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

31 Communities of Pediatric Care and Practice 407
child health would be an easiest focus for coalition, frequently it is forgotten in
the initial stages of HIE formation. Failure to consider pediatrics can have severe
consequences to how children’s health information is represented in the HIE.
In larger markets, children’s hospitals or the department of pediatrics of a medical
school may be a source of support for pediatrics in an HIE. In areas without a children’s
hospital or medical school, the hospital medical director of pediatrics may need
to take the lead. Alternatively, the state pediatric society may provide assistance.
Champions need support. A significant portion of pediatric payments come
from Medicaid, which historically has paid poorly. As a result of this relatively
poorer funding source for pediatricians, they may not have the time or resources
to “work” all of the connections that need to be made to generate support for the
HIE. Planners are well-advised to provide adequate support for their champions,
particularly child health advocates including pediatricians.
31.7.3 Creating the Business Case for Development
and Obtaining Funding
While initial funding of many HIEs is from grants, it is important that the HIE
provides identifiable services that generate a stream of funding. Starting with the
basics such as supporting medication reconciliation is a way to gain credibility and
funding, as this function in particular has been extremely difficult for hospitals to
accomplish successfully. Quantifying savings to users is critical.
One way for a HIE to provide value to child health practitioners is to make state
registry information available through the HIE. Frequently individual physicians
have had difficultly electronically accessing immunization and birth screening
records in a way that is supportive of their workflow. The difficulty and rewards
of incorporating these into each HIE vary by region, but the net result in terms of
added value is often significant. Of note, pediatricians do not gain financially in any
significant way by gaining access to this information and so it is payors, including
state Medicaid programs that probably should fund these efforts.
31.7.4 Establishing a Governance Structure
Governance is probably one of the most important tasks in the formation of a HIE.
Key tasks include:
Determining what kind of legal form the HIE will take
Establishing a mission and vision statement that is inclusive and fair for all
parties and
Determining who will be on the governing structure (e.g., Board of Directors)
Access to child healthcare information through the HIE is probably not affected
much by the most common legal forms of HIEs. Perhaps the most important aspect