Dr Alok Bhatia,
Director & Business Head- Northern Region, NationWidePrimary Healthcare Services Pvt Ltd
Adoption of health informationtechnology (HIT) hasbeen advocated by one andall as a major approach toimprove patient safety through reductionand prevention of medicalerrors. Adoption of HIT tools such asElectronic Health Records (EHRs),Computerised Provider Order Entry(CPOE), and Clinical DecisionSupport (CDS) is increasing, and althoughcurrent implementation of allthese HIT tools is not yet widespreadamong Indian healthcare providers,although most tertiary care hospitalsthat provide care for children and infantsuse some form of an electronicinformation system to manage personalhealth information and otherdata that affect childrens health.
Children and infants have vulnerabilitiesand needs that are distinctfrom adults with regard to the managementof their clinical care and itsassociated information. The extendednormal ranges of body weights, sizes,and physiologic responses requiremodifications of clinical, technical,and information workflows to providepediatric-specific care that is safe. Asystematic evidence base for designand implementation of effective HITthat improves care quality and safetyis needed but lacking,and recent observationsand experience indicatethat changes (such as the adoptionof information technology) can introducenew and unanticipated errors.
The major technical barrier toadoption of pediatric HIT tools is a lackof pediatric-specific information technologystandards. Among these needsfor standards are pediatric data thatare machine-readable, terminologiesand dictionaries that fully describepediatric clinical entities (such as pediatricdrug-dose data), and electronicstandards (Health Level 7 Child HealthFunctional Profile is currently in developmentin the US) that adequately describepediatric clinical events.
During an inpatient stay, patientsundergo numerous care transitions,including admission (from emergencydepartments, transport services, andphysician offices), discharge (to homeor other facilities), and/or transfer todifferent locations within the institutionfor tests (imaging), procedures(surgery), and special levels of care(postanesthesia recovery care).
The most common transition isthe transfer of care responsibilities(handovers, handoffs, or sign-outs).Physicians, nurses, consultants, andancillary staff members transfer responsibilitiesin parallel (physician tophysician, nurse to nurse, etc) and, inmost cases, asynchronously accordingto shift and call schedules.
It is commonly seen and felt that inalmost all the above mentioned situationsthe IT & its usefulness is beyonddoubt changed the inpatient care statistics.
Another important milestoneachieved has been the availability ofthese applications on the hand held devices& smart phones and in future willrevolutionise the way we look at treatingour children both in the hospital aswell as in our out patient department.
Electronic Medical Record (EMR)
EMRs are a central structure forpatient-specific data documentation.Their multiple roles include facilitatingcommunication among providers,standardising medico-legal documentationof care, historical recordarchiving and retri, and coordinationof care. They can facilitate centralisedclinical communication anddocumentation among hospitalists,primary care providers in medicalhomes, consultants, and emergencycare providers. They form the basisfor medication reconciliation andmay support personal health recordsto inform and empower patients andfamilies about their care. Importanttechnical functions of EMRs includeinteroperability of data elements,connectivity to other electronic records,and information assurance(according to established standards).Essential in their implementationis effective user training to preventmisuse that may lead to errors. Theyhave a significant contribution in theprimary healthcare and family medicinewhere they form the main stay ofmedical records.
Technical standards and certificationcriteria for inpatient systemsare still in development. The IndianAcademy of Paediatrics (IAP), thestatutory body at par with AAP, is alsoequally focused on developing its ownguidelines and algorithms for Indiansubcontinent.
Introduction of HIT may significantlyimprove clinical performance,reduce costs, and reduce workloads;however, every HIT-system implementationwill invariably introduce newand sometimes unforeseen errorsand challenges.
The majortechnical barrierto adoption ofpediatric HIT toolsis a lack of pediatricspecificinformationtechnologystandards
Pediatric functions in an EMR have been articulated in an AAP policystatement and include:
- Immunisation management (recording data, linking to immunisation systems, decision support);
- Growth tracking (graphing and percentile calculation);
- Medication dosing (dosing by weight, dose-range checking, safe and convenient dose rounding, age-based decision support, dosing for the school day);
- Patient identification (prenatal identifiers, newborn identifiers, name changes, ambiguous gender);
- Norms for pediatric data (numeric; nonnumeric; complex normative, such as blood pressures; gestational age); and
- Privacy (adolescent, foster/custodial care, consent by proxy, adoption, guardianship, emergency treatment).
Teaching & training
Several modules have made it botheasy as well as interesting to imparttraining and teaching to both undergraduateas well as postgraduatestudents. Simulation tools have beendeveloped to orient students with uniformity.In situations where trainingwas indeed difficult like the PaediatricsAdvanced Life Support (PALS)& Neonatal Advanced Life Support(NALS) courses have seen more andmore enthusiasm from the attendees.
Availability of articles, journalsand e-scripts has only made learningeasy and effective.
In conclusion, IT is there to stayin our lives.