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

342 C.U. Lehmann and G.R. Kim
the association of CPOE implementation with increased mortality generated much
discussion within the pediatric and informatics literature. 12 Subsequent studies 13,14
support that CPOE does not increase mortality in pediatric critical care.
26.8.3 Study 3: CDS in Pediatric Oncology
Pediatric oncology presents challenges that increase the likelihood of medication
errors 15 that result in patient harm (in an already vulnerable population). Issues that
contribute to the complexity of the problems in caring for this particularly vulnerable
class of patients include:
Drug dosage calculation challenges (dependent on age, weight, and body surface
area)
Inclusion of many patients in clinical trials (including issues of scheduling,
tracking, and billing)
Complex protocols that combine time-critical surgery, chemotherapy (that may
be delivered to different body cavities: intra-thecal, etc.) and radiation treatments
of varying intensities 16
The need for continuity of care that transcends inpatient/outpatient patient care
environment distinctions 17
Interruptions, adjustments and delays to individual treatment schedules due to
intercurrent illnesses, some as complications of therapy
The narrow therapeutic profile and high potential for acute and cumulative
toxicities of the agents used
Risks of preventable long-term effects of therapy that may create needs for
modifications of treatment protocols and individual schedules
Because of these complexities, global approaches have been used to examine the risks
at different steps of ordering chemotherapy 18 and oncology laboratory testing 19 and
of the global prescribing-pharmacy processing-administration process. 20 The design,
application, and evaluation of clinical decision and workflow support for all phases
of pediatric oncology remains an important area of inquiry and development.
References
1. Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC:
National Academy Press; 1999.
2. Osheroff JA, Pifer EA, Teich JM, et al. Improving Outcomes with Clinical Decision Support:
An Implementer’s Guide. Chicago IL: Healthcare Information and Management Systems
Society; 2005.
3. Perrault LE, Metzger JB. A pragmatic framework for understanding clinical decision support.
J Healthc Inf Manag. 1999;13:2–21.
4. Center for Information Technology Leadership. The Value of Computerized Provider Order
Entry in Ambulatory Settings; 2006. Available at: http://www.citl.org/research/ACPOE.asp.
Accessed December 21, 2008.