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

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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
238 M.G. Leu et al. Table 17.4 Clinical areas for health IT use, and available solutions (adapted from18 ) Impact on clinician workflow Tools track and follow up preventive care needs, results, and outcomes Multidisciplinary coordinated care; specific fields in structured, analyzable format Area of Health IT use Minimal/none Some Moderate Significant Orders, results, Results for ordered tests Online order sets, online results Online chart or results and results printed or faxed for clinicians of ordered tests review between management (paper-based) different care settings Intra-clinic Providers and clinic staff Clinical tasks assigned Electronic documentation communication communicate with electronically, document by clinician (EHR, e-mail, text messages; imaging of paper notes word processor) notes dictated (a.k.a., “Go paperless”) Patient education Practice website with Automatically generated forms/ E-mail with patients Clinical care managed between and outreach educational materials, care plans (e.g., asthma visits (includes goal-setting automated reminders action plan) and tracking) for appointments Inter-clinic Paper immunization cards Electronic referral paperwork Information exchanges, Referrals managed per coordination provider-maintained electronically reinforced personal health record protocols; information systems exchanges Medication Online drug reference e-prescribing (with interaction e-prescribing with dose e-prescribing with diagnosis- management checking), frequently calculation, medication and patient- based decision used lists reconciliation support Provider education Web site links, online clinic Integrated or handheld reference Clinical calculators Integrated electronic clinical and feedback policy manuals materials, online training decision support; report cards, assessments
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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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172 M.J. Feldman system or etiology
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174 M.J. Feldman ED-12: “Practica
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176 M.J. Feldman Fig. 12.7 DXplain:
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178 M.J. Feldman For GIDEON: Rabies
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180 M.J. Feldman KB on infectious d
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182 M.J. Feldman 4. Johnson KB, Fel
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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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