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

17 Aligning Pediatric Ambulatory Needs with Health IT 237
increased patient throughput and increased revenue. Theoretical modeling also
suggests that benefits accrue from savings in drug expenditures, improved utilization,
better charge capture, and decreased billing errors. 16 In current EHR systems,
revenue has been derived primarily through improved documentation via electronic
charting and coding optimization. 17 Under proposed Medical Home models, primary
care clinicians may also be reimbursed at a higher rate for care continuity
and coordination.
Although health IT has a great potential to improve quality and safety, actual
improvements in efficiency are highly dependent on providers and existing practice
workflows. For some, the increased efficiencies in performing some tasks are offset
by additional tasks which they must now accomplish (for example, examining
additional patient information that is available, or reviewing a more comprehensive
set of lab results presented to them). 18
17.3 Clinical and Workflow Impact of Health IT
Prior to health IT adoption, clinical and organizational leadership must have a
clear and thorough understanding of the workflows and processes that will be
affected. Inappropriate adoption, implementation and deployment of health IT will
not “fix” dysfunctional workflows and processes, but may in fact reinforce and
worsen them. A realistic accounting of organizational needs, coupled with organizational
process and culture change is necessary. If these changes are overlooked
or ignored, the technical deployment may take much longer than anticipated, and
may ultimately fail.
The first step in adopting a health IT solution is formal exploration of existing
workflows, problems, and potential technical solutions. With the exception of mandated
(and proven) technical initiatives, practices tend to begin adoption initiatives
with those that have minimal impact on clinician workflow and/or high probability
of success (“low-hanging fruit”). With small successes, organizations gain internal
structures and overcome organizational inertia, resulting in increased clinician
participation and medical oversight (e.g., clinical committees, clinical champions),
which allows for more ambitious projects to be undertaken with greater impact on
clinician workflow (Table 17.4). 18
17.3.1 Health IT with Minimal Impact
on Clinician Workflow
Health IT that supports clerical functions has minimal impact on clinician workflow.
This may include CPMS (as discussed previously); and practice Websites or
portals that provide information and services for patients (e.g., contact information,
provider lists, description of services the clinic can provide, office hours). Personal