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

Recommendations

Info

7 Pediatric Emergency and Pediatric Critical Care Considerations 73 7.4 Linking PEM/PCC Information Needs to IT Tools The goal of health information technology (HIT) design and implementation in PEM/PCC is to support the core functionalities, to coordinate communication and data flow, to inform and support clinician decisions for timely and effective response and to reduce information failures and errors. Central tools in achieving these goals include: Data/knowledge level management tools � A usable electronic clinical information infrastructure: to collect, organize, and distribute timely information for multiple uses from disparate sources (bedside nursing, laboratory, imaging) 34 � Search engine: to allow users to locate patients, test results, providers quickly 35 � Customized record and trend views and dashboards: to provide users with overviews of information and to “drill down” to specific levels of detail (“Overview, zoom and filter, details on demand”) 36 � Clinical decision support: to guide care and trigger appropriate user actions Patient level management tools � Electronic medical records: to document and review patient course (Chapter 18) � Computerized order entry: to initiate and document care actions (Chapter 26) � Medication administration tools (Chapter 28): to track and control medication delivery � Picture archiving and communication systems: to allow point-of-care visualization of imaging results for clinical use and education37 Care unit level management � 38 Central monitors: to monitor physiologic measures for multiple patients � 18 Electronic whiteboards: To locate/organize patient workflow Beyond the unit � Communications networks: to communicate, to assess and allocate regional resources � 39 Telemedicine, Virtual ICUs: to provide expertise and control remotely � Surveillance systems: to alert care systems of possible hazards or threats at the hospital and community levels40,41 7.5 Case Study: Seattle Children’s Hospital 7.5.1 EMR Implementation and Deployment The Seattle Children’s Hospital in Seattle, Washington implemented a hospital-wide commercial EMR in several stages. In July 2002 Children’s deployed laboratory and imaging results viewing, radiology workflow, demographic/visit data and document transcription, with limited online documentation. By November 2003 a rapid
74 M.A. Del Beccaro et al. (“Big Bang”) deployment brought CPOE, including the electronic medication administration record (eMAR) to all inpatient units (including psychiatry and rehabilitation units), ICUs, ED and pre and post operative areas. Since then, the hospital has expanded from 200 to 250 inpatient beds. All orders except chemotherapy are entered by clinicians, with chemotherapy orders entered by pharmacists (based on physician orders entered on paper templates). By June 2006, hospital ambulatory specialty clinics (approximately 25 different clinics with 150,000 visits that year) went live with all orders including future visit orders, electronic prescriptions and fee sheet orders. 7.5.2 CPOE in Pediatric Critical Care Children’s also published one of two studies that evaluated implementation of a commercial CPOE in academic PICUs 42,43 with different findings with regard to mortality. The Children’s deployment and study benefited from the shared experience of the University of Pittsburgh, and found that many of the same issues in PICU with regard to CPOE were also important in the pediatric ED. Lessons learned included: The presence of an EMR/CPOE does not guarantee perfect communication: Communication and workflow failures are frequently root causes in medical errors. CPOE may: (1) remove informal but critical communication between nurses and physicians during ordering (“technology does not replace talking”) and (2) reduce workflow efficiency by requiring more operators during critical situations (such requiring an additional physician to order medications while resuscitation is progressing). Order set design is crucial: Order sets and prescripted choices for completing single orders are powerful ways to supply decision support. These standards for care must be accessible to users: (1) users must know they exist (education) and (2) users must be able to find them (search mechanism with knowledge of the proper terminology to find them quickly). This is especially true in high-stress patient situation where nonstandard (verbal) orders may contribute to a high chance of medical errors. 44 Order sets must be based on published evidence and must be organized to guide provider choices and actions based on patient attributes. By “go live” Children’s had over 20 ICU and 20 ED specific order sets covering general and specific conditions, including standard admit, intubation and tumor lysis order sets for the PICU and new leukemia patient, diabetic ketoacidosis, fractures, dehydration, and four different fever order sets based on age or condition (neonate or cancer for example) in the Pediatric ED. Order sets configure the appropriate routes, frequencies and other details to minimize effort (clicks) and to standardize care. Orders can be generated from the ED or PICU within 10 min and are immediately routed to the appropriate areas (nursing, laboratory, radiology, pharmacy, etc.). In both PICU and Peds ED, additional order sets were designed
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 72 and 73: 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 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 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 138 and 139:
9 Pediatric Care, Safety, and Stand
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 ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?