PEDIATRICS Vol. 111 No. 3 March 2003, pp. 679
COMMENTARY |
Medical Information Systems in Pediatrics
The safety, effectiveness, impact, and risks of medical information systems have received little attention from clinical investigators in pediatrics. Krishna and colleagues’1 study of the impact of a multimedia asthma education program published in this issue of Pediatrics is an exception to this observation and a wonderful example of a clinical research study on the effects of a medical information system.Information systems that collect, process, and disseminate medical information are ubiquitous in our practice of pediatric medicine. These information resources serve a variety of functions, but they all have 1 thing in common: they are being used in a high-stakes environment. Technical glitches such as programming errors,2 hardware malfunctions, communication failures, and data corruption or data loss can endanger the well-being of our patients. Human-machine interface errors like inappropriate use (a program designed for adults used in pediatrics), incomplete or inaccurate data entry, rearranged physician priorities, and the generation of false expectations and overreliance (the program will tell me when I made a mistake) all may lead to medical errors and subsequently to morbidity and mortality.
Despite their increasing presence, relatively little effort has been undertaken to systematically gather evidence on the safety and efficacy of medical information systems used with pediatric patients. Information systems used in pediatrics are fundamentally different from adult systems. They must handle weight-based dosing, different history components (such as development), monitor growth based on age, and if targeted for use by a child, must be designed to be child-friendly in language and graphics.
In April 2002, the Bush Administration decided to retain a 3-year-old rule that gives the Food and Drug Administration power to demand that pharmaceutical companies conduct targeted studies to learn about medication side effects and set proper doses for children.3 Linked to an incentive program by Congress, this "pediatric rule" has generated evidence on particular pediatric risks as well as pediatric-specific metabolism.
Medical information systems are burdened with inherent danger in conjunction with pediatric-specific risks as well as significant expenses. In the best interest of our patients, pediatricians should lobby for an extension of the "pediatric rule" to information systems in pediatric settings. I applaud Pediatrics for providing a forum for evidence-based pediatric medical informatics.
Eudowood Neonatal Pulmonary Division and Division of Health
Sciences Informatics
Johns Hopkins University
Baltimore, MD 21287
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FOOTNOTES
Received for publication Dec 19, 2002; Accepted Dec 19, 2002.
Reprint requests to (C.U.L.) 600 N Wolfe St, Children’s Medical and Surgical Center 210, Baltimore, MD 21287. E-mail: clehmann{at}jhmi.edu
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REFERENCES |
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 TOP REFERENCES |
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1. Krishna S, Francisco BD, Balas EA, König P, Graff GR, Madsen RW. Internet-enabled interactive multimedia asthma education program: a randomized trial. Pediatrics.2003; 111 :503 –510
2. McDaniel JG. Improving system quality through software evaluation. Comput Biol Med.2002; 32 :127 –140[CrossRef][Web of Science][Medline]
3. Marshall E. Pediatric drug trials: challenge to FDA’s authority may end up giving it more.
Science.2002; 296
:820
–821
PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics
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