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

31 Communities of Pediatric Care and Practice 411
HIEs represent a tremendous opportunity to improve the quality and efficiency of
care that is provided to children. However, they face many challenges and the longterm
survivability of many is questionable. HIE planners should strongly consider
including pediatricians in their development and management. Pediatricians should
take an active role in HIEs as failure to do this could lead to systems that are not
pediatric-friendly.
31.9 Case Studies
31.9.1 The Indiana Network for Patient Care (INPC)
The INPC is a sustained (30 years +) city-wide clinical informatics network
that leverages the success of the Regenstrief Medical Record System (RMRS)
throughout Indianapolis and providers in the state of Indiana. Through the efforts
of a group of clinical informaticians led by Clement MacDonald MD, the RMRS
was able to realize three goals: (a) to make “just-in-time” information available
to authorized clinicians, (b) to assist in diagnosis and prevention through support
of the record-keeping process and (c) to aggregate clinical information for multiple
uses. In 2004, the INPC was operational in all five major hospital systems in
Indianapolis as well as all county and state public health departments, 20 primary
care sites, 3,000 specialists, 30 school health sites and four homeless organizations
(95% of inpatient and non-office based ambulatory care in Indianapolis),
serving 390,000 emergency, 165,000 inpatient and 2.5 million ambulatory visits
per year. Data input from clinical systems included: laboratory results, inpatient,
and outpatient summaries, medication lists, and radiology, operative and pathology
reports, tumor and immunization registry data, pharmacy prescription data and
other information. The central data store is a series of federated databases located at
the Regenstrief Institute. Secure data connections transfer data in the HL7 messaging
standard, using domain-specific terminologies (LOINC for laboratory results,
CPT-4 for procedures, ICD-9 for diagnoses and National Drug Codes (NDC) and
RxNorm for drug names). Records within the federated data store use a central global
patient registry. The system supports many applications including a system for
child health (Child Health Improvement through Computer Automation (CHICA) )
that provides pediatric decision support at the point of care. 33
31.9.2 An Electronic Health Record-Public
Health System Prototype
A prototype for an electronic health record for public health that links (via HL7
messages) from EHRs to multiple public health systems (newborn metabolic
screening, newborn hearing screening, immunization, and communicable disease
registries) has been described. 34