Letter from the Chair

Andy Spooner, MD, MSCS, FAAP

It’s been a busy year for pediatric information technology medical informatics.

The handheld market in medicine has exploded, and pediatricians are right therewith everyone else. At the last AAP annual meeting in October of 2000, it was commonplace to encounter people with Palm Organizers, in sharp contrast to the meeting in 1999. We saw the publication of the 5-minute Pediatric Consult and the AAP Red Book from handheldmed.com, Palm-based abstracts in pediatric journals from MedScape.com, and the inclusion of pediatric dosing in the epocrates drug information program, among other pediatric applications. And the Microsoft Win CD/Pocket PC market is catching up with compatible versions of the same sort of applications. A resident in Washington, DC, founded the web site http://www.pedsonhand.com to keep up with these new applications, so check it out.

HIPAA dominated the health information technology policy arena. HIPAA, the Health Insurance Portability and Accountability Act of 1996, promises to do a lot of things, but one thing it promises is to promulgate a new set of rules to keep individually identifiable patient data safe. These rules apply to all medical information, not just electronic data, so if you think you’re off the hook because of a paper-based office, guess again. At least with electronic information, the computer can give you some guidance and offer some enforced security in keeping with the HIPAA regulations. President Bush made a big stir when he interpreted the HIPAA laws to mean that parents can have access to adolescent’s records, even in cases of abuse, mental illness, and domestic violence. This will be an interesting battle as we try to maintain the pediatrician’s right to give confidential care to adolescent patients.

The AAP’s Task Force on Medical Informatics put the finishing touches on the AAP publication "Practice Management Software Review Guide" which is available in both hard-copy and web-based form at http://www.aap.org. This is a first attempt to help provide a set of criteria for the practitioner to use in deciding how to buy a computer system for office management.

Medicaid programs in at least 18 states (http://www.hcfa.gov/medicaid/telelist.htm) started providing reimbursement for telemedicine services. Finally, we will be able to start using high-bandwidth audio/video to extend care to kids in rural areas and spread pediatric subspecialty care over larger regions. Ask your local hospital how you can use their telemedicine facilities to get needed care for your patients with a minimum of disruption to families.

Those of you whoa are interested in implementing pediatric informatics educational programs for students or residents should check out http://groups.yahoo.com/group/peds-informatics-ed. Even if your only exposure to house staff is the half-day per week they cme to your office, you might be the only pediatrician they encounter with any level of comfort with information technology. You might be their only chance to get some exposure to useful applications in pediatrics.

The Institute of Medicine stirred things up in March 2001 with their report, "Crossing the Quality Chasm," (http://www.nap.edu/books/0309072808/html/) which said, among other things, that we need to get rid of handwritten patient information altogether in the next ten years. Are you ready? We’ll see how seriously this report is taken by American Society. I hope it is taken more seriously than the 2001 IOM report showing no link between MMR vaccine and autism, which was pooh-poohed by some members of Congress because it disagreed with their preconceived notions.

The Agency for Health Care Research and Quality (AHRQ) and the AAP’s Center for Child Health Research sponsored a meeting in September, 2000, called Information Technology for Child Health (ITCH). This meeting set in motion a number of papers that will published in the pediatric literature over the next year or so on the importance of technology that works for children’s health care.

Electronic medical record systems are proliferating. While we do not yet have a "Consumer Reports" styled reference for EMRs in pediatrics, one report you should look at is actually from the world of family Practice: the FPM EMR vendor survey, found at http://www.aafp.org/fpm/20010100/45elec.html. This comes as close as I’ve seen to a review that paints a broad, if not deep, picture of what’s out there. Check it out, and if you want to write a review of an EMR you have seen, please submit it and we will put it into the next newsletter.