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

17 Aligning Pediatric Ambulatory Needs with Health IT 239
productivity tools which can be accessed independently of the patient visit (such
as online medical reference materials) can support clinician work without forcing
workflow to change.
Practices which use these technologies are likely to use paper-based medical
records and personal health records (such as immunization cards). Electronic information
exchange is likely to be limited to administrative data (billing and mandated
reports).
17.3.2 Health IT with Some Impact on Clinician Workflow
When small gains, practices may advance to adopt health IT solutions that are
considered to be “big wins” (high probabilities of success and/or that provide
“instant gratification”), but which also have limited impact on clinician workflow.
These solutions may require few simple changes in manual activities that
save time for clinicians. These focused activities reduce the risk of failure, while
increasing enthusiasm when gains are realized. Modules that fall under this
category include: document imaging, electronic prescribing (e-Rx)/computerized
provider order entry (CPOE), electronic results lookup, and intra-clinic
communication.
17.3.2.1 Document Imaging
Purported advantages of “paperless” offices include: speedy access to up-to-date
information, decreased staffing requirements, and decreases in filing errors. 19 One
study suggests that document imaging may result in an ongoing net savings of over
$9,000 per provider per year. 20 However, there are many hardware and operational
requirements for in-house scanning solutions ( 21 for a partial list), as well as limitations
on full-text retrieval. Administrative costs of document imaging include the
purchase of the scanning hardware and software, and the initial and ongoing costs
of converting archived and new paper-only information, including faxes and paper
communications from other practices or laboratories.
However, the impact of this technology may be limited. Although the technology
itself has minimal effects on clinician workflow, scanned image data lacks the
advantages of truly digital data. Scanned handwritten notes are searchable only by
direct visualization. Scanned graphical data (x-rays, photos, electrocardiograms,
etc.) are not amenable to electronic interpretation. In order for data to be analyzable,
there must be a process to allow for discrete data elements to be created.
Either these elements can be entered via structured data entry, or data conversion
processes can be used. Some researchers use scanned mark-sense forms and optical
character recognition (OCR) to perform these conversions. 22 However, these
technologies are not yet in widespread use.