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

Recommendations

Info

6 Children with Developmental Disorders and Other Special Needs 57 Therapists form the state EI program evaluated Jeffrey within 45 days of referral (as mandated by federal law), assured by the program’s computerized tracking system that provided timely reminders. By 7 months of age, Jeffrey was receiving occupational and physical therapy services weekly and developmental therapy and monitoring monthly. Therapists educated his parents about infant motor development by using several accredited health information Websites. Through these, his parents found information on organizing health records and “coordinated care plans,” and wondered if there were better ways to collect these records by using a computer. The first part of the Case Study suggests examples of how information technology can be used for CSHCN. The 2006 AAP recommendations on Developmental Surveillance and Screening aims for the early identification of children with developmental disorders and includes a clinical algorithm specifically designed for incorporation into an EMR and medical informatics system. 11,12 (see Fig. 6.1) In the hypothetical Case Study, parental concern over a problem was discovered through developmental surveillance at the 6 month visit, which was verified by screening and further medical and developmental evaluation. Surveillance was 1 Pediatric Patient at Preventive Care Visit 2 Perform Surveillance 3 Does Surveillance Demonstrate Risk? No Schedule Next Routine Visit Yes 5a 6a No No No Yes No 4 5b 6b Yes Is This a 9-, 18-, or 30-mo Yes a / Visit? Administer Screening Tool Are the Screening Tool Results Positive/ Concerning? Visit Complete Administer Screening Tool Visit Complete Visit Complete Schedule Early Return Visit Are the Screening Tool Results Positive/ Concerning? Schedule Early Return Visit 8 7 Make Referrals for: Developmental and Medical Evaluations and Early Developmental Intervention/Early Childhood Services Developmental and Medical Evaluations 9 Is a Developmental Disorder Identified? Increasing Developmental Concern Related Evaluation and Follow-up Visits Yes 10 Start Action / Process Decision Stop Visit Complete Identify as a Child With Special Health Care Needs Initiate Chronic Condition Management Fig. 6.1 The American Academy of Pediatrics Developmental surveillance and screening algorithm 12
58 L.W. Desch and P.H. Lipkin performed using a standardized developmental questionnaire through the office Website for use at the visit. At present, there are only a few standardized developmental surveillance and screening instruments that are adaptable to an EMR or include specific EMR-compatible software, such as the Ages and Stages Questionnaires 13 and the Parent’s Evaluation of Developmental Status (PEDS). 14 Other tools, such as the Achenbach Child Behavior Checklist 15 have undergone extensive evaluation for EMR incorporation. Nonstandardized tools, which typically consist of questions on milestone achievement that the physician asks the parent during a health maintenance visit or could be on an office website, are best suited for surveillance. Regardless of the implementation (paper, Web-based, using an EMR or other software), the reliability of a developmental test depends on evaluation of the validity, the sensitivity and specificity of the instrument, 12 the size and appropriateness of its normative population needs and the applicability of the test and its implementation to the practice population. Finding information on test validity is not a problem for commonly used questionnaires, but their availability in electronic (or EMR-compatible) versions may be limited due to development costs and royalty issues, but this will change as demand for EMR-compatible standardized instruments increases. As in the Case Study (and as is recommended 12 ), detection of a developmental problem should lead to a referral for Early Intervention (EI). All states have systems for EI, 4,5 including computerized data collection, but not all state agencies use collected data for more than internal administrative functioning. 16 In one example, in the state of Illinois, prevalence tracking of diagnoses by geographic regions has been used to allocate resources and funding. 17 At one time, Illinois had the only system in the US in which specialty pediatricians assisted the state EI program with determining appropriate services and service levels for the infants and toddlers who qualified for the program. In this program, these physicians had access to summaries of the entire state database of services to help ensure equity and standardization of decisions regarding the types and frequencies of therapy services provided. It is possible that EI databases and other large state agency databases (e.g., Special Education, Medicaid) and subsets may be used to monitor programs and therapies being given to individual patients through linkage to public health agencies and/or private practice EMRs. 18,19 However, a major hurdle is the issue of privacy protection (HIPAA). 20 The Illinois project, although terminated by Federal administrators of EI because of concerns that it was “intrusive” on the parents’ and clinical teams’ decision-making for the children, remains an example of how large administrative databases can be used to assist in individualized clinical decisions for CSHCN. The collection of accurate prevalence statistics for CSHCN is challenging. One approach has been to use state Medicaid data or data from large health care systems (such as Kaiser-Permanente). Research by the Institute for Child Health Policy using these data sets has found that this administrative data “disproportionately identifies children with injuries and tends to miss children with chronic well-controlled conditions.” 21 Children with temporarily incapacitating injuries are sometimes inappropriately counted as CSHCN. Specialized questionnaires to collect and analyze the data have been devised, evaluated and demonstrated to be much better at correctly identifying CSHCN. 22,23
Page 2 and 3:
Health Informatics (formerly Comput
Page 4 and 5:
Editors Christoph U. Lehmann George
Page 6 and 7:
vi Series Preface changes to both t
Page 8 and 9:
viii Foreword This text will prove
Page 10 and 11:
x Preface financial investment and
Page 12 and 13:
How to Use This book This book is t
Page 14 and 15:
xvi Contents 9 Pediatric Care, Safe
Page 16 and 17:
xviii Contents Part VII A Vision an
Page 18 and 19:
xx Contributors Donna M. D’Alessa
Page 20 and 21:
xxii Contributors Christoph U. Lehm
Page 22 and 23: xxiv Contributors Mark M. Simonian,
Page 24 and 25: 4 G.R. Kim pharmacy, medical educat
Page 26 and 27: 6 K.B. Johnson and G.R. Kim Deaths
Page 28 and 29: 8 K.B. Johnson and G.R. Kim 2.4.1 I
Page 30 and 31: 10 K.B. Johnson and G.R. Kim 2.4.3
Page 32 and 33: 12 K.B. Johnson and G.R. Kim Educat
Page 34 and 35: 14 K.B. Johnson and G.R. Kim 2.6 Co
Page 36 and 37: Chapter 3 Core Pediatric Data Kevin
Page 38 and 39: 3 Core Pediatric Data 21 3.3 Pediat
Page 40 and 41: 3 Core Pediatric Data 23 3.6 Pediat
Page 42 and 43: Chapter 4 Neonatal Care and Data De
Page 44 and 45: 4 Neonatal Care and Data 27 Essenti
Page 46 and 47: 4 Neonatal Care and Data 29 4.3 The
Page 48 and 49: 4 Neonatal Care and Data 31 some ma
Page 50 and 51: 4 Neonatal Care and Data 33 Measure
Page 52 and 53: 4 Neonatal Care and Data 35 4.5.2.4
Page 54 and 55: 4 Neonatal Care and Data 37 4.6.3 I
Page 56 and 57: 4 Neonatal Care and Data 39 4.7.2.2
Page 58 and 59: 4 Neonatal Care and Data 41 Availab
Page 60 and 61: 44 D.M.N. Paperny Tasks related to
Page 62 and 63: 46 D.M.N. Paperny Behavioral risk d
Page 64 and 65: 48 D.M.N. Paperny for outside ancil
Page 66 and 67: 50 D.M.N. Paperny Video reinforceme
Page 68 and 69: 52 D.M.N. Paperny 3. Litzelman DK,
Page 70 and 71: Chapter 6 Children with Development
Page 74 and 75: 6 Children with Developmental Disor
Page 84 and 85: Chapter 7 Pediatric Emergency and P
Page 86 and 87: 7 Pediatric Emergency and Pediatric
Page 96 and 97: 84 W.H. Drummond et al. A recovery
Page 98 and 99: 86 W.H. Drummond et al. 8.2.2 Forma
Page 100 and 101: 88 W.H. Drummond et al. 8.2.2.1 Sys
Page 102 and 103: 90 W.H. Drummond et al. The multidi
Page 104 and 105: 92 W.H. Drummond et al. noise overl
Page 106 and 107: 94 W.H. Drummond et al. needs requi
Page 108 and 109: 96 W.H. Drummond et al. Children’
Page 110 and 111: 98 W.H. Drummond et al. After the P
Page 112 and 113: 100 W.H. Drummond et al. Table 8.2
Page 114 and 115: 102 W.H. Drummond et al. Table 8.3
Page 116 and 117: 104 W.H. Drummond et al. when to su
Page 118 and 119: 106 W.H. Drummond et al. It is crit
Page 120 and 121: 108 W.H. Drummond et al. traditiona
Page 122 and 123:
110 W.H. Drummond et al. and human
Page 124 and 125:
112 W.H. Drummond et al. blood prod
Page 126 and 127:
114 W.H. Drummond et al. Table 8.5
Page 128 and 129:
116 W.H. Drummond et al. 35. Collin
Page 130 and 131:
Chapter 9 Pediatric Care, Safety, a
Page 132 and 133:
9 Pediatric Care, Safety, and Stand
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
134 D.M. D’Alessandro The EBM pro
Page 146 and 147:
136 D.M. D’Alessandro 10.4 Pragma
Page 148 and 149:
138 D.M. D’Alessandro 4. Case ser
Page 150 and 151:
140 D.M. D’Alessandro Ontario, BC
Page 152 and 153:
142 D.M. D’Alessandro Table 10.1
Page 154 and 155:
144 D.M. D’Alessandro Children ar
Page 156 and 157:
146 D.M. D’Alessandro 17. Ely JW,
Page 158 and 159:
Chapter 11 Clinical Practice Guidel
Page 160 and 161:
11 Clinical Practice Guidelines: Su
Page 162 and 163:
Page 164 and 165:
Page 166 and 167:
Page 168 and 169:
Page 170 and 171:
162 M.J. Feldman in patients withou
Page 172 and 173:
164 M.J. Feldman The art of medicin
Page 174 and 175:
166 M.J. Feldman important design g
Page 176 and 177:
168 M.J. Feldman Incorrect or missi
Page 178 and 179:
170 M.J. Feldman Fig. 12.4 GIDEON D
Page 180 and 181:
172 M.J. Feldman system or etiology
Page 182 and 183:
174 M.J. Feldman ED-12: “Practica
Page 184 and 185:
176 M.J. Feldman Fig. 12.7 DXplain:
Page 186 and 187:
178 M.J. Feldman For GIDEON: Rabies
Page 188 and 189:
180 M.J. Feldman KB on infectious d
Page 190 and 191:
182 M.J. Feldman 4. Johnson KB, Fel
Page 192 and 193:
Chapter 13 Managing Pediatric Knowl
Page 194 and 195:
13 Managing Pediatric Knowledge Res
Page 196 and 197:
Page 198 and 199:
Page 200 and 201:
Page 202 and 203:
Page 204 and 205:
Chapter 14 Supporting Continuing Pe
Page 206 and 207:
14 Supporting Continuing Pediatric
Page 208 and 209:
14 Supporting Continuing Pediatric
Page 210 and 211:
Chapter 15 Pediatric Care Coordinat
Page 212 and 213:
15 Pediatric Care Coordination: The
Page 214 and 215:
Page 216 and 217:
Page 218 and 219:
Page 220 and 221:
Page 222 and 223:
Page 224 and 225:
Page 226 and 227:
Chapter 16 Prioritizing Pediatric I
Page 228 and 229:
16 Prioritizing Pediatric Investmen
Page 230 and 231:
Page 232 and 233:
Page 234 and 235:
Page 236 and 237:
Page 238 and 239:
Chapter 17 Aligning Pediatric Ambul
Page 240 and 241:
17 Aligning Pediatric Ambulatory Ne
Page 242 and 243:
Page 244 and 245:
Page 246 and 247:
Page 248 and 249:
Page 250 and 251:
Page 252 and 253:
Page 254 and 255:
Page 256 and 257:
Page 258 and 259:
Page 260 and 261:
Page 262 and 263:
258 G.R. Kim and C.U. Lehmann Elect
Page 264 and 265:
260 G.R. Kim and C.U. Lehmann 18.2.
Page 266 and 267:
262 G.R. Kim and C.U. Lehmann There
Page 268 and 269:
264 G.R. Kim and C.U. Lehmann 13. C
Page 270 and 271:
266 K.B. Johnson and C.G.M. Weigle
Page 272 and 273:
Page 274 and 275:
Page 276 and 277:
Page 278 and 279:
Page 280 and 281:
Page 282 and 283:
Page 284 and 285:
280 C. Sable et al. computer for la
Page 286 and 287:
282 C. Sable et al. Table 20.3 Tele
Page 288 and 289:
284 C. Sable et al. without increas
Page 290 and 291:
286 C. Sable et al. Fig. 20.1b Wash
Page 292 and 293:
288 C. Sable et al. prior to case d
Page 294 and 295:
290 C. Sable et al. presence of con
Page 296 and 297:
292 C. Sable et al. 17. Sable C, Ro
Page 298 and 299:
294 A.E. Zuckerman and G.R. Kim 21.
Page 300 and 301:
296 A.E. Zuckerman and G.R. Kim �
Page 302 and 303:
Page 304 and 305:
Page 306 and 307:
Chapter 22 Privacy Issues David M.N
Page 308 and 309:
22 Privacy Issues 305 22.3 Pediatri
Page 310 and 311:
22 Privacy Issues 307 patient must
Page 312 and 313:
22 Privacy Issues 309 and receipt o
Page 314 and 315:
Chapter 23 Electronic Mail in Pedia
Page 316 and 317:
23 Electronic Mail in Pediatric Pra
Page 318 and 319:
Page 320 and 321:
Page 322 and 323:
Chapter 24 Information Management b
Page 324 and 325:
24 Information Management by Patien
Page 326 and 327:
Page 328 and 329:
Page 330 and 331:
Page 332 and 333:
Chapter 25 Overview of Pediatric In
Page 334 and 335:
25 Overview of Pediatric Inpatient
Page 336 and 337:
Chapter 26 Prescribing/Ordering: Co
Page 338 and 339:
26 Prescribing/Ordering: Computeriz
Page 340 and 341:
Page 342 and 343:
Page 344 and 345:
Page 346 and 347:
346 S.H. Mitchell et al. 27.2.1 Med
Page 348 and 349:
348 S.H. Mitchell et al. context of
Page 350 and 351:
350 S.H. Mitchell et al. 27.3.3.1 C
Page 352 and 353:
352 S.H. Mitchell et al. challenges
Page 354 and 355:
354 S.H. Mitchell et al. work round
Page 356 and 357:
Chapter 28 Medication Administratio
Page 358 and 359:
28 Medication Administration and In
Page 360 and 361:
Page 362 and 363:
Page 364 and 365:
Page 366 and 367:
Page 368 and 369:
Chapter 29 Understanding and Preven
Page 370 and 371:
29 Understanding and Preventing Err
Page 372 and 373:
Page 374 and 375:
Page 376 and 377:
Page 378 and 379:
Page 380 and 381:
Page 382 and 383:
Page 384 and 385:
386 D.C. Stockwell and A.D. Slonim
Page 386 and 387:
Page 388 and 389:
Page 390 and 391:
Page 392 and 393:
Page 394 and 395:
Page 396 and 397:
400 J.H. Schneider a number of prob
Page 398 and 399:
402 J.H. Schneider on governance, u
Page 400 and 401:
404 J.H. Schneider 31.6.1 Data Rele
Page 402 and 403:
406 J.H. Schneider Understanding op
Page 404 and 405:
408 J.H. Schneider of this componen
Page 406 and 407:
410 J.H. Schneider Table 31.1 (cont
Page 408 and 409:
412 J.H. Schneider References 1. Am
Page 410 and 411:
Chapter 32 Developing Pediatric Dat
Page 412 and 413:
32 Developing Pediatric Data Standa
Page 414 and 415:
Page 416 and 417:
Page 418 and 419:
Page 420 and 421:
Page 422 and 423:
Page 424 and 425:
430 G.R. Kim and S.T. Rosenbloom Co
Page 426 and 427:
432 G.R. Kim and S.T. Rosenbloom No
Page 428 and 429:
434 G.R. Kim and S.T. Rosenbloom pr
Page 430 and 431:
436 G.R. Kim and S.T. Rosenbloom ab
Page 432 and 433:
Chapter 34 Pediatric Research and I
Page 434 and 435:
34 Pediatric Research and Informati
Page 436 and 437:
Page 438 and 439:
Page 440 and 441:
Page 442 and 443:
Page 444 and 445:
Page 446 and 447:
Page 448 and 449:
Chapter 35 The Moving Picture of Pe
Page 450 and 451:
35 The Moving Picture of Pediatric
Page 452 and 453:
Page 454 and 455:
Page 456 and 457:
Page 458 and 459:
Page 460 and 461:
470 G.R. Kim and K.B. Johnson Cente
Page 462 and 463:
472 G.R. Kim and K.B. Johnson 36.4
Page 464 and 465:
Index A 2006 AAP recommendations on
Page 466 and 467:
Index 477 psychological data, 45 se
Page 468 and 469:
Index 479 High frequency flow inter
Page 470 and 471:
Index 481 O Online Mendelian Inheri
Page 472:
Index 483 Standards development org
show all

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

Create successful ePaper yourself

Delete template?

Save as template?