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

246 M.G. Leu et al.
17.4.2.5 Assimilation of Relevant Patient Historical Data
When a new EHR system is implemented, migration of historical clinical data
(from paper or electronic formats) into the EHR system should be considered.
This will allow patients to be correctly targeted for practice guidelines, and to be
included when adherence to these guidelines is being evaluated. Some performance
measures may require an accurate historical record (such as immunization histories
or history of exposures to radiation, environmental, or chemotherapeutic agents).
The assimilation of historical data may require time-intensive manual entry, so
practices may need to prioritize which records are of greatest importance.
17.4.2.6 Incorporation of Additional Measures
As performance indicators evolve, including those for pay-for-performance,
practices and measurement systems must be able to adapt to changes quickly and
gracefully. EHRs and performance measurement systems need to be easily configurable,
so that new data items can be created for collection. These items should be
stored in formats which allow for ready retrieval and subsequent analysis. 53
17.4.2.7 Creation and Dissemination of Reports
Clinical analytics, 54 the linkage of clinical and financial outcomes, involves using
tools developed for business intelligence 55 to measure, then to optimize performance.
Dashboards, visualizations which provide real-time data “at-a-glance,” can be configured
to track key clinical and performance indicators for the organization. The automated
generation of these graphically summarized performance measures has been
exploited in business, and prototypes have been developed for the clinical setting. 56,57
17.5 Current Statistics and Observations
on Ambulatory Health IT Adoption
In the United States, it is estimated that 29.2% of practices had electronic health
record systems in 2006. 58 From a study in Florida, the overall pediatric ambulatory
EHR adoption rate is estimated to be about 16%. 59 These adoption rates are far
lower than those in the Netherlands (98%), New Zealand (92%), the U.K. (89%),
and Australia (79%). 60,61
Studies suggest that only 12.4% of U.S. practices (slightly more than a third of the
self-reported EHR adoption rate) have adopted comprehensive EHR systems (defined
by the IOM as systems which support e-Rx, computerized test ordering, online test
results, and clinical notes 29 ). Other countries also report lower rates of adoption for
comprehensive systems. Reported rates include: New Zealand (33%), Australia (10%),
the U.K. (5%), Germany (4%), Canada (2%), and the Netherlands (1%). 61,62