4.09 Health Information Technology

Healthcare Systems: Supporting and Advancing Child Health

4.09 HEALTH INFORMATION TECHNOLOGY • Give examples of human errors that can occur when using an EHR, such as medication entry errors, documenting in the Introduction wrong patient record, and others. Health information technology (Health IT) is comprised of a • Identify problems of a poorly designed EHR and describe range of digital tools used within the health care systems to col- how pediatric hospitalists can partner with hospital systems lect, store, analyze, and share medical data. In today’s health- to mitigate these problems. care systems, health IT is an invaluable component for delivery • Cite common risks that may occur when utilizing an EHR of high-quality and safe care. Recognizing the role of health designed for adult aged patients and review actions to miti- IT, the Institute of Medicine (now the National Academies of gate these risks for pediatric patients. Medicine), in 1999, issued reports highlighting the potential of the electronic health record (EHR) in reducing medical errors Skills through electronic order entry, facilitating care coordination, Pediatric hospitalists should be able to: and improving clinical efficiencies. Despite these benefits, hos- • Demonstrate proficiency with the local EHR or computer- pitals were slow to adopt these technologies until Congress ized provider order entry system. passed the Health Information Technology for Economic and • Access and use web-based educational resources for con- Clinical Health (HITECH) Act in 2009. Under this act, standards tinuing education and enrichment of trainee learning expe- were set for ‘meaningful use’ of health IT and substantial re- riences. sources and incentives were provided to eligible hospitals and • Utilize local health IT systems for clinical care, education, QI providers to offset EHR implementation costs. The result over and patient safety initiatives, and research in an effective and the past decade has been widespread adoption of the EHR efficient manner. across the United States, although children’s hospitals remain • Assist in or champion the creation, ongoing maintenance, at the slower end of the adoption curve. Pediatric hospitalists and optimization of electronic order sets and documenta- use health IT systems for clinical care, education, quality im- tion templates. provement (QI), patient safety efforts, and for research and • Assess and assist with improving and optimizing clinical de- thus play a critical role in implementing and optimizing health cision support tools, including rules and alerts, to meet the IT use within hospital systems. changing needs of the health care system and hospitalized children. Knowledge • Use hospital health IT system downtime procedures to pro- Pediatric hospitalists should be able to: vide safe continued medical care to patients in the event of • Describe the unique role of health IT in providing care to a system failure or shutdown. hospitalized children and the importance of careful design • Demonstrate best practices in use of the EHR, such as use and implementation of health IT systems within hospitals of “navigators” and order sets, importing relevant medical and hospital systems that care for children. records where available, and avoiding potentially risky prac- • Describe the impact of the Health Insurance Portability and tices such as copy-paste where appropriate. Accountability Act (HIPAA) Privacy Rule on health IT security • Educate trainees on correct use of the EHR and edit and and the importance of secure storage and retrieval of pro- attest to trainee notes as appropriate. tected health information. • Explain the value of clinical decision support in rendering Attitudes patient care. Pediatric hospitalists should be able to: • Compare and contrast the influence of health IT systems on • Exemplify accountability by adhering to regulations around practice management, clinical decision-making, QI initia- proper use of health IT. tives, safety initiatives, and research in the healthcare setting. • Acknowledge the value of collaboration with healthcare • List resources that can be accessed to address questions providers, patients and the family/caregivers, and hospital about information systems, such as local system super users, administration to ensure the successful functioning of health hospital IT support, vendor support lines, online access to IT systems. other healthcare providers who use the system, and others. • Advocate for the proper alignment of health IT system • Delineate how staff dedicated to health IT support quality choices with clinical needs, particularly for pediatric-specific and safety efforts and data retrieval. needs in predominantly adult healthcare systems. • List information resources and tools available to support life- • Realize the importance of communicating effectively with long learning in dynamic health IT. health IT system managers and leaders. • Discuss the importance of pediatric hospitalists in develop- • Recognize and respect patient confidentiality by using the ing, modifying, and evaluating changes to health IT systems security-directed features of information systems. on an ongoing basis to optimize workflow and patient care. • Recognize that dependence on technology for some clinical Systems Organization and Improvement tasks is an unintended consequence that has arisen since In order to improve efficiency and quality within their organiza- the institution of the EHR. tions, pediatric hospitalists should:

An Official Publication of the Society of Hospital Medicine Journal of Hospital Medicine® Vol 15 | No S1 | April 2020 127 Healthcare Systems: Supporting and Advancing Child Health

• Lead, coordinate, or participate in appropriate hospital and ized child, such as clinical decision support tools, telemedi- health systems committees to assist in developing and op- cine, health information exchange, registries, and others. timizing health IT solutions to improve quality, safety, and • Seek opportunities to improve the role of health IT in man- workflow efficiencies. aging costs and supporting quality and clinical research, as • Partner with hospital leaders and administration to optimize applicable. use of the EHR to improve clinical documentation and de- velop performance measures and dashboards for the hospi- talist practice and the hospital system. References • Collaborate with family advisory groups, hospital adminis- 1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press: 2001. tration, healthcare providers, and community partners to 2. Koutkias V, Bouaud J. Contributions from the 2017 Literature on Clini- support and enhance the use of the EHR by patients and the cal Decision Support. Yearb Med Inform. 2018;27(1):122–128. https://doi. family/caregivers. org/10.1055/s-0038-1641222. • Partner with hospital administration and healthcare provid- 3. Vélez-Díaz-Pallarés M, Pérez-Menéndez-Conde C, Bermejo-Vicedo T. Sys- tematic review of computerized prescriber order entry and clinical deci- ers to integrate new technologies that improve pediatric sion support. Am J Health Syst Pharm. 2018;75(23):1909-1921. https://doi. hospital medicine practice and care delivery to the hospital- org/10.2146/ajhp170870.

128 Journal of Hospital Medicine® Vol 15 | No S1 | April 2020 An Official Publication of the Society of Hospital Medicine