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

156 R.N. Shiffman
relevant knowledge (atomization, de-abstraction, disambiguation, verification of
completeness, addition of explanation and building of executable code). 31 The GEM
model then focuses on workflow integration. 32 GEM users specify origins of decision
variables and insertions of actions into clinical workflow, define action-types, select
associated implementation strategies, choose interface components and ultimately
create a specification that can be instantiated by local information technology teams.
11.7.3 Pediatric Guidelines: The Role of the American
Academy of Pediatrics
The American Academy of Pediatrics (AAP) has been a leader in the development
and implementation of evidence-based guidelines for child health. The earliest
example of a specialty-society guideline is its Report of the Committee on
Infectious Diseases, also known as the AAP Red Book (first published in the 1930s,
and currently available in print, CD-ROM, online, and handheld formats). 33 Since
the early 1990s, the AAP has regularly convened multispeciality panels to review
evidence and provide guidelines and technical reports on the management of common
pediatric problems (including urinary tract infection, febrile seizures, head
trauma, attention deficit and hyperactivity disorder, gastroenteritis, otitis media
with effusion, developmental dysplasia of the hip, and bronchiolitis. 34
In recognition of the importance of practice guideline implementation strategies,
the AAP recently formed the Partnership for Policy Implementation (PPI), which
includes pediatric informaticians with special interest in guideline-based decision
support and expertise in pediatric quality improvement. The PPI works with AAP
guideline (and policy) authoring committees to assure that the developed recommendations
will be implementable in practice settings.
The AAP Steering Committee on Quality Improvement and Management
(SCOQIM) 35 has oversight over AAP guideline development. A scheme for classifying
pediatric guideline recommendation strength based on evidence quality and
consideration of the benefits, risks, harms, and costs associated with implementation
has been published. Transparency of guidelines (the degree to which their
purpose and development are made clear to users) is emphasized.
To participate fruitfully in guideline development, committee members must
understand the guideline authoring process and have skill in critical appraisal of
the scientific literature.
11.8 Case Study: Decision Support for Pediatric
Chronic Asthma
A multidisciplinary team at Yale University has developed and implemented a decision
support system for chronic asthma management in children based on National
Heart Lung and Blood Institute (NHLBI) guidelines. The Pediatric Primary Care