance is critically dependent upon the nature of the relationship they
develop, not just their professional knowledge and skills. Developing positive relationships
depends in turn upon two sets of skills: communication / helping skills and family-centred
care / partnerships skills. 1
Training provided by LHDs for the PEDS and the ASQ must equip staff with these skills.
4.5 Providing families with education and support on safe sleeping
Promotion of safe sleeping is one of the important activities undertaken in the 1-4 week
check (often undertaken in the context of the universal health home visit) and other
contacts with families in the first year of their child’s life. Safe sleeping messages are
summarised on the NSW SIDS and Kids website http://www.sidsandkids.org/safesleeping/ as follows:
How to Sleep your Baby Safely:
1. Sleep baby on the back from birth, not on the tummy or side
2. Sleep baby with head and face uncovered
3. Keep baby smoke free before birth and after
4. Provide a safe sleeping environment night and day
5. Sleep baby in their own safe sleeping place in the same room as an adult
caregiver for the first six to twelve months
6. Breastfeed baby
SIDS and Kids online education can be found at:
http://www.sidsandkids.org/offices/queensland/online-education-safe-sleeping/
4.6 Families who have difficulty reading English
The following sections of the revised PHR are available in Arabic, Chinese (Simplified),
Chinese (Traditional), Dinka, Hindi, Indonesian, Khmer, Korean, Lao, Nepali, Somali,
Tamil, Thai, Turkish and Vietnamese on the Multicultural Health Communications Service
Website at www.mhcs.health.nsw.gov.au/mhcs/topics/Blue_Book.html:
1
Department of Education and Early Childhood Development Melbourne Best Practice Guidelines for
Parental Involvement in Monitoring and Assessing Young Children Published July 2008
http://www.eduweb.vic.gov.au/edulibrary/public/earlychildhood/mch/guidelinesparentpresence.pdf
Page 5 of 12
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Information for Parents pages 1.1, 1.2, 1.3
My information and family history page 3.2 (Health Risk Questions)
Measuring and monitoring your child’s growth page 5.1
Birth Details and Newborn Check page 6.5 Questions for parents about hearing
1-4 week check pages 7.1, 7.2, 7.3 (includes parent questions)
6-8 week check pages 8.1, 8.2, 8.3, 8.4 (includes parent questions)
6 month check pages 9.1, 9.2, 9.4, 9.7, 9.8 (includes parent questions)
12 month check pages 10.1, 10.2, 10.4 (includes parent questions)
18 month check pages 11.1, 11.2, 11.4 (includes parent questions)
2 year check pages 12.1, 12.2, 12.4 (includes parent questions)
3 year check pages 13.1, 13.2, 13.4 (includes parent questions)
4 year check pages 14.1, 14.2, 14.3, 14.4, 14.6 (includes parent questions)
Immunisation pages 15.1, 15.2
Clinicians should have access to the website and capacity to print the appropriate pages
for parents who require them. Note that parents completing the pre-health check
questionnaires must also have access to the developmental information for that check
before answering the questions.
5 Contact information
For further information regarding the revised child Personal Health Record: My Personal
Health Record please contact Deborah Beasley, Manager, Child & Family Health, NSW
Kids & Families on 02 9424 5828 or at [email protected]
Joanna Holt
Chief Executive
NSW Kids & Families
Page 6 of 12
APPENDIX A: List of changes to this version of the PHR
Changes to the
name and format of
the PHR to make it
more user-friendly
The PHR is now titled My Personal Health Record. (It was
formerly My First Health Record).
The title and the graphics from the 2007 version were
adapted slightly to better reflect a record for 0 – 18 year olds.
It was agreed that the previous version targeted infants and
this focus needed to be widened to an older age group and
emphasise a continuum of care.
Parents wanted the option to add electronically generated
supplementary information to the hard copy, tailored to the
unique conditions of their individual child; for example,
chronic illnesses and disabilities.
Clinicians should encourage parents to personalise the
ringbinder and add information to suit the specific needs of
their child.
Information in the front section has been simplified. The first
section now consists of:
 An introductory letter to parents on page i;
 A simpler, easier to navigate table of contents on
page ii;
 A summary of the routine recommended checks with
space to record appointment details on page iii;
 Birth registration information on page iv; and
 Information for people who may require an interpreter
or translations on page v-viii.
Information for
parents
Parent/carer feedback in the survey indicated support for
significant child health and development information being
provided through links to websites, with minimal information
being contained in the PHR. This approach ensures that
information remains current.
An ‘Information for parents’ section has accordingly been
included in the 2012/2013 version of the PHR. This section
includes streamlined and updated information about:
 early childhood health services and child health
professionals;
 child health and development checks;
 parents’ evaluation and monitoring of their child’s
health and development; and,
 child safety.
The new ‘Information for parents’ section has replaced the
section that used to contain child and family health service
information and appointments. A page for routine
Page 7 of 12
appointments is now included in the front section, at page iii.
Useful contacts and The contacts section has been revised in line with parent
feedback, and now has space for parents to insert personal
websites
contacts for their child’s health services on the first page, and
then expanded information on the websites NSW Health
recommends to parents.
My information and
family history
For information on specific early childhood and parenting
issues, clinicians should promote the Raising Children
Network and the NSW Children’s Hospitals’ fact sheets.
Links are provided on page 2.2 of the PHR.
The sections that were previously called ‘Records & family
history’ and ‘Progress notes’ have been replaced with ‘My
information and family history’ and ‘Records’.
Records
Clinicians should note that the ‘My information and family
history’ section contains not only the page for personal and
identifying information, but also a set of questions to identify
family health history and risk factors. These questions are
to be reviewed by the health professional conducting the
health check each time a scheduled check is performed.
The answers form part of the clinical assessment performed
at each check.
The questions for parents at each child health check now
include a prompt to parents about these questions to ensure
they have been answered.
The ‘Records’ section places together the notes pages for
recording illnesses and injuries (pages 4.1-4.4), and for
progress notes (pages 4.5 to 4.16), to be completed by
parents and also used by clinicians to record any information
additional to the routine checks.
Growth charts
A major change in the 2012/13 version of the PHR is the
inclusion of new Growth Charts.
Consistent with National recommendations, the NSW PHR
now includes:
 The World Health Organisation growth standard
charts for children up to 2 years old (published 2006);
 The US Centers for Disease Control (CDC) growth
charts for 2 – 18 year olds (2000).
More information on the implications of this change can be
found in the Implementation section of this Information
Bulletin (section 4.3, page 6).
The growth charts have been ordered according to gender
so that parents can remove the growth charts that are not
Page 8 of 12
relevant to their child eg: if their child is a girl, the boy related
growth chart pages can be removed.
Updated information on ‘Monitoring your child’s growth’
appears in this section rather than the ‘Birth & newborn’
section where it appeared in the previous version.
Birth Details and
Newborn Check
The ‘Birth and newborn’ section is now called ‘Birth details
and newborn check’.
Feedback during the review indicated that the birth details
and newborn examination pages must continue to be
completed on carbonless copy paper in triplicate. Clinicians
must take care to ensure that each copy is legible, and that:
 the original remains in the child’s PHR;
 the duplicate is included in the early childhood health
centre file; and
 the triplicate goes into the hospital file.
Specific changes include:
 The forms are now formatted as medical record forms
with a barcode and space for the patient label, so that
they can be scanned into the electronic Medical
Record;
 The Birth Details item on Labour now includes “none’
as an option; and
 The ‘Newborn Examination’ form now specifies
general observation and red reflex for eyes.
Page 6.5 lists the revised ‘Questions for parents about
hearing’. Changes here include:
 Parents are reminded to complete the health risk
factor questions on page 3.2;
 The questions do not repeat those on page 3.2, and
have revised wording for the remaining questions. The
revised wording is intended to more accurately identify
possible risk factors.
Clinicians should ensure that they review these risk factors at
each check as part of their clinical assessment.
Updated child health and development checks 1-4 weeks to 4 years
One of the most substantial content changes to this version of the PHR is the
addition of developmental milestones at the beginning of each child health check, to
promote child development anticipatory guidance for parents and professionals.
These start with the “I am 2 weeks old” page at the beginning of the 1-4 week check.
These developmental milestones provide parents with guidance regarding normal
child development, ideas for encouraging development, and advice about specific
instances when they should seek help.
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From the 6 month child health check, the milestones are positioned in front of the
Parents’ Evaluation of Development Status (PEDS) response form to support
parents understanding of normal development and increase the likelihood that they
will raise any concerns when they answer the parent questions and attend their
child’s health check.
The format for the developmental milestones pages at each child health check are
based on the ‘My Health and Development Record’ developed by the Victorian
Department of Education and Early Childhood Development. The content has been
heavily influenced by the Centers for Disease Control resources on milestones for
the Learn the signs. Act early. campaign. More detailed information and practice
resources including milestones checklists from two months to five years, and videos
for parents, are available at
http://www.cdc.gov/ncbddd/actearly/milestones/index.html
At the bottom of each milestones page in the PHR is information on the Families
NSW resource Love, Talk, Sing, Read, Play. This resource is designed to help
parents nurture the social and emotional development of their child. Clinicians should
ensure they are familiar with the resource so they can effectively use and promote it
with parents. The website http://www.families.nsw.gov.au/resources/love-sing.htm
includes links to:
 The developmental chart Love, Talk, Sing, Read, Play for parents in English,
Korean, Arabic, Chinese, and Vietnamese
 The Service Provider Book with information to help clinicians best use the
resource with parents
 The Indigenous version named Love, yarn, sing, read, play developed by the
‘Deadly tots’ project
 A ‘Deadly tots’ flip chart
 Parent and Carer Handouts
The ‘Topics for discussion’ pages have been revised and updated. The list of topics
at each check are age-appropriate and serve as a discussion prompt for both health
professionals and parents at each child health check.
Questions for parents at each health check incorporate most of the questions used in
the previous PHR, with some questions updated. Questions about ‘Feeding’ have
been moved from after the child health check questions in to the ‘Questions for
parents’.
Information about oral health has been moved to the 6 month child health check as
this is considered to be the average age for a first tooth to emerge.
Information relating to ‘Before school starts’ has been included in the revised PHR at
the 4 year health check. Ideas are given to parents about how to support their child
as they enter into kindergarten or pre-school for the first time. This information is
sourced from the Raising Children Network.
Page 10 of 12
Immunisation
Schedule
The print out of the NSW Immunisation Schedule has been
removed and a link to the current schedule on the NSW
Ministry of Health website is provided. This is to ensure that
parents have access to a current immunisation schedule to
help them have their child vaccinated on time at each
milestone.
Timely vaccination is the best way to keep children protected
from serious vaccine-preventable diseases. There are very
few medical reasons to delay immunisation. If a child is sick
with a high temperature (over 38ºC), immunisation should be
postponed until the child is recovered. However, a child who
has a runny nose, but is not ill, can be immunised, as can a
child who is on antibiotics and recovering from an illness.
NSW Health is making it easier for parents to ensure their
children are fully immunised on time. As part of an
immunisation awareness campaign, the “Save the Date”
phone App helps parents ensure timely vaccination through
a series of reminders and prompts as well as access to a
personalised immunisation schedule for their child.
CPR Chart
An updated CPR chart (September 2011 version) is provided
at the back of the PHR.
Emergency
Numbers
The emergency numbers on the back page have been
updated.
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APPENDIX B: Model pathway for child health and development assessment and referral
Page 12 of 12