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

136 D.M. D’Alessandro
10.4 Pragmatics
10.4.1 Educational and Quality Assurance
The evolution of formal continuing medical education (CME) throughout the
last century originally separated physicians from practice in classroom settings.
Educational content was (and often still is), passive, course-centered, and teacherdriven.
This is not an efficient nor effective form of learning for clinicians, 27,28
and changes in continuing education have emphasized continuous professional
development (CPD) where the educational content is active, physician-centered,
and practice driven. Other areas of changing focus in continuing education include
collaborative, interprofessional team training and professional communities of
practice and learning. 29,30
The American Board of Pediatrics (ABP), along with other members of the
American Board of Medical Specialties (ABMS), now requires evidence of lifelong
learning and self-assessment and satisfactory practice performance as two of the
four parts of the maintenance of certification (MOC). 31 The American Academy
of Pediatrics (AAP) provides online tools through its Pedialink© (http://www.
pedialink.org) Website: educational modules, an activity finder, a CME hour tracking
tool and a system for developing an individualized learning plan (ILP) for lifelong
learning. ILPs are now required during residency training and may become
an intrinsic part of CPD for practicing pediatricians in the future. 32 The AAP’s
eQIPP© (Educational in Quality Improvement for Pediatric Practice) program also
supports CPD by providing pediatric practices with a structured clinical performance
feedback process based on data collected from patient charts to identify opportunities
for practice improvement based on performance compared to published
evidence 31 (see Case Study). Structured feedback affects the individual pediatrician,
and also the entire healthcare team by identifying areas for practice team
education, organizational change and evaluation of outcomes.
10.4.2 Workflow and Organizational Issues
Ideally, physicians would like to streamline and combine their information use and
maximize its benefits. They would like to have best evidence on hand (wherever
they are) to answer all their clinical questions efficiently during patient encounters.
They would like to be able to measure and document the effectiveness of their use
of evidence in improving patient outcomes while concurrently receiving credit
(both educational and reimbursement) for doing so. This ideal cannot be met easily,
but there are (intertwined) steps that can move pediatricians along the continuum
toward this ideal.
The physical placement of information access for easy use in clinician workflow
is dependent on practice size (Chapters 16 and 17). In larger practices, assessment