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

15 Pediatric Care Coordination: The Business Case for a Medical Home 207
their needs. The paper chart world makes gathering all of the necessary information
nearly impossible, or at least a daunting and time consuming task. Even when the
paper chart contains all of the information, finding the necessary data and then correlating
it with the child’s current clinical status remains difficult at best. On the
other hand, finding, sorting, and collating information in an electronic record can
be much more expedient and certainly more accurate that relying on the traditional
paper chart search methods. Thus, an electronic chart can make finding and organizing
chart data much more achievable. 4–6
Like all record keeping systems, however, getting data into the electronic
chart is the key to having information available for clinical use. Direct access to
consultant reports, lab and x-ray reports, as well as details of school performance
and therapy interventions, is a critical component of coordinating complex care
regimens and ensuring quality and safety. EHR systems for CYSHCN must be
accessible for data entry by all of the child’s consultants, as well as from laboratories,
radiology departments and the many types of therapists who provide
services for these children. Information in the chart must be available, if the child
is to receive the best possible care, with access adequately secured, through biometric
identification methods or through smartcards that authenticate and track
all users of the record.
Informed care managers enable children to achieve a quality of care that exceeds
that of those who are left to fend for themselves in the complicated health care
environment. Through effective use and analysis of clinical information, these professionals
can achieve the goal of the AAP’s Medical Home Project, i.e. the highest
quality care available for children and youth with special needs. 7–9
15.3 Business Case for the EHR
If health care consists of multiple processes, and the delivery of care by physicians
and other providers uses those processes to create diagnostic and therapeutic
approaches for patients, then virtually every health care decision has economic
implications. As every process has inputs and expected outcomes, so each process
has expected costs and revenues. Some processes generate only costs, while others
involve both costs and revenues. For example, when a child is evaluated by a pediatrician
in the office, the process of care involves costs (physician time, overhead,
capital costs for property and equipment) and revenues (payment for services). As
with any business, the goal is to generate more revenues than costs, and so a variety
of approaches are deployed to reduce costs and maximize revenues.
Maximization of revenues for CYSHCN can occur in only a few ways:
Proper coding to ensure maximum reimbursement by third party payers
Complete documentation to justify code levels
Performance of lab tests, imaging studies, and special services (e.g., therapy)
that can be billed to patients or third parties
Sales of equipment or special devices for use by the child or parent