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

56 L.W. Desch and P.H. Lipkin
Bureau, 15% of children (3.7 million) in the US have some type of disabling condition,
8 ranging from mild learning disabilities to severe physical disabilities. The
National Survey of Children’s Health, 9 estimates that nearly 8% of children in the
US have two or more problematic behaviors (with two thirds requiring ongoing
professional treatment).
During the past 50 years, treatments for CSHCN have also radically changed,
increasing the need for access to specialty care and improvements in the quality of
primary care. The greatest need for this population has been coordinated primary
and specialty care. Since 1985, the AAP has been promoting the Medical Home as
a model for CSHCN. In response to increasing interest from the federal government
(especially the MCHB) in the past 15 years, the AAP has articulated the Medical
Home model, 10 two components of which are (1) early detection and referral of
children with or at risk for special health care needs and (2) care coordination
between the primary care provider and all specialists (e.g., medical, allied health,
and educational). The potential for informatics and health information technology
in facili tating these functions is great, and we illustrate these in a two-part case
study.
6.2 Developmental Surveillance, Screening, and Referral
6.2.1 Case Study: Part 1
Jeffrey was born at term and had an unremarkable neonatal course. A newborn
hearing screen performed on day two of life identified a hearing impairment in one
ear. A faxed note and email was automatically sent from the hospital nursery to the
primary care physician’s office. The pediatrician sent an electronic referral to an
audiologist to have a Brain Auditory Evoked Response (BAER) confirmatory text,
which was reported as normal.
At 5 months of age, Jeffrey’s mother noticed that he “didn’t seem to move his
left hand as well as his right,” but thought she would “wait and see” before mentioning
it to her pediatrician. One week prior to the 6-month visit, an automated
e-mail was sent to the parents reminding them to complete an online developmental
questionnaire on the practice Website. It was then on this online form that his
mother related her concern about his left hand.
Just prior to seeing Jeffrey for the 6-month visit, his pediatrician reviewed Jeffrey’s
electronic medical record (EMR) and noted the flagged entry on the questionnaire,
indicating a possible developmental problem. The flagged entry also informed the
pediatric staff to give the parents a secondary questionnaire in the office waiting
room, which verified the developmental concern. During the visit, his pediatrician
confirmed through examination and developmental testing that the left hand in fact
did not move as well as the right and that referrals were needed. Her office staff
completed the appropriate EMR referral forms which were sent electronically to the
state’s Early Intervention (EI) program as well as to the local neuro-developmental
specialist.