Pediatrics and IT

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Dr Alok Bhatia

Dr Alok Bhatia,

Director & Business Head- Northern Region, NationWide Primary Healthcare Services Pvt Ltd

Adoption of health information technology (HIT) has been advocated by one and all as a major approach to improve patient safety through reduction and prevention of medical errors. Adoption of HIT tools such as Electronic Health Records (EHRs), Computerised Provider Order Entry (CPOE), and Clinical Decision Support (CDS) is increasing, and although current implementation of all these HIT tools is not yet widespread among Indian healthcare providers, although most tertiary care hospitals that provide care for children and infants use some form of an electronic information system to manage personal health information and other data that affect children’s health.

Children and infants have vulnerabilities and needs that are distinct from adults with regard to the management of their clinical care and its associated information. The extended normal ranges of body weights, sizes, and physiologic responses require modifications of clinical, technical, and information workflows to provide pediatric-specific care that is safe. A systematic evidence base for design and implementation of effective HIT that improves care quality and safety is needed but lacking,and recent observations and experience indicate that changes (such as the adoption of information technology) can introduce new and unanticipated errors.
The major technical barrier to adoption of pediatric HIT tools is a lack of pediatric-specific information technology standards. Among these needs for standards are pediatric data that are machine-readable, terminologies and dictionaries that fully describe pediatric clinical entities (such as pediatric drug-dose data), and electronic standards (Health Level 7 Child Health Functional Profile is currently in development in the US) that adequately describe pediatric clinical events.

Pediatrics and ITInpatient patient transitions & out patient departments

During an inpatient stay, patients undergo numerous care transitions, including admission (from emergency departments, transport services, and physician offices), discharge (to home or other facilities), and/or transfer to different locations within the institution for tests (imaging), procedures (surgery), and special levels of care (postanesthesia recovery care).
The most common transition is the transfer of care responsibilities (handovers, handoffs, or sign-outs). Physicians, nurses, consultants, and ancillary staff members transfer responsibilities in parallel (physician to physician, nurse to nurse, etc) and, in most cases, asynchronously according to shift and call schedules.
It is commonly seen and felt that in almost all the above mentioned situations the IT & its usefulness is beyond doubt changed the inpatient care statistics.
Another important milestone achieved has been the availability of these applications on the hand held devices & smart phones and in future will revolutionise the way we look at treating our children both in the hospital as well as in our out patient department.

Electronic Medical Record (EMR)

EMRs are a central structure for patient-specific data documentation. Their multiple roles include facilitating communication among providers, standardising medico-legal documentation of care, historical record archiving and retri, and coordination of care. They can facilitate centralised clinical communication and documentation among hospitalists, primary care providers in medical homes, consultants, and emergency care providers. They form the basis for medication reconciliation and may support personal health records to inform and empower patients and families about their care. Important technical functions of EMRs include interoperability of data elements, connectivity to other electronic records, and information assurance (according to established standards). Essential in their implementation is effective user training to prevent misuse that may lead to errors. They have a significant contribution in the primary healthcare and family medicine where they form the main stay of medical records.
Technical standards and certification criteria for inpatient systems are still in development. The Indian Academy of Paediatrics (IAP), the statutory body at par with AAP, is also equally focused on developing its own guidelines and algorithms for Indian subcontinent.
Introduction of HIT may significantly improve clinical performance, reduce costs, and reduce workloads; however, every HIT-system implementation will invariably introduce new and sometimes unforeseen errors and challenges.

“The major technical barrier to adoption of pediatric HIT tools is a lack of pediatricspecific information technology standards”

Pediatric-Specific Features

Pediatric functions in an EMR have been articulated in an AAP policy 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 both easy as well as interesting to impart training and teaching to both undergraduate as well as postgraduate students. Simulation tools have been developed to orient students with uniformity. In situations where training was indeed difficult like the Paediatrics Advanced Life Support (PALS) & Neonatal Advanced Life Support (NALS) courses have seen more and more enthusiasm from the attendees.
Availability of articles, journals and e-scripts has only made learning easy and effective.
In conclusion, IT is there to stay in our lives.

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