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

134 D.M. D’Alessandro
The EBM process consists of collecting and summarizing research studies using
an explicit review process to integrate evidence about prevention and therapy for a
broad array of clinical problems. 4 EBM summaries “result in recommendations that
are more consistent with the evidence than do [other] approaches” such as expert
recommendations. Patients receiving efficacious therapy based on evidence, in the
setting and context of routine care, have better outcomes.
Adoption and dissemination of EBM techniques and findings are enhanced by
their availability in the form of clinical decision support tools at the point and time
of care, through active physician engagement (interactive educational meetings,
educational outreach visits) and through audit and feedback to providers from
patient care indicators (see Case Study). Acceptance and use is further enhanced by
local opinion leaders and champions and organizational support to improve quality,
safety and to decrease costs through the provision of better care. 5
The use of EBM in the course of clinical pediatric care is evolving. More pediatricians
are connected to the Internet in their offices (95%), are using the Internet
(50%), and an increasing number are using personal digital assistants (PDAs,
38%). 6 These tools, which provide easy access to information, have fundamentally
changed pediatricians’ expectations. Dissemination of important medical information
from trusted sources (such as the American Academy of Pediatrics, the Centers
for Disease Control and local health departments) is now be measured in hours
instead of days to weeks (through e-mail alerts, Internet, and newsfeeds (RSS,
really simple syndication) from trusted sources). Still, this vision has not been fully
realized.
10.3 Practice Barriers
10.3.1 Time
Clinical workflow is busy and consequently important patient care questions arise
but may go unanswered. Physicians’ information needs may vary from 0.01–5.0
questions per patient encounter. 7, 8 On average, primary care physicians require
2–12 min to search textbooks, 2–6 min to search Internet resources and 20 min to
9, 10
do an average MEDLINE search.
10.3.2 Practical Internet Access
Although pediatricians may have office computers, this does not equal true accessibility
to electronic resources such as clinical practice guidelines, journals, textbooks,
and even consultants. Physical placement away from the point-of-care (such as the
front office), slow connections and shared use may create functional and practical