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

458 G.R. Kim and S.T. Weinberg
saturation is greater than 94%. The nurse presses a “Send” button on the screen
and the information is sent to Johnny’s pediatric Medical Home to the practitioner
in the clinic that morning. By Johnny’s mother’s request, a copy is also sent via
text message to her.
The computer beeps. A message from the practice is returned to the nurse,
which notes the pediatrician’s review of the data, and that instructs her to follow an
order set created for Johnny’s asthma exacerbations: administration of an albuterol
metered dose, with recheck of vital signs in 10 min. Johnny, who has already performed
this several times, has already taken his spacer and MDI from the storage
locker in the nurse’s office. The nurse administers the albuterol.
The phone rings. It is Johnny’s mother, who was able to excuse herself from her
meeting. She asks how Johnny is doing, and the nurse reassures her and informs her
of his progress. Johnny’s mother asks if the doctor has called, and the nurse tells
her of the assessment and order. Johnny’s mother tells the nurse that she will be in
a meeting, but will be reachable via cell phone. The time of the phone message is
recorded, and the nurse enters a note and adds the cell phone number to the contact
information in the PHR encounter.
The computer beeps again. The new vital signs return. The nurse instructs Johnny
to provide a peak flow measurement and records the measurement. It is in the green
zone. She sends the data to the practice office (again with a copy is sent to Johnny’s
mother’s cell phone). The computer beeps a third time. A chat box from the practice
opens. The pediatrician has reviewed the new data. The nurse sends a structured
message that reviews the visit with an assessment that Johnny has improved. The
pediatrician returns that Johnny should start a second protocol (that is in his PHR)
with an inhaled corticosteroid dose to be given in the nurse’s office, with follow up
with the practice later that evening. The pediatrician also instructs the nurse to run a
quick strep test, which is negative, which she enters into the encounter record. The
pediatrician signs off, and the school nurse sends Johnny back to class.
The nurse completes a text message form that summarizes the visit and provides
home instructions and recommends follow up care with the Medical Home physician
using an appointment time provided by the pediatrician’s office staff. The
nurse closes the computer record, updating the medication record and vital signs
in the PHR. Johnny’s mother receives an e-mail alert that Johnny’s PHR has been
modified and a copy of the report is now available for her review (Since Johnny is
still a minor, she has full access to his record according to state law). The encounter
data is forwarded via a secure connection to the practice for the evening visit. The
coding and billing for the visit in the nurse’s office and the tele-consultation from
the pediatric practice are automatically documented and forwarded to the state child
health insurance program for reimbursement. The school health administrator also
receives an electronic copy of the encounter for billing and to track inventory use
to replace the disposable equipment used during the visit.
Later in the month, the collected clinical data from all school nurse visits in the
county and the state are de-identified and sent to a regional registry created by a
partnership between the school system, the pediatric practice (as a member of the
local pediatric professional society) and the state child health insurance program.