In 2006, Peter Belamarich and colleagues published an article called, “Drowning in a Sea of Advice: Pediatricians and American Academy of Pediatrics Policy Statements,” in which they describe over 344 Clinical Practice Guidelines and Policies from the American Academy of Pediatrics (AAP), the world’s most authoritative source of clinical guidance for care of children. Since then, the AAP has produced hundreds more documents giving clinical advice to pediatricians. This does not include the AAP’s Bright Futures Guidelines for well child care, which offer over 2,000 action statements.
Pediatricians and other healthcare providers caring for children are left in a quandary. How can they be expected to meet these recommendations in a typical 15-20 minute (if you’re lucky) visit? There’s even less time if parents or children bring concerns to the visit. Yet health systems and insurance companies routinely grade physicians on how well they adhere to these guidelines.
Investigators at Indiana University School of Medicine developed a software system that can help. Now a new company, Digital Health Solutions, LLC, is making that software widely available. The software, CHICA (for Child Health Improvement through Computer Automation), is a computer based decision support system that works with the provider’s electronic health record (EHR) to capture data directly from patients, deliver alerts and reminders to physicians, and quickly documents services the physician provides. The software has been the subject of dozens of clinical studies that consistently show improved adherence to clinical guidelines.
CHICA has run in pediatric clinics at Eskenazi Health in Indianapolis, Indiana for a dozen years. In these clinics, when a patient registers for a visit with the doctor, the EHR sends the child’s electronic medical record to CHICA. CHICA applies hundreds of rules to the data and selects 20 questions to ask the family about the child’s health. Questions may be about smokers in the home, dietary risk factors, safety issues, asthma symptoms, or anything the physician might want to know about that particular child. CHICA has a special algorithm to select the most important questions for each child. Parents answer these questions on an electronic tablet while they are in the waiting room.
Once the questions are answered, CHICA applies hundreds of other rules to the child’s record and the family’s answers to select six alerts or reminders to show the physician. The physician can access these alerts and reminders from within the EHR by clicking a tab. Each reminder alerts the physician to an issue and the physician can respond by checking boxes that document what he or she did in response. Based on what boxes the doctor checked, CHICA can write information into the doctor’s note in the EHR. CHICA also produces patient handouts tailored to each patient. The doctor can use them to help with advice and counseling.
Doctors have more guidelines than they can handle in a patient visit, yet they are accountable for delivering these services. CHICA addresses this problem in several ways.
First, it screens patients for health risks BEFORE the visit, saving the physician valuable time. Second, it reminds physicians of care they might otherwise have forgotten, improving care quality. Third, CHICA documents, in a coded, easy to retrieve format, the quality of services provided. Finally, CHICA’s prioritization scheme helps assure that the most important services for each patient are provided.
Because CHICA not only improves the quality of care, but also documents that quality, providers and health systems are better positioned to negotiate with insurers for better reimbursement.
Because CHICA has been such a success at Eskenazi Health, its developers were eager to form Digital Health Solutions, LLC, to make it available to the rest of the country.
About the Authors
Stephen M Downs, MD, MS, President
Steve Downs is a general pediatrician, professor, and medical informatician. He has worked in the world of pediatric decision support for 30 years. He is an elected fellow of the American College of Medical Informatics and earned the Oberst Award for significant contributions to the field of Child Health Informatics.
Tammy Dugan, CTO
Tammy Dugan is the Chief Technology Officer of Digital Health Solutions, LLC. She has over a decade of experience developing medical informatics software with a focus on clinical decision support.
Steve Downs authored this piece with contributor Tammy Dugan.