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

48 D.M.N. Paperny
for outside ancillary services (laboratory, pharmacy) to be sent instead of the
parents’ address. Additional management functions should allow confidentiality
to be assigned to portions of a visit (such as the family planning portion of a
health maintenance encounter). This may require the creation of two visits on
the same day/encounter, resulting in two separate bills (Chapter 22).
5.4.2 Screening Teens Who Are at Risk
for Health Problems
Adolescent risk behaviors may surface in various ways:
Chart review by a clinician at the beginning of a visit
Screening questionnaires that trigger further investigation
� CAGE questions for alcohol abuse
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Perceived Benefit of Drinking Scale (PBDS) for alcohol abuse
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8 Various generic health screening instruments including HEADSS
� AMA Guidelines for Adolescent Preventive Services (GAPS) questionnaires
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Youth Health Program(YHP) computerized screening
Discovery of hidden agendas during the interview and examination
Laboratory testing requests or results, either routine, voluntary, or mandated
Follow up visits and communications with patients
Review of practice performance for quality assurance
5.4.2.1 Case Study 2
Dr Jones evaluates his panel of high risk adolescents by selecting ages 14–17, and all
those who have had any of three measures of ever being sexually-experienced (1. ever
had a chlamydia or gonorrhea test, or 2. have a prescription for oral contraceptive, or
3. received Depo-Provera in the last year) but have not had a chlamydia test in the
last 12 months—to evaluate needs to meet HEDIS requirements. He contacts those
patients needing a test by that confidential method already selected by the patient:
usually private cell phone, sometimes secure messaging, rarely a letter to home.
5.4.2.2 Opportunities
Electronic medical records simplify collection and processing of data for quality
improvement and risk identification within a practice population. Clinical decision
support allows prompts to clinicians to improve practice during a visit and for
proactive practice quality improvement. 11
In addition, teens’ comfort and facility with computers make automated medical,
behavioral history collection easier 12–16 and sometimes preferable. Interviews
through interactive computer programs on sensitive topics may be perceived as
more confidential and less judgmental 17,5 than by human interviewers. 18,19 Functions
that interviewing software should perform include:
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