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

20 K.B. Johnson et al.
For the infant, initial clinical questions surround the maternal and perinatal
history: the gestational age of the infant, the results of prenatal screening tests
(including those for bacterial and viral infections and blood types), the medical
condition and treatment of the mother prior to delivery.
For the toddler, questions will revolve around the child’s recent illnesses, activities,
and exposures, presence of fever, to be confirmed by examination and laboratory
testing.
For the adolescent, the questions will include medical and family history, medications,
exposures to sexual contacts and substance use, in addition to reports of
similar illnesses from the patient’s family and community.
The different lists of questions (plus others that are not included), their appropriate
choice and use to create differential diagnoses to guide further testing, treatment,
and outreach and follow-up are second nature to most practicing pediatricians,
based on clinical training and experience.
3.2 Core Data, Knowledge, and Functionality
The organization and codification of clinical questions, their answers and their
contexts for communication with other practitioners and for use in computerized
systems begins with three levels of abstraction of the information needs of pediatricians
for specific tasks (such as patient care, administration, and research).
Core clinical data is a basic set of defined medical, historical, and demographic
information about a patient or set of patients necessary for specified clinical tasks.
Core clinical data is typically in text, numerical, or categorical forms, although it
may also consist of multimedia (imaging, audio) or complex (genomic, physiologic
(ECG, EEG) ) forms in the future. Example of core clinical data include:
patient identifiers, examination findings, and laboratory results for a patient or set
of patients at a given date and time.
Core clinical knowledge is a synthesis of core clinical data from a patient or set of
patients that provides medical meaning or significance in the context of clinical tasks.
One example of core clinical knowledge is a list of reference values for normal blood
pressures and weights of children over different age ranges based upon a statistical inference
of measurements from a large population of healthy children at different ages.
Core clinical functionality is the application of clinical knowledge and patient data
within the context of a clinical task. Examples include: the generation of an appropriate
dose (from a pediatric formulary) of a specific medication according to a patient’s
weight (from a patient record) for an outpatient prescription and the automated
calculation of a patient’s body mass index according to a patient’s height, weight,
and population normal values for a pre-participation sports physical examination.