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

17 Aligning Pediatric Ambulatory Needs with Health IT 245
Performance monitoring systems must be able to link guideline or intervention
parameters to specific patient records. For example, if patients with asthma are to
be prioritized for influenza vaccinations, it must be easy to find the patients in the
practice with asthma. Such applications should also be able to be used to prospectively
identify patients at risk for medical conditions. For example, all patients
with a high body mass index and laboratory abnormalities may be identified for
prospective diabetes screening. In current systems, the absence of linkages between
administrative data (from a CPMS) and clinical data (from EHR systems) may
make these tasks difficult.
17.4.2.2 Linkage of Identified Patients to Clinicians
Responsible for Their Care
Identified at-risk patients (those eligible for guideline-based care) must be able to
be linked to their primary care providers (PCPs). This linkage provides accountability
for patient care and gives providers an incentive to be active in managing these
patients. Performance measures are generally associated with individual providers
or teams, which for pediatrics is the provider who manages the patient’s well child
visits (the PCP). Integrated performance measurement systems should support and
give feedback on PCPs’ management of chronic conditions by tracking patient
visits and reminding providers of scheduled or overdue preventive care tasks.
17.4.2.3 Assurance That Data Integrity Is Sufficient for Analysis
Data from Health IT applications such as CPMS and clinical systems (EHR,
laboratory, pathology, or imaging) may be collected and transmitted to regulatory
or reporting systems (regional registries, data warehouses). For performance
measurement and other analytical activities, this data must be of high integrity
(trustworthiness and consistency). Data collected by manual data entry processes is
often not suitable for analysis. If data is to be reused, it should be validated and/or
normalized. For pediatric performance measures, this task may be more difficult
than for adults because of the need to consider additional attributes – norms may
be dependent on patient age, size, and/or maturity.
17.4.2.4 Control of Identification/De-Identification of Data
Performance measurement tools and systems must be able to maintain the oneto-one
linkage between clinical data and its source, while de-identifying data for
specific projects and reports. 50 Data de-identification should be accompanied by
protocols and procedures for data access rights, for human subjects/institutional
review (for research projects), for improving safety, 51 and for digital discovery and
disclosure. 52