Dr Alok Bhatia,
Director & Business Head- Northern Region, NationWideÂ Primary Healthcare Services Pvt Ltd
Adoption of health informationÂ technology (HIT) hasÂ been advocated by one andÂ all as a major approach toÂ improve patient safety through reductionÂ and prevention of medicalÂ errors. Adoption of HIT tools such asÂ Electronic Health Records (EHRs),Â Computerised Provider Order EntryÂ (CPOE), and Clinical DecisionÂ Support (CDS) is increasing, and althoughÂ current implementation of allÂ these HIT tools is not yet widespreadÂ among Indian healthcare providers,Â although most tertiary care hospitalsÂ that provide care for children and infantsÂ use some form of an electronicÂ information system to manage personalÂ health information and otherÂ data that affect childrenâs health.
Children and infants have vulnerabilitiesÂ and needs that are distinctÂ from adults with regard to the managementÂ of their clinical care and itsÂ associated information. The extendedÂ normal ranges of body weights, sizes,Â and physiologic responses requireÂ modifications of clinical, technical,Â and information workflows to provideÂ pediatric-specific care that is safe. AÂ systematic evidence base for designÂ and implementation of effective HITÂ that improves care quality and safetyÂ is needed but lacking,and recent observationsÂ and experience indicateÂ that changes (such as the adoptionÂ of information technology) can introduceÂ new and unanticipated errors.
The major technical barrier toÂ adoption of pediatric HIT tools is a lackÂ of pediatric-specific information technologyÂ standards. Among these needsÂ for standards are pediatric data thatÂ are machine-readable, terminologiesÂ and dictionaries that fully describeÂ pediatric clinical entities (such as pediatricÂ drug-dose data), and electronicÂ standards (Health Level 7 Child HealthÂ Functional Profile is currently in developmentÂ in the US) that adequately describeÂ pediatric clinical events.
During an inpatient stay, patientsÂ undergo numerous care transitions,Â including admission (from emergencyÂ departments, transport services, andÂ physician offices), discharge (to homeÂ or other facilities), and/or transfer toÂ different locations within the institutionÂ for tests (imaging), proceduresÂ (surgery), and special levels of careÂ (postanesthesia recovery care).
The most common transition isÂ the transfer of care responsibilitiesÂ (handovers, handoffs, or sign-outs).Â Physicians, nurses, consultants, andÂ ancillary staff members transfer responsibilitiesÂ in parallel (physician toÂ physician, nurse to nurse, etc) and, inÂ most cases, asynchronously accordingÂ to shift and call schedules.
It is commonly seen and felt that inÂ almost all the above mentioned situationsÂ the IT & its usefulness is beyondÂ doubt changed the inpatient care statistics.
Another important milestoneÂ achieved has been the availability ofÂ these applications on the hand held devicesÂ & smart phones and in future willÂ revolutionise the way we look at treatingÂ our children both in the hospital asÂ well as in our out patient department.
Electronic Medical Record (EMR)
EMRs are a central structure forÂ patient-specific data documentation.Â Their multiple roles include facilitatingÂ communication among providers,Â standardising medico-legal documentationÂ of care, historical recordÂ archiving and retri, and coordinationÂ of care. They can facilitate centralisedÂ clinical communication andÂ documentation among hospitalists,Â primary care providers in medicalÂ homes, consultants, and emergencyÂ care providers. They form the basisÂ for medication reconciliation andÂ may support personal health recordsÂ to inform and empower patients andÂ families about their care. ImportantÂ technical functions of EMRs includeÂ interoperability of data elements,Â connectivity to other electronic records,Â and information assuranceÂ (according to established standards).Â Essential in their implementationÂ is effective user training to preventÂ misuse that may lead to errors. TheyÂ have a significant contribution in theÂ primary healthcare and family medicineÂ where they form the main stay ofÂ medical records.
Technical standards and certificationÂ criteria for inpatient systemsÂ are still in development. The IndianÂ Academy of Paediatrics (IAP), theÂ statutory body at par with AAP, is alsoÂ equally focused on developing its ownÂ guidelines and algorithms for IndianÂ subcontinent.
Introduction of HIT may significantlyÂ improve clinical performance,Â reduce costs, and reduce workloads;Â however, every HIT-system implementationÂ will invariably introduce newÂ and sometimes unforeseen errorsÂ and challenges.
âThe majorÂ technical barrierÂ to adoption ofÂ pediatric HIT toolsÂ is a lack of pediatricspecificÂ informationÂ technologyÂ standardsâ
Pediatric functions in an EMR have been articulated in an AAP policyÂ statement 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 bothÂ easy as well as interesting to impartÂ training and teaching to both undergraduateÂ as well as postgraduateÂ students. Simulation tools have beenÂ developed to orient students with uniformity.Â In situations where trainingÂ was indeed difficult like the PaediatricsÂ Advanced Life Support (PALS)Â & Neonatal Advanced Life SupportÂ (NALS) courses have seen more andÂ more enthusiasm from the attendees.
Availability of articles, journalsÂ and e-scripts has only made learningÂ easy and effective.
In conclusion, IT is there to stayÂ in our lives.