http://pediatrics.aappublications.org:80 This feed contains articles for Pediatrics Subject Collection "Computers" Pediatrics http://pediatrics.aappublications.org:80 http://pediatrics.aappublications.org:80/cgi/content/short/124/1/375?rss=1 State-of-the-art electronic health record systems with advanced clinical decision support (CDS) capabilities can fundamentally improve quality and reduce costs of health care.1,2 However, these outcomes have not been universally achieved.3,4 As the study by Fiks et al5 in this issue of Pediatrics demonstrates, providing CDS in the form of "alerts" to encourage desired health care activities may not be sufficient to make a substantial impact.6 Maximizing the potential of CDS for improving quality and safety of care requires attention to several factors, not all of which are related to the computer system.7 The goal for the study by Fiks et al was to increase vaccination rates in ... Sittig, D. F. Teich, J. M. Osheroff, J. A. Singh, H. 2009-07-01 doi:10.1542/peds.2009-0339 Improving Clinical Quality Indicators Through Electronic Health Records: It Takes More Than Just a Reminder American Academy of Pediatrics 1 124 377 375 2009-07-01 COMMENTARIES http://pediatrics.aappublications.org:80/cgi/content/short/123/Supplement_2/S61?rss=1 Articles in this issue show clearly the enormous impact that the use of health information technology can have on the quality of health care for children. However, they also point out the challenges that need to be overcome to realize fully the potential of health information technology to improve the quality and efficiency of health care. Fairbrother, G. Simpson, L. A. 2009-01-01 doi:10.1542/peds.2008-1755B It Is Time! Accelerating the Use of Child Health Information Systems to Improve Child Health American Academy of Pediatrics SUPPLEMENT_2 123 63 61 2009-01-01 SUPPLEMENT ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/123/Supplement_2/S64?rss=1 On any given day, hundreds of physicians, nurses, informaticists, health information management directors, and other health care providers are collaborating on how to improve health information technology systems for use in child health care. Many work in small communities of practice to share ideas, to find solutions, and to build innovations that support the goal of making electronic health record systems accessible by 2014. Together, they are a formidable virtual community aligned around a common strategy, to ensure that health information technology works for children. Each member in the community represents a children's hospital or pediatric practice affiliated with one of the 4 major national pediatric organizations that constitute the Alliance for Pediatric Quality. The alliance works with the pediatric health information technology community to speed the adoption of pediatric data standards and to define data collection and reporting systems that would work for both quality improvement and electronic health record systems. With this foundation, hospitals and physicians should be better positioned to improve the quality of health care for US children by implementing technology equipped to care for children, actively participating in improvement initiatives, conducting meaningful measurement of care, and appropriately reporting for accountability. Miles, P. V. Miller, M. Payne, D. M. Perelman, R. Saffer, M. Zimmerman, E. for the Alliance for Pediatric Quality, 2009-01-01 doi:10.1542/peds.2008-1755C Alliance for Pediatric Quality: Creating a Community of Practice to Improve Health Care for America's Children American Academy of Pediatrics SUPPLEMENT_2 123 66 64 2009-01-01 SUPPLEMENT ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/123/Supplement_2/S67?rss=1 This article describes health information systems used for children in a variety of settings (eg, clinical care, public health, emergency medicine systems, and schools) and their current ability to exchange information. The potential benefits from linking these systems are considered, as well as the barriers to linkage. In addition, an example of efforts linking information systems together is summarized, and conclusions are drawn from this example for future efforts. Hinman, A. R. Davidson, A. J. 2009-01-01 doi:10.1542/peds.2008-1755D Linking Children's Health Information Systems: Clinical Care, Public Health, Emergency Medical Systems, and Schools American Academy of Pediatrics SUPPLEMENT_2 123 73 67 2009-01-01 SUPPLEMENT ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/123/Supplement_2/S74?rss=1 Progress in using information technology to achieve the goal of high-quality health care is hindered by the lack of coordinated data standards. To accelerate quality improvement in pediatrics, child health providers must participate actively in the creation of health care data standards. To do so will require far greater understanding on the part of pediatricians and other pediatric providers regarding the scope and role of data standards in advancing health information systems for children, as well as how data standards could improve quality in child health, what kinds of data standards hold the most promise for quality improvement in child health, and how child health professionals can engage in the work of creating data standards. Child health professionals in organized and academic medicine should participate in standards development organizations, to present the pediatric point of view as data standards emerge. They also should support efforts to certify electronic health record systems that include pediatric functionality. A major challenge to academic pediatrics is to prove that data standards can lead to improved health outcomes for children; this is only a compelling conjecture as of this writing. Spooner, S. A. Classen, D. C. 2009-01-01 doi:10.1542/peds.2008-1755E Data Standards and Improvement of Quality and Safety in Child Health Care American Academy of Pediatrics SUPPLEMENT_2 123 79 74 2009-01-01 SUPPLEMENT ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/123/Supplement_2/S80?rss=1 OBJECTIVE. The purpose of this study was to examine the adoption of health information technology by children's hospitals and to document barriers and priorities as they relate to health information technology adoption. METHODS. Primary data of interest were obtained through the use of a survey instrument distributed to the chief information officers of 199 children's hospitals in the United States. Data were collected on current and future use of a variety of clinical health information technology and telemedicine applications, organizational priorities, barriers to use of health information technology, and hospital and chief information officer characteristics. RESULTS. Among the 109 responding hospitals (55%), common clinical applications included clinical scheduling (86.2%), transcription (85.3%), and pharmacy (81.9%) and laboratory (80.7%) information. Electronic health records (48.6%), computerized order entry (40.4%), and clinical decision support systems (35.8%) were less common. The most common barriers to health information technology adoption were vendors' inability to deliver products or services to satisfaction (85.4%), lack of staffing resources (82.3%), and difficulty in achieving end-user acceptance (80.2%). The most frequent priority for hospitals was to implement technology to reduce medical errors or to promote safety (72.5%). CONCLUSION. This first national look at health information technology use by children's hospitals demonstrates the progress in health information technology adoption, current barriers, and priorities for these institutions. In addition, the findings can serve as important benchmarks for future study in this area. Menachemi, N. Brooks, R. G. Schwalenstocker, E. Simpson, L. 2009-01-01 doi:10.1542/peds.2008-1755F Use of Health Information Technology by Children's Hospitals in the United States American Academy of Pediatrics SUPPLEMENT_2 123 84 80 2009-01-01 SUPPLEMENT ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/123/Supplement_2/S85?rss=1 BACKGROUND. Electronic results management may improve the reliability and efficiency of test results management, but few studies have investigated this topic in pediatrics. METHODS. We conducted semi-structured, key informant interviews before and after implementation of electronic results management at 8 pediatric ambulatory care practices. We also surveyed all pediatricians at 18 practices (10 additional practices). All practices were members of Partners Healthcare and had been using an electronic health record when they were offered electronic results management. We assessed baseline processes for results management, barriers to electronic results management adoption, and the perceived impact of electronic results management on quality, efficiency, and provider satisfaction. RESULTS. From interviews, we found a range of processes in place to manage test results, but all practices reported losing some results and no practice tracked all test results from the time of ordering to parent/patient notification. Practices that fully adopted electronic results management reported gains in efficiency, reliability, timeliness, and provider satisfaction, whereas some partial adopters reported decreased efficiency and increased risk of lost test results. Barriers to electronic results management adoption included lack of inclusion of all ordered tests in the electronic results management system, user interface design issues, and lack of sufficient pediatric customization. Survey results (response rate: 62%) indicated that pediatricians thought electronic results management improved the quality and efficiency of care, with 72% of pediatricians reporting safer care and 63% reporting more-effective care. CONCLUSIONS. We found that pediatric practices have room for improvement in the management of test results, and electronic results management may be an effective method for improving the efficiency and safety of test results management. However, partial adoption of electronic results management may decrease efficiency and pose a threat to patient safety. Ferris, T. G. Johnson, S. A. Co, J. P. T. Backus, M. Perrin, J. Bates, D. W. Poon, E. G. 2009-01-01 doi:10.1542/peds.2008-1755G Electronic Results Management in Pediatric Ambulatory Care: Qualitative Assessment American Academy of Pediatrics SUPPLEMENT_2 123 91 85 2009-01-01 SUPPLEMENT ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/123/Supplement_2/S92?rss=1 OBJECTIVE. Pay-for-performance programs are used to promote improved health care quality, often through increased use of health information technology. However, little is known about whether pay-for-performance programs influence the adoption of health information technology, especially among child health providers. This study explored how various pay-for-performance compensation methods are related to health information technology use. METHODS. Survey data from 1014 child health providers practicing in Florida were analyzed by using univariate and multivariate techniques. Questions asked about the adoption of electronic health records and personal digital assistants, as well as types of activities that affected child health provider compensation or income. RESULTS. The most common reported method to affect respondents' compensation was traditional productivity or billing (78%). Of the pay-for-performance-related methods of compensation, child health providers indicated that measures of clinical care (41%), patient surveys and experience (34%), the use of health information technology (29%), and quality bonuses or incentives (27%) were a major or minor factor in their compensation. In multivariate logistic regression analyses, only pay-for-performance programs that compensated directly for health information technology use were associated with an increased likelihood of electronic health record system adoption. Pay-for-performance programs linking measures of clinical quality to compensation were positively associated with personal digital assistant use among child health providers. CONCLUSIONS. Pay-for-performance programs that do not directly emphasize health information technology use do not influence the adoption of electronic health records among Florida physicians treating children. Understanding how different pay-for-performance compensation methods incentivize health information technology adoption is important for improving quality. Menachemi, N. Struchen-Shellhorn, W. Brooks, R. G. Simpson, L. 2009-01-01 doi:10.1542/peds.2008-1755H Influence of Pay-for-Performance Programs on Information Technology Use Among Child Health Providers: The Devil Is in the Details American Academy of Pediatrics SUPPLEMENT_2 123 96 92 2009-01-01 SUPPLEMENT ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/123/Supplement_2/S97?rss=1 Personal health records may enhance pediatric care and outcomes. Few systems have been developed or customized for pediatrics, and evaluations are scarce. Special considerations in pediatrics include pediatric content such as growth charts, complex privacy and confidentiality considerations, and the changing developmental needs of children and adolescents. Britto, M. T. Wimberg, J. 2009-01-01 doi:10.1542/peds.2008-1755I Pediatric Personal Health Records: Current Trends and Key Challenges American Academy of Pediatrics SUPPLEMENT_2 123 99 97 2009-01-01 SUPPLEMENT ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/123/Supplement_2/S100?rss=1 Many primary care physicians are not providing care that is consistent with recommendations to prevent, to identify, and to manage childhood obesity. This report presents modifications made to the electronic medical record system of a large pediatric health care system, using a quality improvement approach, to support these recommendations and office system changes. Although it is possible to make practice changes secondary to electronic medical record system enhancements, challenges to development and implementation exist. Rattay, K. T. Ramakrishnan, M. Atkinson, A. Gilson, M. Drayton, V. 2009-01-01 doi:10.1542/peds.2008-1755J Use of an Electronic Medical Record System to Support Primary Care Recommendations to Prevent, Identify, and Manage Childhood Obesity American Academy of Pediatrics SUPPLEMENT_2 123 107 100 2009-01-01 SUPPLEMENT ARTICLES