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

236 M.G. Leu et al.
17.2.2.1 Reductions Through Administrative Redesign
Computerized practice management systems (CPMS) perform essential business
functions such as scheduling, registration and billing. CPMS are used nearly universally,
with 84% of practices submitting claims electronically in 2005. 9 In addition
to managing these functions, the administrative data stored in CPMS can measure
practice efficiency (e.g., no-show rates) and effectiveness of resource allocation,
allowing practices to optimize staffing and productivity. An example of technologyenhanced
administrative redesign is the use of automated telephone appointment
reminders in conjunction with letters to encourage childhood immunizations. 10
CPMS can reduce paper use, decreasing on-site storage requirements and
making information more readily accessible. Inventory management systems can
help track vaccine and medication inventory to reduce waste. Online “dashboards”
can keep managers informed by presenting real-time measures of operational efficiency,
allowing timely focus on practice areas needing improvement.
17.2.2.2 Reductions Through Clinical Workflow Redesign
The “Medical Home” concept, first articulated in 1967 in Standards of Child
Health Care published by the American Academy of Pediatrics (AAP), 11 is a partnership
between the patient (a child with special health care needs), his/her family,
and the primary care provider (PCP). This partnership originates in the clinical care
provider’s office. Within this model, the role of the PCP is to plan and ensure access
to, and create linkage and coordination between the patient and a community of
resources tailored to the patient’s needs. The original model has been expanded 12,13
as the Advanced Medical Home in which primary care is transformed to emphasize
preventive and chronic care management in the ambulatory care setting. Cost
reductions are realized through prevention of hospitalizations and severe complications
of chronic medical conditions.
One study suggests that adoption of electronic health records (EHRs) in conjunction
with other health IT to facilitate prevention and chronic care management can
result in a savings of more than $81 billion annually. 14 The central hypothesis of
this study is that authenticated, ubiquitous access to medical records in electronic
form will provide a better historical context for the patient’s medical care, leading
to reductions in unnecessary duplication of testing and services. In the ambulatory
setting, it is postulated that reduced costs of transcription, chart pulls, laboratory testing,
medication usage, and radiology may be as great as $159 billion over 15 years,
with $20.4 billion saved annually when 90% of clinics have adopted health IT.
17.2.3 Increasing Revenue and Provider Efficiency
It is believed that health IT can increase provider efficiency, by allowing speedier
access to information with less effort. 15 This increase in efficiency would lead to