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

274 K.B. Johnson and C.G.M. Weigle
also possess team-building and leadership skills to achieve consensus among
disparate stakeholders.
Pediatricians as liaison: Pediatricians are the link between children and
pediatricians and the leadership of the clinical enterprise, institution, and between
clinicians and the leadership of the health information technology infrastructure
(usually a CMIO, industry group or regulatory agency). In this role, pediatricians,
especially pediatric informatics experts can: articulate clearly the needs of children
and pediatricians in terms of patient safety, influence decisions in executive HIT
choices, guide application development, deployment, and educational programs to
optimize safe ordering. Pediatricians must represent the needs of children on local,
national, and industry levels.
Pediatricians as facilitators: The most vital roles for pediatricians and pediatric
informatics experts are: to recognize what questions need to be asked about
improving pediatric clinical processes (such as pediatric ambulatory medication
ordering), to ask how an intervention (such as ACPOE) impacts (positively and
negatively) on the process and how to get information that answers these questions
(what types of studies or measures are needed). As users affected by implementations
of HIT, pediatricians must have some understanding of why and how systems
are developed, and more importantly, how to guide that development to improve
care and safety.
Examples of questions that pediatricians may need to ask about ambulatory
prescribing and ACPOE include:
1. What types of medication ordering, dispensing, and administration errors
occur within the local clinic and how frequently? How can that information be
captured?
2. How can ACPOE reduce identified errors? How can its impact on errors be
measured?
3. How are laboratory tests ordered by and returned to a practitioner within the
local clinic?
4. Is there a way that ACPOE systems can help pharmacists with compounded
formulations of medications?
5. How do we design, implement, and manage computerized pediatric dosing rules
for off-label (but locally sanctioned) use of medications currently not based on
FDA-based evidence?
19.6 The Future of ACPOE
ACPOE/eRx is leading health information technology in terms of likelihood of
widespread adoption. The Centers for Medicare and Medicaid is quickly moving
forward to push the adoption of e-Prescribing with the establishment of the Final
Rule on e-Prescribing outlining regulations, incentives, and exemptions. 38 At this
time, use of e-Prescribing is not required for participation in Medicare (or Medicaid).