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US adoption of health information technology as a path to improved quality of patient care (effectiveness, safety, timeliness, patient-centeredness, efficiency, and equity) has been promoted by the medical community. Children and infants (especially those with special health care needs) are at higher risk than are adults for medical errors and their consequences (particularly in environments in which children are not the primary patient population). However, development and adoption of health information technology tools and practices that promote pediatric quality and patient safety are lagging. Two inpatient clinical processesmedication delivery and patient care transitions-are discussed in terms of health information technology applications that support them and functions that are important to pediatric quality and safety. Pediatricians and their partners (pediatric nurses, pharmacists, etc) must develop awareness of technical and adaptive issues in adopting these tools and collaborate with organizational leaders and developers as advocates for the best interests and safety of pediatric patients. Pediatric health information technology adoption cannot be considered in terms of applications (such as electronic health records or computerized physician order entry) alone but must be considered globally in terms of technical (health information technology applications), organizational (structures and workflows of care), and cultural (stakeholders) aspects of what is best. Pediatrics 2008;122:e1287-e1296 INTRODUCTION US adoption of health information technology (HIT) has been advocated by federal agencies, health care industry groups, and patient-advocacy organizations as a major approach to improve patient safety through reduction and prevention of medical errors. 1-5 Adoption of HIT tools such as electronic health records (EHRs), computerized provider order entry (CPOE), and clinical decision support (CDS) is increasing, and although current implementation of all these HIT tools is not yet widespread in US hospitals, 6,7 most 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. 8 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 pediatricspecific 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, 9 and recent observations and experience indicate that changes (such as the adoption of information technology) can introduce new and unanticipated errors. [10][11][12]
US adoption of health information technology as a path to improved quality of patient care (effectiveness, safety, timeliness, patient-centeredness, efficiency, and equity) has been promoted by the medical community. Children and infants (especially those with special health care needs) are at higher risk than are adults for medical errors and their consequences (particularly in environments in which children are not the primary patient population). However, development and adoption of health information technology tools and practices that promote pediatric quality and patient safety are lagging. Two inpatient clinical processesmedication delivery and patient care transitions-are discussed in terms of health information technology applications that support them and functions that are important to pediatric quality and safety. Pediatricians and their partners (pediatric nurses, pharmacists, etc) must develop awareness of technical and adaptive issues in adopting these tools and collaborate with organizational leaders and developers as advocates for the best interests and safety of pediatric patients. Pediatric health information technology adoption cannot be considered in terms of applications (such as electronic health records or computerized physician order entry) alone but must be considered globally in terms of technical (health information technology applications), organizational (structures and workflows of care), and cultural (stakeholders) aspects of what is best. Pediatrics 2008;122:e1287-e1296 INTRODUCTION US adoption of health information technology (HIT) has been advocated by federal agencies, health care industry groups, and patient-advocacy organizations as a major approach to improve patient safety through reduction and prevention of medical errors. 1-5 Adoption of HIT tools such as electronic health records (EHRs), computerized provider order entry (CPOE), and clinical decision support (CDS) is increasing, and although current implementation of all these HIT tools is not yet widespread in US hospitals, 6,7 most 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. 8 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 pediatricspecific 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, 9 and recent observations and experience indicate that changes (such as the adoption of information technology) can introduce new and unanticipated errors. [10][11][12]
Clinical Health Act accelerated the adoption of electronic health records (EHRs) with providers and hospitals, who can claim incentive monies related to meaningful use. Despite the increase in adoption of commercial EHRs in pediatric settings, there has been little support for EHR tools and functionalities that promote pediatric quality improvement and patient safety, and children remain at higher risk than adults for medical errors in inpatient environments. Health information technology (HIT) tailored to the needs of pediatric health care providers can improve care by reducing the likelihood of errors through information assurance and minimizing the harm that results from errors. This technical report outlines pediatric-specific concepts, child health needs and their data elements, and required functionalities in inpatient clinical information systems that may be missing in adult-oriented HIT systems with negative consequences for pediatric inpatient care. It is imperative that inpatient (and outpatient) HIT systems be adapted to improve their ability to properly support safe health care delivery for children.
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