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

400 J.H. Schneider
a number of problems that his aunt was only beginning to learn about from his
pediatrician. However, they were about 500 miles from home and the pediatrician’s
office, with Samuel’s records, were nine feet under water.
Samuel was having difficulty breathing. His aunt explained that he had run out of
his home oxygen this morning. An internist who was helping to triage the planeload
of people put Daniel on oxygen, thought he heard wheezing when he listened to
Samuel’s lungs, and wrote for albuterol. That seemed to make Samuel’s breathing
easier. They were placed on a bus to the Dallas Convention Center. When Samuel
and his aunt arrived at the Convention Center he was finally examined by a pediatrician.
His aunt knew, that he had been in the hospital for a month at birth and had
some vaccinations. She also knew that he used inhalers and took some medicines
but she didn’t know why. She also wasn’t sure of Samuel’s exact birth date.
The pediatrician did the best she could to diagnose Samuel’s problems. She
hoped that he didn’t have any allergies. There was a loud holosystolic heart murmur
over the left sternal border. She was able to get him to the children’s hospital where
a large ventricular septal defect was diagnosed with left to right shunt. The medications
he needed were restarted in time and slowly his fluid overload was corrected.
A few days later the pediatrician was able to connect to the Houston
Immunization Registry through a friend and she learned that Samuel’s pediatrician
in Louisiana had participated in LINKS, the Louisiana immunization registry. The
Houston registry had an emergency link to LINKS that was made possible because
they were developed by the same vendor. With some work, the pediatrician was able
to retrieve Samuel’s history and avoided having to revaccinate him.
Samuel’s medical record wasn’t available at the time that he needed critical care.
In this regard, he wasn’t different than most other children if their medical need
occurs away from where their medical record is stored. Even in the age of Electronic
Medical Records (EMRs), it is not unusual for medical records to be unavailable in
emergencies. Children with Special HealthCare Needs (CSHCN) are often the most
affected as their care can be fragmented across multiple specialists. Samuel spent
days without critical medications and was under diagnosed at the airport triage by
an adult medicine physician unfamiliar with pediatric conditions. He also underwent
an expensive cardiac workup that simply confirmed what was already recorded
in his birth hospital, which was now closed, and in his pediatrician’s office, which
was nine feet under water. Luckily Samuel’s vaccination history was in a registry,
which saved him at least from having to repeat this portion of his medical care.
31.3 Health Information Exchange: Definitions and Goals
It is estimated that in 14% of primary care visits clinical information is missing, 2
enough to affect care adversely in 44% of those visits. For complex patients (such
as children with special health care needs (CSHCN) ), missing information is three
times more likely. In many cases, practitioners will construct records anew, based
on patient or parent verbal histories, while requesting photocopied medical records