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

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286 C. Sable et al. Fig. 20.1b Washington, DC Pediatric Telemedicine Community Hospital Network— Graph showing annual teleechocardiography volume; approximately 1,000 studies were transmitted in both 2005 and 2006 Fig. 20.2 MPEG Digitization and Medical Record—Screen shot of telecardiology application (developed by collaboration between Children’s National Medical Center and VitelNet, Inc, McLean, VA). The incoming live echocardiogram is reviewed and can be digitized with allowance for bookmarks and measurements. A patient database is built with demographic information and a report is created on the same screen. The report can be faxed or transmitted via telemedicine. A permanent digital medical record is immediately created
20 Telemedicine Applications in Pediatrics 287 hospital 5 mi away and a remote referral hospital in Germany. Patients scheduled for surgery and those who are candidates for surgery are discussed, with all sites being able to see the same data simultaneously. A new tele-cardiology application is being piloted involving home health care. 22 The most complex congenital heart defects: hypoplastic left heart, hypoplastic right heart (tricuspid atresia and pulmonary atresia) and other complex single ventricle hearts require staged surgeries including: an initial surgical procedure in the first 2 weeks of life (Norwood procedure), a second surgical procedure between 3 and 8 months of life (Glenn procedure) and a third surgical procedure between 18 months and 3 years of life (Fontan procedure). Improved surgical techniques along with better preoperative, intraoperative, and postoperative care have led to survival to hospital discharge approaching 90% for the most complex of these conditions (hypoplastic left heart) and even higher for other defects. Well over 95% of patients who reach the second operation survive into adulthood and have excellent quality of life. This makes it imperative that considerable focus is put upon this vulnerable period in the first 6 months of life. Despite vastly improved outcomes, children with single ventricles remain at high risk during the vulnerable period between hospital discharge and the second operation with a risk of death up to 15% during this period. They are much more susceptible to normal child illnesses that cause fever, dehydration, and low oxygen. Close daily monitoring of simple parameters (formula intake, weight gain, pulse oximetry) has been shown to almost eliminate this mortality. We are in the process of instituting a simple home device that will electronically measure these parameters in this patient population and transmit them to a centralized computer over regular telephone lines for daily review. 20.4.2 Neurology Seizure disorders are common in children, especially premature babies. At CNMC, the remote interpretation of electroencephalograms (EEG) began in 2002, and we are now connected to three community hospitals. These hospitals have the ability to perform EEGs on infants and children but not the pediatric neurology expertise to interpret them. EEGs are now acquired in a digital format and stored on a server at the remote hospital or transmitted to CNMC. Pediatric neurologists may connect via a Web client to the server, interpret the EEG and submit the final report online. Over 500 studies have been interpreted in this manner, with a next business day turnaround, and the option for stat studies. EEG interpretation lends itself nicely to a “store and forward” model because the quality of the test has very little dependence on the interaction between physician and technician. Telepathology is another tele-neurology application, offered in both “live” and “store and forward” modes. A formal collaboration between CNMC and hospitals in Cincinnati and Chicago permits referral of brain tumor pathology cases for second opinions. Slides of pathology specimens are digitized and send for review
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Health Informatics (formerly Comput
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Editors Christoph U. Lehmann George
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vi Series Preface changes to both t
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viii Foreword This text will prove
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x Preface financial investment and
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How to Use This book This book is t
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xvi Contents 9 Pediatric Care, Safe
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xviii Contents Part VII A Vision an
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xx Contributors Donna M. D’Alessa
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xxii Contributors Christoph U. Lehm
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xxiv Contributors Mark M. Simonian,
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4 G.R. Kim pharmacy, medical educat
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6 K.B. Johnson and G.R. Kim Deaths
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8 K.B. Johnson and G.R. Kim 2.4.1 I
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10 K.B. Johnson and G.R. Kim 2.4.3
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12 K.B. Johnson and G.R. Kim Educat
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14 K.B. Johnson and G.R. Kim 2.6 Co
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Chapter 3 Core Pediatric Data Kevin
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3 Core Pediatric Data 21 3.3 Pediat
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3 Core Pediatric Data 23 3.6 Pediat
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Chapter 4 Neonatal Care and Data De
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4 Neonatal Care and Data 27 Essenti
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4 Neonatal Care and Data 29 4.3 The
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4 Neonatal Care and Data 31 some ma
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4 Neonatal Care and Data 33 Measure
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4 Neonatal Care and Data 35 4.5.2.4
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4 Neonatal Care and Data 37 4.6.3 I
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4 Neonatal Care and Data 39 4.7.2.2
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4 Neonatal Care and Data 41 Availab
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44 D.M.N. Paperny Tasks related to
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46 D.M.N. Paperny Behavioral risk d
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48 D.M.N. Paperny for outside ancil
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50 D.M.N. Paperny Video reinforceme
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52 D.M.N. Paperny 3. Litzelman DK,
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Chapter 6 Children with Development
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6 Children with Developmental Disor
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Chapter 7 Pediatric Emergency and P
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7 Pediatric Emergency and Pediatric
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84 W.H. Drummond et al. A recovery
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86 W.H. Drummond et al. 8.2.2 Forma
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88 W.H. Drummond et al. 8.2.2.1 Sys
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90 W.H. Drummond et al. The multidi
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92 W.H. Drummond et al. noise overl
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94 W.H. Drummond et al. needs requi
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96 W.H. Drummond et al. Children’
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98 W.H. Drummond et al. After the P
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100 W.H. Drummond et al. Table 8.2
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104 W.H. Drummond et al. when to su
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106 W.H. Drummond et al. It is crit
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108 W.H. Drummond et al. traditiona
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110 W.H. Drummond et al. and human
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112 W.H. Drummond et al. blood prod
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116 W.H. Drummond et al. 35. Collin
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Chapter 9 Pediatric Care, Safety, a
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9 Pediatric Care, Safety, and Stand
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134 D.M. D’Alessandro The EBM pro
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136 D.M. D’Alessandro 10.4 Pragma
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138 D.M. D’Alessandro 4. Case ser
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140 D.M. D’Alessandro Ontario, BC
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142 D.M. D’Alessandro Table 10.1
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144 D.M. D’Alessandro Children ar
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146 D.M. D’Alessandro 17. Ely JW,
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Chapter 11 Clinical Practice Guidel
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11 Clinical Practice Guidelines: Su
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162 M.J. Feldman in patients withou
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164 M.J. Feldman The art of medicin
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166 M.J. Feldman important design g
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168 M.J. Feldman Incorrect or missi
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170 M.J. Feldman Fig. 12.4 GIDEON D
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172 M.J. Feldman system or etiology
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174 M.J. Feldman ED-12: “Practica
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176 M.J. Feldman Fig. 12.7 DXplain:
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178 M.J. Feldman For GIDEON: Rabies
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180 M.J. Feldman KB on infectious d
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182 M.J. Feldman 4. Johnson KB, Fel
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Chapter 13 Managing Pediatric Knowl
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13 Managing Pediatric Knowledge Res
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Chapter 14 Supporting Continuing Pe
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14 Supporting Continuing Pediatric
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14 Supporting Continuing Pediatric
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Chapter 15 Pediatric Care Coordinat
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15 Pediatric Care Coordination: The
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Chapter 16 Prioritizing Pediatric I
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16 Prioritizing Pediatric Investmen
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Chapter 17 Aligning Pediatric Ambul
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26 Prescribing/Ordering: Computeriz
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346 S.H. Mitchell et al. 27.2.1 Med
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348 S.H. Mitchell et al. context of
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350 S.H. Mitchell et al. 27.3.3.1 C
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352 S.H. Mitchell et al. challenges
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354 S.H. Mitchell et al. work round
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Chapter 28 Medication Administratio
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28 Medication Administration and In
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Chapter 29 Understanding and Preven
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29 Understanding and Preventing Err
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386 D.C. Stockwell and A.D. Slonim
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400 J.H. Schneider a number of prob
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402 J.H. Schneider on governance, u
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404 J.H. Schneider 31.6.1 Data Rele
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406 J.H. Schneider Understanding op
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408 J.H. Schneider of this componen
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410 J.H. Schneider Table 31.1 (cont
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412 J.H. Schneider References 1. Am
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Chapter 32 Developing Pediatric Dat
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32 Developing Pediatric Data Standa
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430 G.R. Kim and S.T. Rosenbloom Co
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432 G.R. Kim and S.T. Rosenbloom No
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434 G.R. Kim and S.T. Rosenbloom pr
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436 G.R. Kim and S.T. Rosenbloom ab
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Chapter 34 Pediatric Research and I
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34 Pediatric Research and Informati
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Chapter 35 The Moving Picture of Pe
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35 The Moving Picture of Pediatric
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470 G.R. Kim and K.B. Johnson Cente
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472 G.R. Kim and K.B. Johnson 36.4
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Index A 2006 AAP recommendations on
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Index 477 psychological data, 45 se
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Index 479 High frequency flow inter
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Index 481 O Online Mendelian Inheri
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Index 483 Standards development org
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