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

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cost-beneficial; and clinical decision support systems were only beneficial for large
provider organizations. The other interventions were not cost-beneficial. Despite
these findings, provider-focused disease management systems may prove to be the
least likely to be adopted given existing incentive structures.
17.4.2 Providing Performance Measures
and Feedback to Clinicians
In many health care organizations, the process of clinician performance management
and feedback exists on a small scale (periodic random selection and manual
review of charts). Some practices (such as federally-funded community health
centers) are required to submit structured quality measures to external agencies for
review (e.g., the Health Disparities Collaboratives, public health agencies), and in
many cases, this data abstraction is performed manually.
The use of electronic reporting tools that extract data electronically from records
is generally restricted to large practices and organizations (that can afford them).
As the health industry moves to pay for performance measures for remuneration
of services, 48 the automated collection of data from EHRs will become increasingly
desirable if not mandatory. Research also suggests that health IT-supported
performance monitoring may improve adherence to clinical practice guidelines. 49
Such performance monitoring requires basic functionalities:
Identification of patients to whom clinical practice guidelines apply
Linkage of identified patients to clinicians responsible for their care
Assurance that data integrity is sufficient for analysis
Control of identification/de-identification of data
Assimilation of relevant patient historical data
Incorporation of additional measures
Creation and dissemination of reports
Once these functions are realized, practices can derive performance measures
to examine the appropriateness and impact of practice guidelines on their own
practices. 18
17.4.2.1 Identification of Patients to Whom Clinical Practice
Guidelines Apply
With the increasing desire to use evidence-based clinical practice guidelines, and to
comprehensively manage patients with chronic medical conditions through health
IT (e.g., with automated reminder and recall systems, or with remote communication,
monitoring and feedback systems), it is important to be able to easily identify
patients which may benefit from these interventions.