Chapter 7

### Introduction

Information technology is currently evolving at a rapid pace and its application in healthcare is no exception. Health information technology (HIT) has the potential for revolutionizing patient safety and improving healthcare quality. A series of Institute of Medicine (IOM) reports helped catalyze the view that HIT has the potential for improving patient safety and quality. The 1999 IOM Report “To err is human: building a safer health system” brought to the forefront the problem of medical errors and proposed HIT as a solution for reducing those errors.1 This was further iterated by the IOM report “Crossing the quality chasm: a new health system for the 21st century” where one of the key recommendations was the application of health information technology to help redesign the healthcare system. It was recognized in this report that HIT had the potential for impacting all six aims of this report: safety, effectiveness, patient-centered, timely efficient, and equitable.2

HIT may have a particularly important impact in a specific area of high risk for pediatric patients: that of medication errors and adverse drug events (ADEs). Adverse drug events in pediatric patients are estimated to occur at a rate of 2.3 to 11.2 ADEs per 100 pediatric inpatients.3–6 It is estimated that the rate of ADE in pediatric inpatients is approximately three times that in hospitalized adults.3 Health information technologies such as computerized physician order entry and computerized clinical decision support have been proposed as an important strategy to reduce ADEs in pediatric patients.3,7–10

Electronic health records (EHRs) are defined as the computerized record system that contains the patient’s data on their inpatient and outpatient visits. Key functionality of EHRs as defined by the Institute of Medicine are health information and data, results management, order entry/management, decision support, electronic communication and connectivity, patient support, administrative processes, and reporting and population health management.11 Despite national calls for the adoption of EHRs, surveys of ambulatory physicians and hospitals show that 13% of ambulatory physicians have a basic EHR system and 4% have an extensive EHR system while 7.6% of hospitals have a basic EHR system and 1.5% of hospitals have a comprehensive electronic system.12,13 In one survey of pediatric hospitals, 48.6% of respondents surveyed had an EHR system and 39% of respondents planned on implementing one within 2 years.14 Another survey found that 10.5% of pediatricians who answered the survey had implemented an EHR.15

Improving patient safety and decreasing medical errors is a common driver for the implementation of HIT.14 Multiple barriers exist for pediatric hospitals and general hospitals to implement these systems.14,16 One large barrier is the cost to purchase EHRs. Hospital systems have spent millions to hundreds of millions of dollars on such systems, and the average cost of an EHR for an outpatient practice is estimated to be approximately $15,000 to$70,000 ...

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