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

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16 Prioritizing Pediatric Investment for IT in Smaller Practices 225 16.3.2.2 Costs to Customize Products Small practice decision makers must decide if “commercial off-the-shelf (COTS)” technology will meet practice needs or if customization is required. Customization may range from “built-in” specification of forms (low cost) to changes in the underlying data structures that require technologist intervention (high cost). In addition, practices need to determine the frequency of customization updates and how these will incur further costs. 16.3.2.3 Costs to Interface/Integrate Systems In the same manner, practices must decide if “standalone” products will meet needs of if they must connect to other systems (and on what basis). Interface/integration considerations include the costs of interfaces (and functionalities) of an EHR to: Practice cost centers or management system Different office locations (and home/mobile) Commercial laboratory and imaging services New entities (How much will it cost to modify current interfaces) The most useful interface is between clinical information tools (such as EHRs and eRx) to practice management systems to integrate clinical information with billing and scheduling functions. Interfaces that connect products from different vendors to form value-added integrated suites are available. Challenges to practices include decisions on how to transition from current management systems while minimizing costs of productivity loss and retraining of staff. Transitions may require operation of more than one system. 16.3.2.4 Upgrade Costs Proprietary and customized systems are vulnerable to discontinuation by their vendors. Contractual negotiations with vendors should include contingency plans for continued service, including if needed, availability of code or interfaces for modification. All hardware and software have a life span and upgrades may include major changes, with accompanying costs. Tools are available that can help a provider look at individual pieces or the cost breakdown. 11 16.4 Planning IT Adoption 16.4.1 The Steps The steps in planning adoption for small practices may be less formal than for larger ones. These include:
226 M.M. Simonian Outline practice information needs for now and the future Participate in different vendor displays or demonstrations Select vendor and product candidates Check the vendor performance and experience, especially in service and support Test drive products and ask around Narrow choice and make selection Negotiate the contract 16.4.2 Information Resources Information sources on products may include other physicians and practices, vendors, and professional medical societies who have experience with specific products. Consultation with colleagues in close proximity to the office allows office staff access to what other groups or individuals are doing. First hand experience is also very helpful in providing lessons learned. If a paid consultant is used, the experience and recognized expertise of the consultant should be researched. 16.4.3 Deployment and Operation Most practices will require help with installation. Tasks include: hardware configuration and networking, software installation and testing, data conversion, staff training, and rollout. Some vendors provide help themselves or contract with local technicians for setup and support of their system. Purchasers and staff should feel comfortable about operating the system (including remote access) and about finding support. This aspect of products should be explored with other practices that have experience with the system. 16.4.4 Expenses – Initial Setup The most complex part of adoption is choosing how to finance the process for a given practice. Each practice must decide how to approach the decision and which approach is the best. Four general approaches (not including private development or open-source tools) include direct purchase, traditional loans, leasing, subscription (application service providers) and (if available) gift, grants or network membership benefit. 16.4.4.1 Direct Purchase Some technology will not require much deliberation and can be purchased as a practice expense. These include office workstations, printers, wireless networking,
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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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11 Clinical Practice Guidelines: Su
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162 M.J. Feldman in patients withou
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164 M.J. Feldman The art of medicin
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166 M.J. Feldman important design g
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168 M.J. Feldman Incorrect or missi
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170 M.J. Feldman Fig. 12.4 GIDEON D
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276 K.B. Johnson and C.G.M. Weigle
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278 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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