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

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Chapter 15 Pediatric Care Coordination: The Business Case for a Medical Home Donald E. Lighter Objectives To outline the needs of children, especially children and youth with special health care needs (CYSHCN) and an architecture for a clinical record to meet those needs To make a business case for adoption of an electronic health record for pediatrics, especially for CYSHCN To illustrate by way of a financial ledger the set-up, use and maintenance of an electronic health record for a pediatric practice and its positive impact on the quality of care 15.1 Introduction: The Medical Home Children and Youth with Special Health Care Needs (CYSHCN) have complex health care issues that require multiple providers, as well as numerous procedures and medications that potentially can interact with each other to endanger health and safety (Chapter 5). The American Academy of Pediatrics created the Medical Home program in 1992 in a policy statement that defined the concept and recommended an infrastructure for children with conditions that fit the special needs criteria. That policy statement was updated in 2002 1 to include several enhancements (with emphasis on the concept of the Medical Home for ALL children) and specifying the following list of services provided: 1. Family centered care 2. Unbiased and clear information 3. Primary care, in the broadest definition 4. Assurance that care for acute and chronic conditions is continuously available 5. Continuity of care, including transitions to other providers 6. Appropriate and timely referrals to pediatric medical and surgical specialists 7. Interaction with early intervention programs 8. Care coordination C.U. Lehmann et al. (eds.), Pediatric Informatics: Computer Applications 205 in Child Health, Health Informatics, © Springer Science + Business Media, LLC 2009
206 D.E. Lighter 9. A centralized record with all information needed for comprehensive care 10. Developmentally appropriate, culturally competent health assessments and counseling Of particular importance, the ninth service reads specifically as follows: Maintenance of an accessible, comprehensive, central record that contains all pertinent information about the child, preserving confidentiality. The need for information to facilitate care coordination is not only logical, but is a central factor in implementation of effective care management since the inception of the concept. 2 Only by having the complete picture of an individual’s clinical status can cogent decisions be made about health care interventions. As pediatric electronic health records (EHRs) are deployed throughout the industry, recognition of the specific needs of children, particularly Children and Youth with Special Health Care Needs, must be central to the design of the record. 15.2 Architecture of the Clinical Record for CYSHCN Most of the data elements for CYSHCN are similar to those required for all other children, but there are a number of important additional features that become important for these children, including: Storage and retrieval of consultant reports, not only by consultant, but also by consultant type (neurology, urology, etc.), dates of interventions/evaluations, types of interventions (e.g., CT scan, initiation of drug therapy) Appointment types and dates by consultant name or specialty Diagnostic or therapeutic interventions by procedure or type of procedure (e.g., radiology, surgical, etc.) Parental involvement in care, based on evaluations from all providers Child’s functional level (assessed by outcome instruments like the Pediatric Evaluation of Disability Inventory, Gross Motor Function Classification System, etc.) Medication list and potential drug interactions Case managers for CYSHCN require considerably more information than professionals who manage children with less complex conditions. For example, a child with cerebral palsy may be taking medications for seizures, osteopenia, gastroesophageal reflux, as well as receiving high calorie alimentation feedings for failure to grow. This combination of drugs and nutrients can produce abnormal drug levels, diminishing therapeutic effect or causing adverse drug reactions. Care managers must understand not only the scope of the child’s therapeutic regimen, but also the potential interactions between all these factors. Primary care pediatricians are often hesitant to provide Medical Home care coordination for uninsured or underinsured CYSHCN 3 partly because of the difficulty in assembling all of the information needed to adequately manage all of
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Health Informatics (formerly Comput
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Editors Christoph U. Lehmann George
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vi Series Preface changes to both t
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viii Foreword This text will prove
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x Preface financial investment and
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How to Use This book This book is t
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xvi Contents 9 Pediatric Care, Safe
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xviii Contents Part VII A Vision an
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xx Contributors Donna M. D’Alessa
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xxii Contributors Christoph U. Lehm
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xxiv Contributors Mark M. Simonian,
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4 G.R. Kim pharmacy, medical educat
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6 K.B. Johnson and G.R. Kim Deaths
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8 K.B. Johnson and G.R. Kim 2.4.1 I
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10 K.B. Johnson and G.R. Kim 2.4.3
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12 K.B. Johnson and G.R. Kim Educat
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14 K.B. Johnson and G.R. Kim 2.6 Co
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Chapter 3 Core Pediatric Data Kevin
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3 Core Pediatric Data 21 3.3 Pediat
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3 Core Pediatric Data 23 3.6 Pediat
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Chapter 4 Neonatal Care and Data De
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4 Neonatal Care and Data 27 Essenti
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4 Neonatal Care and Data 29 4.3 The
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4 Neonatal Care and Data 31 some ma
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4 Neonatal Care and Data 33 Measure
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4 Neonatal Care and Data 35 4.5.2.4
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4 Neonatal Care and Data 37 4.6.3 I
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4 Neonatal Care and Data 39 4.7.2.2
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4 Neonatal Care and Data 41 Availab
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44 D.M.N. Paperny Tasks related to
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46 D.M.N. Paperny Behavioral risk d
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48 D.M.N. Paperny for outside ancil
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50 D.M.N. Paperny Video reinforceme
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52 D.M.N. Paperny 3. Litzelman DK,
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Chapter 6 Children with Development
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6 Children with Developmental Disor
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Chapter 7 Pediatric Emergency and P
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7 Pediatric Emergency and Pediatric
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84 W.H. Drummond et al. A recovery
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86 W.H. Drummond et al. 8.2.2 Forma
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88 W.H. Drummond et al. 8.2.2.1 Sys
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90 W.H. Drummond et al. The multidi
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92 W.H. Drummond et al. noise overl
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94 W.H. Drummond et al. needs requi
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96 W.H. Drummond et al. Children’
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98 W.H. Drummond et al. After the P
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100 W.H. Drummond et al. Table 8.2
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104 W.H. Drummond et al. when to su
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106 W.H. Drummond et al. It is crit
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108 W.H. Drummond et al. traditiona
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110 W.H. Drummond et al. and human
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112 W.H. Drummond et al. blood prod
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116 W.H. Drummond et al. 35. Collin
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Chapter 9 Pediatric Care, Safety, a
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9 Pediatric Care, Safety, and Stand
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134 D.M. D’Alessandro The EBM pro
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136 D.M. D’Alessandro 10.4 Pragma
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138 D.M. D’Alessandro 4. Case ser
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140 D.M. D’Alessandro Ontario, BC
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142 D.M. D’Alessandro Table 10.1
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144 D.M. D’Alessandro Children ar
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146 D.M. D’Alessandro 17. Ely JW,
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Chapter 11 Clinical Practice Guidel
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17 Aligning Pediatric Ambulatory Ne
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258 G.R. Kim and C.U. Lehmann Elect
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260 G.R. Kim and C.U. Lehmann 18.2.
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262 G.R. Kim and C.U. Lehmann There
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264 G.R. Kim and C.U. Lehmann 13. C
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266 K.B. Johnson and C.G.M. Weigle
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280 C. Sable et al. computer for la
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282 C. Sable et al. Table 20.3 Tele
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284 C. Sable et al. without increas
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286 C. Sable et al. Fig. 20.1b Wash
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288 C. Sable et al. prior to case d
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290 C. Sable et al. presence of con
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292 C. Sable et al. 17. Sable C, Ro
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294 A.E. Zuckerman and G.R. Kim 21.
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296 A.E. Zuckerman and G.R. Kim �
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Chapter 22 Privacy Issues David M.N
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22 Privacy Issues 305 22.3 Pediatri
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22 Privacy Issues 307 patient must
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22 Privacy Issues 309 and receipt o
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Chapter 23 Electronic Mail in Pedia
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23 Electronic Mail in Pediatric Pra
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Chapter 24 Information Management b
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24 Information Management by Patien
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Chapter 25 Overview of Pediatric In
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25 Overview of Pediatric Inpatient
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Chapter 26 Prescribing/Ordering: Co
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26 Prescribing/Ordering: Computeriz
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346 S.H. Mitchell et al. 27.2.1 Med
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348 S.H. Mitchell et al. context of
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350 S.H. Mitchell et al. 27.3.3.1 C
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352 S.H. Mitchell et al. challenges
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354 S.H. Mitchell et al. work round
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Chapter 28 Medication Administratio
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28 Medication Administration and In
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Chapter 29 Understanding and Preven
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29 Understanding and Preventing Err
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386 D.C. Stockwell and A.D. Slonim
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400 J.H. Schneider a number of prob
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402 J.H. Schneider on governance, u
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404 J.H. Schneider 31.6.1 Data Rele
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406 J.H. Schneider Understanding op
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408 J.H. Schneider of this componen
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410 J.H. Schneider Table 31.1 (cont
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412 J.H. Schneider References 1. Am
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Chapter 32 Developing Pediatric Dat
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32 Developing Pediatric Data Standa
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430 G.R. Kim and S.T. Rosenbloom Co
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432 G.R. Kim and S.T. Rosenbloom No
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434 G.R. Kim and S.T. Rosenbloom pr
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436 G.R. Kim and S.T. Rosenbloom ab
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Chapter 34 Pediatric Research and I
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34 Pediatric Research and Informati
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Chapter 35 The Moving Picture of Pe
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35 The Moving Picture of Pediatric
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470 G.R. Kim and K.B. Johnson Cente
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472 G.R. Kim and K.B. Johnson 36.4
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Index A 2006 AAP recommendations on
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Index 477 psychological data, 45 se
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Index 479 High frequency flow inter
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Index 481 O Online Mendelian Inheri
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Index 483 Standards development org
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