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

17 Aligning Pediatric Ambulatory Needs with Health IT 241
17.3.2.3 Electronic Results Lookup and Intra-clinic Communications
Clinicians believe that electronic medical records can help them to process
ambulatory laboratory results more efficiently. 15 Many EHR products that support
automated results lookup also support intra-practice communications (instructions
for follow-up tasks to be performed by other staff). One example might be an electronic
message from a pediatrician to a clinic nurse, to arrange home phototherapy
for an infant with an elevated discharge bilirubin level. The EHR and the CPMS
may facilitate this process by providing easy access to insurance and contact information.
More sophisticated systems may allow future labs to be ordered, and communications
about the patient’s condition to be saved to their electronic record.
While many clinicians find these functions increase their efficiency, some may
be overwhelmed by the new workflow. Receiving too many results may increase the
potential for error or the likelihood that the physician will not process messages in a
timely manner. In part, this may be addressed through effective clinician training
and/or by a monitoring system that can identify providers who have problems (such
as a large backlog of unchecked results) in using the system.
17.3.3 Health IT with Moderate Impact
on Clinician Workflow
“Transitional” health IT is a class of applications that have a moderate impact the
way clinicians work. These applications include clinical calculators, interfaces
that allow users to access, create, and update electronic information and patient–
provider e-mail. Currently there is little data on the clinical efficacy of these applications,
but there is face validity to claims that increased information will lead to
reduced duplication of services, increased accuracy, and improved care. 29 Because
the impact on clinician workflow is more than minimal, individual variation in
adoption and use of these technologies may result in significant variations in health
care outcomes.
17.3.3.1 Clinical Calculators
Clinical calculators automate computations, but may require manual data entry.
Most studies using them have been in academic or research settings, and these
tools are not yet used in a widespread and standardized manner. Domains in which
calculators have been developed include nephrology, 30 nutritional support (e.g.,
total parenteral nutrition 31 ), and anthropometrics (weight, height, body mass index
percentiles 32 ). Calculation programs may reside on different platforms, including
programmable calculators, mobile personal digital assistants (PDAs), 33 and
Websites; they may also be integrated into electronic medical records. If calculators