Child health improvement through computer automation

October 05, 2004

The latest innovation in medical care for children marries the high tech manufacturing "just-in-time" concept with increased parental participation in the health-care process to produce care guidelines for pediatricians individualized for each patient and delivered when they can do the most good -- at the time of the office visit.

A newly developed computer-based decision support system targeted to medicine's youngest patients utilizes hand-written information acquired from a child's parents within the waiting room, along with preexisting data from the nation's oldest continually operational electronic medical record to provide critical information and clinical reminders to pediatricians.

In a presentation of their work at the recent MedInfo 2004, the premier international meeting of the medical informatics community, researchers from the Indiana University School of Medicine and the Regenstrief Institute, Inc. introduced Child Health Improvement through Computer Automation: The CHICA System. CHICA combines patient-relevant pediatrics guidelines with information learned from the patient's family to enable the pediatrician to provide individually targeted care.

Upon arrival for the child's first appointment, the parent or other family member fills out a simple CHICA waiting room prescreening form, which includes questions specific to the age of the child and reason for visit. The handwritten responses are then scanned and uploaded into the computer system which generates customized items on a form used by the physician when he or she sees the patient. For example, if the parent has indicated that the child lives with a smoker, CHICA will prompt the pediatrician to discuss smoking cessation programs as well as dangers of second hand smoke. Information is tracked from clinic to clinic and from visit to visit.

"Multiple practitioners approached us during the pilot to tell us that the system had informed them of very important clinical data such as guns within homes, abusive family situations, and maternal depression that they would not have known about otherwise," said senior study author Stephen Downs, M.D., associate professor of pediatrics and director of the division of children's health services research of the department of pediatrics at the IU School of Medicine and a Regenstrief Institute affiliated scientist.

CHICA is an extension of the Regenstrief Medical Records System (RMRS), a computer-based inpatient and outpatient information system that contains more than 30 years of patient data and more than 300 million patient observations -- primarily on adults. RMRS includes an internationally respected physician reminder system that offers suggestions on appropriate diagnosis, tests and treatment management for each patient.

The sheer volume and changing nature of guidelines for shot administration, vision screening, injury prevention, management of chronic diseases and a myriad of other child and adolescent medicine topics often overwhelm busy pediatricians who often rely on memory. Most physicians do not use computerized guidelines because they can be costly or, unlike the extensively tested RMRS, may be unappealing to a busy physician. However, the majority of health care providers can't spend sufficient time with the patient and family to learn enough about many factors such as parental behavior, which may affect the child's health. CHICA solves both the information overload and cost problems while helping the pediatrician focus on the specifics of the patient in the clinic. Since the system uses paper, it can be implemented with little or no staff training.

"Pediatricians and others taking care of children are constantly struggling to provide preventative care but are overwhelmed by what counseling is necessary," said co-author Paul Biondich, M.D., assistant professor of pediatrics at the IU School of Medicine and a Regenstrief Institute research scientist. "Combining pediatric preventive care guidelines with a dynamic, scannable paper user interface enables us to better serve our patients and their families."

Dr. Downs estimates that in its first year of use, CHICA will enable the parents and physicians of 55,000 pediatric patients in the Wishard Health System, site of the pilot study, to make better health-care decisions. Given the ease of implementation and use, he believes CHICA will quickly become an indispensable tool of the many pediatricians at Wishard and that its use will quickly expand to other sites. A Spanish language version of the forms is planned.

The CHICA pilot project was funded, in part, by the Robert Wood Johnson Foundation, the Riley Memorial Association, Clarian Health Partners and the National Library of Medicine.

In addition to Dr. Downs and Dr. Biondich, the CHICA team includes Vibha Anand, M.S, Gilbert Liu, M.D., M.S., Aaron Carroll, M.D., M.S., and Marc Rosenman, M.D. All are with the children's health services research division of the department of pediatrics at the IU School of Medicine. With the exception of Ms. Anand all are also affiliated with the Regenstrief Institute.

Indiana University

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