Pediatric Informatics: Computer Applications in Child Health (Health ...

8 Complexity in Healthcare Information Technology Systems 105
rare locations such as “in the elevator”). Response time for “STAT” calls should be
measured in seconds.
8.3.4.4 Demographics and Patient Identification
Patient name changes are very common in pediatrics due to social, legal, and
practical factors. Newborns often retain their mother’s last name until the birth
certificate is created. Admission names may be changed according to local rules
during the baby’s neonatal admission. This may lead to confusion of identity and
incorrect resulting in the complex collection of inpatient archival, clinical, and
laboratory databases. 67 Names are key identifiers in nearly all clinical database systems.
Neonatal and Pediatric intensive care patients often have the same last names,
due to multiple births and family groups involved in auto accidents, etc. In these
situations, it is relatively easy to succumb to error and place an order on an incorrect
patient. 68 The risk increases when orders are placed away from the patient’s
bedside, where physicians lose visual identity cues. In the paper world, “name
alerts” were pasted in bold red letters on the bedside charts, name cards are on the
beds, and the nurse and parents nearby conducted independent, redundant checks.
CPOE eliminates many of these geo-spatial safety checks. Thus, CPOE systems
require increased vigilance by nurses, pharmacists, and physicians to ensure safe
ordering and care delivery practices.
8.3.4.5 Registration, Lack of Registration and HIT
In perinatal medicine, caregivers often must order medicines for, or send blood
samples from, an unborn baby (or babies) while preparing for an emergent delivery.
The perinatal situation is analogous to the problem that Pittsburgh faced when
trying to enter orders on transport patients prior to the patient’s arrival. Many
CPOE systems are not capable of permitting orders on a patient that has not been
admitted yet. Due to billing requirements and antifraud protection, many admitting
systems that feed patient information into CPOE systems do not allow admission
of a patient that has not yet arrived. Entering identities for babies not yet born,
or for other unidentifiable individuals (unconscious emergency room patient) is a
particularly perplexing problem for which future HIT developers need standardized
procedures that are not yet (2008) functionally specified.
Efficient processes must be developed to deal with the complex but common
“pre-admit” dilemma in Pediatric and Perinatal medicine, before hospitals implement
a new technology. Possible solutions include creating “phantom” medical
record numbers, or using a paper based process for arrest situations, unborn babies,
and incoming, possibly unidentified, critical care transports. In this work-around,
the paper orders could be entered into CPOE once the child has been formally
admitted and/or stabilized. In practice, this solution is very time consuming, delays
information flow, eliminates the benefits of a CPOE system, is very error prone
at every step and distracts critical caregivers. (In practice, critical admit records
are often reconstructed from handwritten notes on paper towels and scrub pants.)