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

64 L.W. Desch and P.H. Lipkin
Concerns have been raised regarding financial disincentives to providing
comprehensive services for patients in managed care, including Medicaid managed
care. 54 Information technology can help pediatricians persuade managed
care organizations by providing EMR data on the types of patients seen, by use
of ICD9-CM codes to justify the type and amount of work done for CSHCN and
to improve reimbursement. Managed care databases that share patient information
among primary care physicians, specialists, and hospitals can reduce duplicate
work and improve patient care. 54
Other functions that information technology can provide to enhance the care of
CSHCN include the following:
Integrated growth charts,
which have advantages over paper systems, 58 and for
which modules which incorporate data for CSHCN such as those with Trisomy
21, Turner syndrome, those born prematurely, and other CSHCN may be adapted
for use in a pediatric EMR system.
Patient data entry for visits such as assisted interviewing, is also becoming more
commonplace59 and has been shown to be helpful in identifying behavioral problems
in teens. A self-entry system for patient data from adult rheumatology has
been described and could be used with teenagers with rheumatic disorders. 60
Electronic diaries for recording of daily pain scores have also been found to be
very useful, often leading to more compliance in keeping records, when compared
to paper diaries. 61
Mental health assessment and testing to identify learning disability, intellectual
disability and depression exist, some with the ability to export data to EMRs in
mental health offices. Such tools may be used to screen siblings and family for
secondary mental health problems. 62
Streamlining reliable assessment tests63,64 for outcomes assessments using
“computer adaptive testing” (CAT) versions for those tests65 can be used to
reduce the number of questions needed to make an accurate assessment. 66
Decision support or expert systems may help a clinical therapist select a proper
assessment tool for individual patients or for program evaluations. 67 .
Telemedicine (Chapter 20) combines information and communication technology
to provide care at a distance for review of patient self-assessment tools,
monitoring medical interventions68 or for chronic disease management where
accurate and reliable patient data may produce better outcomes. 69 Real-time
video teleconferencing that interfaces specialists for CSHCN with remote physicians
provides needed expertise with high acceptance. 70
6.6 Future Needs
The medical care of CSHCN is challenging, time-consuming and costly. 71 However,
investment in health information technology for the care of CSHCN can help improve
outcomes and show a positive return on investment, even for the high need, high-cost