Advertisement

Aligning Pediatric Ambulatory Needs with Health IT

  • Michael G. Leu
  • George R. Kim
  • Ari H Pollack
  • William G. Adams
Part of the Health Informatics book series (HI)

Abstract

Primary motivations for health IT adoption, from a federal policy level, are to improve quality and reduce costs in health care. In ambulatory care, incentive alignment among stakeholders is a major obstacle. While patients and payors benefit from adoption, it is the practices and provider groups that must bear the burdens of financial investment, workflow redesign, and organizational change. Even for institutions and practices skilled in managing the necessary changes, the task of health IT adoption is risky (Table 17.1).

Keywords

Electronic Medical Record Electronic Health Record Clinical Decision Support System Ambulatory Setting Electronic Health Record System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993;342:1317–1322.PubMedCrossRefGoogle Scholar
  2. 2.
    Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000.Google Scholar
  3. 3.
    McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635–2645.PubMedCrossRefGoogle Scholar
  4. 4.
    Mangione-Smith R, DeCristofaro AH, Setodji CM, et al. The quality of ambulatory care delivered to children in the United States. N Engl J Med. 357:1515–1523.Google Scholar
  5. 5.
    Wennberg JE, Fisher ES, eds. The Care of Patients with Severe Chronic Illness: A Report on the Medicare Program by the Dartmouth Atlas Project. The Center for the Evaluative Clinical Sciences, Dartmouth Atlas Project, Hanover, New Hampshire; 2006. Available at: http://www. dartmouthatlas.org. Accessed December 20, 2008.Google Scholar
  6. 6.
    Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.Google Scholar
  7. 7.
    Berwick DM. A user's manual for the IOM's ‘Quality Chasm’ report. Health Aff. 2002;21:80–90.CrossRefGoogle Scholar
  8. 8.
    Provnost PJ, Berenholtz SM, Goeschel CA, et al. Creating high reliability in health care organizations. Health Serv Res. 2006;41:1599–1617.CrossRefGoogle Scholar
  9. 9.
    Cherry DK, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2005 Summary. Advance Data from Vital and Health Statistics; No. 387. Hyattsville, MD: National Center for Health Statistics; 2007.Google Scholar
  10. 10.
    Lieu TA, Capra AM, Makol J, et al. Effectiveness and cost-effectiveness of letters, automated telephone messages, or both for underimmunized children in a health maintenance organization. Pediatrics. 1998;101:e3.PubMedCrossRefGoogle Scholar
  11. 11.
    Sia C, Tonniges TF, Osterhus E, Taba S. History of the medical home concept. Pediatrics. 2004;113:1473–1478.PubMedGoogle Scholar
  12. 12.
    Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2–4.PubMedGoogle Scholar
  13. 13.
    Barr M, Ginsburg J. The advanced medical home: a patient-centered, physician-guided model of health care. A Policy Monograph. Philadelphia, PA: American College of Physicians; 2006.Google Scholar
  14. 14.
    Hillestad R, Biegelow J, Bower A, et al. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff. 2005;24:1103–1117.CrossRefGoogle Scholar
  15. 15.
    Joos D, Chen Q, Jirjis J, Johnson KB. An electronic medical record in primary care: impact on satisfaction, work efficiency and clinic processes. AMIA Annu Symp Proc. 2006;394–398.Google Scholar
  16. 16.
    Wang SJ, Middleton B, Prosser LA, et al. A cost-benefit analysis of electronic medical records in primary care. Am J Med. 2003;114:397–403.PubMedCrossRefGoogle Scholar
  17. 17.
    Miller RH, West C, Brown TM, et al. The value of electronic health records in solo or small group practices. Health Aff. 2005;24:1127–1137.CrossRefGoogle Scholar
  18. 18.
    Leu MG, Cheung M, Webster TR, et al. Centers speak up: the clinical context for health information technology in the ambulatory care setting. J Gen Intern Med. 2008;23:372–378.PubMedCrossRefGoogle Scholar
  19. 19.
    Cisco SL, Wertzberger J. Indexing Digital Documents — It's NOT an Option. Pay Now or Pay (More) Later. Inform. 1997;11(2):12–20.Google Scholar
  20. 20.
    Grieger DL, Cohen SH, Krusch DA. A pilot study to document the return on investment for implementing an ambulatory electronic health record at an academic medical center. J Am Coll Surg. 2007;205:89–96.PubMedCrossRefGoogle Scholar
  21. 21.
    Healthcare Reports. Traditional In-House Document Imaging Implementation Costs; 2006. Available at: http://www.healthcarereports.com/di-costsdetail.htm.Accessed December 21, 2008.
  22. 22.
    Biondich PG, Downs SM, Anand V, Carroll AE. Automating the recognition and prioritization of needed preventive services: early results from the CHICA system. AMIA Annu Symp Proc. 2005;51–55.Google Scholar
  23. 23.
    Gerstle RS, Lehmann CU. AAP Council on Clinical Information Technology. Electronic prescribing systems in pediatrics: the rationale and functionality requirements. Pediatrics. 2007;119: e1413–1422.PubMedCrossRefGoogle Scholar
  24. 24.
    Marcus E. E-prescribing can add quality, safety to patient care. AAP News. 2005;26:15.Google Scholar
  25. 25.
    Gerstle RS. Practices should seriously consider e-prescribing systems. AAP News. 2007;28:33.Google Scholar
  26. 26.
    McPhillips HA, Stille CJ, Smith D, et al. Potential medication dosing errors in outpatient pediatrics. J Pediatr. 2005;147:761–767.PubMedCrossRefGoogle Scholar
  27. 27.
    Sittig DF, Stead WW. Computer-based physician order entry: the state of the art. J Am Med Inform Assoc. 1994;1:108–123.PubMedGoogle Scholar
  28. 28.
    Johnston D, Pan E, Walker J. The value of CPOE in ambulatory settings. J Healthcare Inf Manage. 2003;18(1):5–8. Available at: http://www.himss.org/content/files/ambulatorydocs/ValueOfCPOEInAmbulatorySettings.pdf. Accessed 21 December 2008.Google Scholar
  29. 29.
    Institute of Medicine. Key Capabilities of an Electronic Health Record System: Letter Report. Washington, DC: National Academies Press; 2003. Available at: http://www.nap.edu/catalog. php?record_id=10781. Accessed December 21, 2008.Google Scholar
  30. 30.
    Sanfelippo ML, Walker WE, Hall DA, Swenson RS. Clinical application of a single compartment model to urea and creatinine kinetics in dialysis therapy. Comput Programs Biomed. 1978;8:44–50.PubMedCrossRefGoogle Scholar
  31. 31.
    Lehmann CU, Conner KG, Cox JM. Preventing provider errors: online total parenteral nutrition calculator. Pediatrics. 2004;113:748–753.PubMedCrossRefGoogle Scholar
  32. 32.
    Centers for Disease Control. Other Growth Chart Resources. Available at: http://www.cdc. gov/nccdphp/dnpa/growthcharts/resources/index.htm#BMI. Accessed December 21, 2008.
  33. 33.
    Stockwell DC. Pediatrics on hand; 2008. Available at: http://www.childrensnational.org/pdas. Accessed December 21, 2008.
  34. 34.
    Linder JA, Ma J, Bates DW, Middleton B, Stafford RS. Electronic health record use and the quality of ambulatory care in the United States. Arch Intern Med. 2007;167:1400–1405.PubMedCrossRefGoogle Scholar
  35. 35.
    Scott IU, Feuer WJ, Jacko JA. Impact of graphical user interface screen features on computer task accuracy and speed in a cohort of patients with age-related macular degeneration. Am J Ophthalmol. 2002;134:857–862.PubMedCrossRefGoogle Scholar
  36. 36.
    Microsoft Corporation. Microsoft Health Common User Interface; 2007. Available at: http:// www.mscui.org/. Accessed December 21, 2008.
  37. 37.
    Department of Health and Human Services. Office for Civil Rights — HIPAA; 2008. Available at: http://www.hhs.gov/ocr/hipaa/. Accessed December 21, 2008.
  38. 38.
    Sciamanna CN, Rogers ML, Shenassa ED, et al. Patient access to U.S. physicians who conduct internet or E-mail consults. J Gen Intern Med. 2007;22:378–381.PubMedCrossRefGoogle Scholar
  39. 39.
    Stone JH. Communication between physicians and patients in the era of e-medicine. N Engl J Med. 2007;356:2451–2454.PubMedCrossRefGoogle Scholar
  40. 40.
    Anand SG, Feldman MJ, Geller DS, et al. A content analysis of e-mail communications between primary care providers and parents. Pediatrics. 2005;115:1283–1288.PubMedCrossRefGoogle Scholar
  41. 41.
    Kane B, Sands DZ. AMIA Internet Working Group. Guidelines for the clinical use of electronic mail with patients. J Am Med Inf Assoc. 1998;5:104–111.Google Scholar
  42. 42.
    Liederman EM, Lee JC, Baquery VH, et al. Patient-physician web messaging: the impact on message volume and satisfaction. J Gen Intern Med. 2005;20:52–57.PubMedCrossRefGoogle Scholar
  43. 43.
    Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff. 2001;20:64–78.CrossRefGoogle Scholar
  44. 44.
    Lorig KR, Ritter PL, Laurent DD, Plant K. Internet-based chronic disease self-management: a randomized trial. Med Care. 2006;44:964–971.PubMedCrossRefGoogle Scholar
  45. 45.
    Leu MG, Norris TE, Hummel J, Isaac M, Brogan MW. A randomized, controlled trial of an automated wireless messaging system for diabetes. Diabetes Technol Ther. 2005;7:710–718.PubMedCrossRefGoogle Scholar
  46. 46.
    Logan AG, McIsaac WJ, Tisler A, et al. Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients. Am J Hypertens. 2007;20:942–948.PubMedCrossRefGoogle Scholar
  47. 47.
    Bu D, Pan E, Johnston D, et al. The Value of Information Technology-Enabled Diabetes Management. Center for Information Technology Leadership. Charlestown, MA; 2007.Google Scholar
  48. 48.
    Rosenthal MB, Dudley RA. Pay-for-performance: will the latest payment trend improve care? JAMA. 2007;297:740–744.PubMedCrossRefGoogle Scholar
  49. 49.
    Landon BE, Hicks LS, O'Malley AJ, et al. Improving the management of chronic disease at community health centers. N Engl J Med. 2007;356:921–934.PubMedCrossRefGoogle Scholar
  50. 50.
    Agrawal R, Johnson C. Securing electronic health records without impeding the flow of information. Int J Med Inform. 2007;76:471–479.PubMedCrossRefGoogle Scholar
  51. 51.
    Grzybicki DM, Turcsanyi B, Becich MJ, Gupta D, Gilbertson JR, Raab SS. Database construction for improving patient safety by examining pathology errors. Am J Clin Pathol. 2005;124:500–509.PubMedCrossRefGoogle Scholar
  52. 52.
    Dimick C. E-discovery: preparing for the coming rise in electronic discovery requests. J AHIMA. 2007;78:24–29.PubMedGoogle Scholar
  53. 53.
    Chen R, Enberg G, Klein GO. Julius—a template based supplementary electronic health record system. BMC Med Inf Decis Mak. 2007;7:10.CrossRefGoogle Scholar
  54. 54.
    Hammarstedt R, Bulger D. Performance improvement: a “left brain meets right brain” approach. Healthcare Financ Manage. 2006;60:100–4, 106.Google Scholar
  55. 55.
    Luhn HP. A business intelligence system. IBM J. 1958;2:314–319.Google Scholar
  56. 56.
    Olsha-Yehiav M, Einbinder JS, Jung E, et al. Quality dashboards: technical and architectural considerations of an actionable reporting tool for population management. AMIA Annu Symp Proc. 2006;1052.Google Scholar
  57. 57.
    Jung E, Li Q, Mangalampalli A, et al. Report central: quality reporting tool in an electronic health record. AMIA Annu Symp Proc. 2006;971.Google Scholar
  58. 58.
    Hing ES, Burt CW, Woodwell DA. Electronic medical record use by office-based physicians and their practices: United States, 2006. Advance Data from Vital and Health Statistics; No. 393. Hyattsville, Maryland, MD: National Center for Health Statistics; 2007.Google Scholar
  59. 59.
    Menachemi N, Ettel DL, Brooks RG, Simpson L. Charting the use of electronic health records and other information technologies among child health providers. BMC Pediatr. 2006;6:21.PubMedCrossRefGoogle Scholar
  60. 60.
    McInnes DK, Saltman DC, Kidd MR. General practitioners' use of computers for prescribing and electronic health records. Med J Aust. 2006;185:88–91.PubMedGoogle Scholar
  61. 61.
    Schoen C, Osborn R, Huynh PT, Doty M, Peugh J, Zapert K. On the front lines of care: primary care doctors' office systems, experiences, and views in seven countries. Health Aff. 2006;25:w555–w571.CrossRefGoogle Scholar
  62. 62.
    Jha AK, Ferris TG, Donelan K, et al. How common are electronic health records in the United States? A summary of the evidence. Health Aff. 2006;25:w496–w507.CrossRefGoogle Scholar
  63. 63.
    Simon SR, Kaushal R, Cleary PD, et al. Correlates of electronic health record adoption in office practices: a statewide survey. J Am Med Inf Assoc. 2007;14:110–117.CrossRefGoogle Scholar
  64. 64.
    Audet AM, Doty MM, Peugh J, Shamasdin J, Zapert K, Schoenbaum S. Information technologies: when will they make it into physicians' black bags? MedGenMed. 2004;6:2.PubMedGoogle Scholar
  65. 65.
    Bates DW. Physicians and ambulatory electronic health records. Health Aff. 2005; 24:1180–1189.CrossRefGoogle Scholar
  66. 66.
    Certification Committee on Healthcare Information Technology. CCHIT Website; 2008. Available at: http://www.cchit.org/. Accessed December 21, 2008.
  67. 67.
    American Academy of Family Physicians Center for Health Information Technology. Partners for patients electronic health record market survey; 2005. Available at: http://www.center forhit.org/PreBuilt/chit_2005p4pvendsurv.pdf. Accessed December 21, 2008.
  68. 68.
    American Academy of Pediatrics Council on Clinical Information Technology. EMR Review Project Website; 2006. Available at: http://www.aapcocit.org/emr/. Accessed December 21, 2008.

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Michael G. Leu
    • 1
  • George R. Kim
    • Ari H Pollack
      • 2
    • William G. Adams
      • 3
    1. 1.Pediatric Hospitalist/InformaticianSeattle Children's HospitalSeattle
    2. 2.Clinical Instructor of PediatricsUniversity of Washington School of Medicine, Informatics Physician, Seattle Children's HospitalSeattle
    3. 3.Child Health Informatics, Department of PediatricsBoston University School of MedicineBoston

    Personalised recommendations