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

324 M.M. Simonian
with reduced paper waste. Vetted, unbiased patient information is available from a
number of sources: the federal government (from the NIH, 16 CDC 17 , and FDA 18 ),
professional medical societies (such as the AAP), patient advocacy groups and also
from insurance and pharmaceutical companies. 19
Practice Web sites have been driven by several circumstances: the popularity of
the Internet, the availability of libraries of published information, the technology to
make them widely and easily available at low cost, the opportunity to reuse them
to the advantage of member practices (and provide added value to membership).
Additionally, practitioners and professional groups have expressed the concern that
patients (in the case of pediatrics, both children and families) randomly search the
Internet and find erroneous (and possibly harmful) health information. By centralizing
and branding sources, patients may access trusted information in the context
of their ongoing relationship with a practitioner.
Practice Websites may be customized to include special services to support
patient care: secure messaging (described previously), adherence programs and
online consultation:
Adherence programs 20 provide customized, automated e-mail messages to patients
(from their providers) to remind and reinforce information that is provided in the
office. Physicians may program messages that focus on patient-specific medical conditions
and provide instructions and about treatment and medication regimens, with
linkages to information vetted and approved by the member’s society or the Food and
Drug Administration (FDA) (or to information from the physician’s own library).
Online consultation 21 allows established patients or parents to receive
individualized medical advice without an office encounter. Using secure messaging
technology (described previously), physicians may share information with families
about established problems (with new diagnosis and treatment being appropriately
initiated through an office encounter). Patients and families eligible for this service
must be registered and acknowledged by the physician (thus establishing an ongoing
relationship). Parents must agree to a contract of responsibilities for both patients
and physicians prior to being allowed to use the service, and are notified by e-mail
(with a “Terms of Service” agreement) when the service is activated. A standard fee
for online consultations, payable by credit card at the time of service, is established
by the physician and posted on the Website, so the patient knows what the consultation
will cost. Once activated, Online Consultation a physician responds to patient
requests and questions within a specified time period.
24.3.2 Practice Portals
Practice portals add an additional layer of functionality by linking practice Websites
to electronic health records (EHRs) and external services (such as local pharmacies)
to facilitate routine health processes (such as electronic prescription). 22–24 Web portals
provide a personal, online, secure patient interface to online Web services offered by
the practice (secure messaging, self-scheduling of appointments, and prescription