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

15 Pediatric Care Coordination: The Business Case for a Medical Home 213
conversion, and productivity changes follow the usual pattern after a new system
is installed. Within a year post-implementation, a practice can be not only back to
normal rates of productivity, but in many cases can exceed previous levels through
better allocation of resources to generate revenue.
15.5 Improved Quality of Care
A number of organizations have advocated automation of the medical record to
improve the quality of care. The Leapfrog Group, 17 the Institute for Healthcare
Improvement, 18 and the federal government 19 now promote widespread adoption of
electronic records as one way to improve health care quality. Some ways in which
this approach can promote better quality care include:
Ready access to a complete medical record to improve data-based decision
making
Decreased redundancy of laboratory and x-ray tests that could be potentially
harmful
Better documentation and legibility of entries
Enhanced detection of drug interactions and adverse reactions
Improved ability to measure and analyze clinical data
More rapid access to reference and supporting data for patient care
When the medical record is unavailable, practitioners have little recourse but to discern
diagnostic and therapeutic histories from patients, who often have indistinct memories
of past medical treatments. The clinician is left in the difficult position of trying to
design a diagnostic and treatment regimen with incomplete information, leading to
errors such as drug interactions or allergic reactions, repetition of potentially uncomfortable
or harmful tests, and patient dissatisfaction. Additionally, standardized data entry
can improve documentation and availability of information for decision support. 20,21
Quality management hinges on measurement: “You can’t manage what you can’t
measure.” Measurement of clinical processes has relied on two basic sources of
data: (1) transaction data from coded insurance company transactions and (2) paper
chart audits performed by skilled reviewers. The transaction data come from coded
forms submitted by providers to insurance companies for reimbursement. These
data are flawed in a number of ways for measurement of clinical processes. First,
the codes are not descriptive of the richness of a clinical encounter, since they only
provide information regarding the diagnosis assigned and procedures performed
during the patient visit. Many other issues often arise during an interaction between
a provider and patient, and the codes used for an insurance claim rarely capture
those elements, particularly for children with special health needs. Thus, a great
deal of information does not make it into an insurance claim system.
Secondly, the data submitted on an insurance claim form are designed to optimize
reimbursement for services rendered, rather than provide information relating
to quality of care. As such, the codes will not contain important clinical parameters,