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

408 J.H. Schneider
of this component of HIE formation is that pediatricians must be present during the
formation of the HIE to avoid having to play catch-up.
A strong mission and vision statement that explains the need to focus on children’s
healthcare issues is critical. Even a simple phrase such as “The needs of
vulnerable populations, such as children, will be kept paramount” can be used by
child health advocates when difficult decisions need to be made once the HIE is
functional.
Finally, obtaining at least one representative of children’s health on the governing
structure is a necessity. This individual should have a thorough understanding
of the special informatics needs of children’s health and the workings of physician
practices and hospitals in the care of children.
31.7.5 Assessing Information Technology Capabilities
and Needs
Information technology capabilities within states and local regions differ widely.
As mentioned above, there can also be significant differences between subgroups
of physicians within a region.
A key function of a HIE beyond governance can be to provide the means through
which all providers, especially those with limited means, can participate electronically
in the HIE, using an EMR as part of their normal workflow. This can be done by having
HIE developers identify preferred EMR vendors, which reduces the costs to each
practice of vendor investigation. It can also be done by providing support for obtaining
funding for EMRs, such as providing a way that health plans and hospitals can be better
assured that the funding that they can provide to physicians under the relaxed Stark
regulations will have payoffs through data sharing. Efforts to support their members
also indirectly support HIEs financially, as the quality and value of the data in the HIE
increases as physician participation increases. Therefore, efforts by HIEs to support the
conversion of physicians to EMRs should be high on the list of tasks to be done.
Nationally, pediatricians have lower EMR adoption rates than other types of
physicians. 26, 27 Because pediatricians typically do not provide care for Medicare
patients, they are also generally not eligible for EMR implementation support
through Quality Improvement Organizations. Financially, because of their
increased reliance on Medicaid, they often lack the capital for EMR purchases and
implementation. HIE planners need to recognize these technology capability needs
and limitations in their planning.
It is also important for planners to note that the EMR products that may be the
most appropriate for HIE members who provide care for adults are not necessarily
good for pediatric care. This will be covered more in the next section. Lists of preferred
EMR vendors prepared by HIEs should include choices that match the needs of
pediatricians. The American Academy of Pediatrics (AAP) can be an excellent source
for information on “pediatric-friendly” EMRs. 28 The AAP has annually supported
Pediatric Documentation Challenges that identify EMRs with excellent pediatric
functionality and its members rank pediatric EMR products on the Web. 29