Physician Specialty and Variations in Adoption of Electronic Health Records

Do pediatricians lag behind other specialties in electronic heath record adoption? In this study of National Ambulatory Medical Care Survey data from 2005-2009, full EHR adoption was highest for internal medicine, family medicine, and pediatrics (9.9 – 11%), but any EHR adoption was lower in pediatrics than the mean adoption rate. In other words, when pediatricians adopt, they tend to implement fully, but they may adopt at a lower rate than other specialties. Grinspan 2013 (Applied Clinical Informatics)

The Natural History of Weight Percentile Changes in the First Year of Life

Another demonstration that growth in the first year of life is not as smooth as we’d like to think, and that “crossing percentile lines” does not mean what we have long been taught. Before you do a “failure to thrive workup” (whatever you think that is), check out this data to be sure you are interpreting “failed” growth appropriately. In this study from EMR data, 38% of infants fell by 2 “percentile lines” and would have been considered to be failing to thrive by that definition. But they were not.

Bennett 2014 (JAMA Pediatrics) | PubMed 24797161 | Author Search

Using Quality Improvement to Optimise Paediatric Discharge Efficiency

Reports a quality-improvement project that used defined discharge criteria and communication techniques within the electronic medical record system to ensure that pediatric patients were discharged within 2 hours of their being physiologically ready. Results showed on-time discharge went from 42% to 80% of patients across 11 common pediatric conditions. White 2014 (BMJ Quality & Safety)

Principles and strategies of antimicrobial stewardship in the neonatal intensive care unit

Patel SJ, Saiman L

Semin. Perinatol. 2012 Dec;36(6):431-6

PMID: 23177802

The judicious use of antibiotics is an important means to limit the emergence of antibiotic-resistant organisms. Although specific guidelines for neonates are often lacking, antibiotic stewardship principles can be applied to the neonatal intensive care unit. [Read more…]

Evaluating the accuracy of electronic pediatric drug dosing rules

Kirkendall ES, Spooner SA, Logan JR

J Am Med Inform Assoc 2014 Feb;21(e1):e43-9

PMID: 23813541

OBJECTIVE: To determine the accuracy of vendor-supplied dosing eRules for pediatric medication orders. Inaccurate or absent dosing rules can lead to high numbers of false alerts or undetected prescribing errors and may potentially compromise safety in this already vulnerable population. [Read more…]

Sensitivity and specificity of dosing alerts for dosing errors among hospitalized pediatric patients

Stultz JS, Porter K, Nahata MC

J Am Med Inform Assoc 2014 Feb;

PMID: 24496386

OBJECTIVES: To determine the sensitivity and specificity of a dosing alert system for dosing errors and to compare the sensitivity of a proprietary system with and without institutional customization at a pediatric hospital.

METHODS: A retrospective analysis of medication orders, orders causing dosing alerts, reported adverse drug events, and dosing errors during July, 2011 was conducted. Dosing errors with and without alerts were identified and the sensitivity of the system with and without customization was compared.

[Read more…]

A systematic evaluation of different methods for calculating adolescent vaccination levels using immunization information system data

Gowda C, Dong S, Potter RC, Dombkowski KJ, Stokley S, Dempsey AF

Public Health Rep 2013 Nov-Dec;128(6):489-97

PMID: 24179260

OBJECTIVE: Immunization information systems (IISs) are valuable surveillance tools; however, population relocation may introduce bias when determining immunization coverage. We explored alternative methods for estimating the vaccine-eligible population when calculating adolescent immunization levels using a statewide IIS.

METHODS: We performed a retrospective analysis of the Michigan State Care Improvement Registry (MCIR) for all adolescents aged 11-18 years registered in the MCIR as of October 2010. We explored four methods for determining denominators: (1) including all adolescents with MCIR records, (2) excluding adolescents with out-of-state residence, (3) further excluding those without MCIR activity ≥ 10 years prior to the evaluation date, and (4) using a denominator based on U.S. Census data. We estimated state- and county-specific coverage levels for four adolescent vaccines.

RESULTS: We found a 20% difference in estimated vaccination coverage between the most inclusive and restrictive denominator populations. Although there was some variability among the four methods in vaccination at the state level (2%-11%), greater variation occurred at the county level (up to 21%). This variation was substantial enough to potentially impact public health assessments of immunization programs. Generally, vaccines with higher coverage levels had greater absolute variation, as did counties with smaller populations.

CONCLUSION: At the county level, using the four denominator calculation methods resulted in substantial differences in estimated adolescent immunization rates that were less apparent when aggregated at the state level. Further research is needed to ascertain the most appropriate method for estimating vaccine coverage levels using IIS data.

Progress in immunization information systems – United States, 2012

MMWR Morb. Mortal. Wkly. Rep. 2013 Dec;62(49):1005-8

PMID: 24336133

Immunization information systems (IIS) are confidential, computerized, population-based systems that collect and consolidate vaccination data from vaccination providers that can be used in designing and sustaining effective immunization strategies. To monitor progress toward achieving IIS program goals, CDC annually surveys immunization program grantees using the IIS Annual Report (IISAR). Results from the 2012 IISAR, completed by 54 of 56 grantees, indicate that 86% (19.5 million) of U.S. children aged <6 years, and 25% (57.8 million) of U.S. adults participated in IIS.

[Read more…]