How can health IT improve health promotion and disease prevention? What is the role of oral health? Genetic and newborn hearing screening?
In addition to the quality domains developed by the Institute of Medicine (IOM) (effectiveness, timeliness, equity, patient-centeredness, safety, and efficiency), the IOM also provides a framework for quality from the consumer's perspective. According to AHRQ, the IOM's framework defines four categories under which the consumers (patients and families) judge the quality of their care. These categories are based on the principles of staying healthy, getting better, living with illness or disability, and coping with end of life. Using health IT to promote these categories of health care quality can serve to improve health promotion and disease prevention.
In 2009, the Children's Partnership recommended that the definition of meaningful use include "child-specific quality measures for prevention and health promotion." Some of recommendations and measures for child health care quality mentioned include EPSDT standards, the Bright Futures guidelines, and the quality guidelines being developed under CHIP. Bright Futures (PDF - 752KB) , a national health promotion and disease prevention initiative that addresses children's health needs, notes the opportunity to use the newest set of guidelines together with electronic health records (EHRs). Some of the functions mentioned specifically include the ability of an EHR to provide a template to guide the visit, to disseminate information relevant to the child's age, the season, or changing recommendations, and to reach out and connect with the patient and family. An EHR can also promote disease prevention though clinical alerts for immunizations, which according to a 2007 article in the journal Pediatrics have shown to significantly improve immunizations rates for young children in an urban population.
Oral health is another key aspect of children's quality care, and increased coordination between primary and dental providers is critical to children's health as spelled out in a 2008 article from American Medical News. Health IT tools like EHRs can also utilize alerts to improve health promotion and disease prevention during visits for oral health care. Another program run by the Forsythe Institute (PDF - 1.8MB) delivers preventative oral health care to children at school, while documenting important health information electronic dental record that will follow the children over time.
In addition to facilitating the delivery of health care including oral health, health IT can also encourage quality preventative care through newborn screenings. Bright Futures states, with regard to newborn screening, that it is the primary care provider's responsibility to ensure that the results are recorded in the child's medical record and to maintain a central medical record available to parents and other providers while providing follow-up care. Maintaining and making available this medical record can be facilitated through the use of an EHR. The Children's Partnership advocates for the inclusion of newborn screening results into a health IT record, specifically through the incorporation of lab results into the EHR. A 2009 article from Pediatrics notes that health IT can alert a pediatrician when a child has failed a newborn hearing test, but has not yet been examined more comprehensively. The article also mentions, however, that such benefits will not be realized until health IT systems are integrated and interoperable.
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