The Institute of Medicine (IOM) breaks down its definition of quality into six separate domains.  These domains include effectiveness, timeliness, equity, patient-centeredness, safety, and efficiency.  The application of health IT tools in the care of children has the potential to improve quality metrics within these areas.  Listed below are descriptions and examples illustrating how health IT can improve quality through the six domains.

• Effectiveness refers to delivery of care and the resulting health outcomes that are based upon scientific evidence.  The California Office of the Patient Advocate notes that one measure of effectiveness is a performance rating, based on indicators including whether or not your physician provided you with "services recommended for your age group such as pap smears, colorectal screening, mammograms, and vaccinations."  Routine vaccinations are integral to pediatric health care, as are other services such as growth tracking.
• Receiving care in a timely manner is a critical aspect of obtaining the best care possible.  Telemedicine can help to improve the timeliness of care; such is the case for real-time emergency consultations via telehealth for children located in rural areas that may be a significant distance from an emergency room. Another way in which telemedicine can be particularly useful for delivering timely care for children is in the school-based setting.  For example, a recent study published in the journal Pediatrics howed that telemedicine can improve diabetes care for children in elementary and middle schools.
• The adoption of health IT has also been shown to reduce disparities in care, improving equity of care.  A 2007 article published in the journal Health Affairs iscusses the potential of health IT implementation in Community Health Centers to reduce health disparities. 
• Patient-centered health care is another defining characteristic of quality care.  A study conducted by researchers from Boston University, Brigham and Women's Hospital, and Harvard Vanguard Medical Associates illustrates how health IT can be used to support the monitoring and care of children with asthma.
• To improve safety, health IT tools could help to reduce unintentional harm to patients from medical treatment.  Health IT can serve to improve safety, especially through its potential to reduce medication related errors.  A study published in the journal Pediatrics concluded that Computerized Physician Order Entry (CPOE), coupled with Clinical Decision Support Systems (CDSS), was particularly effective in improving safety in a pediatric inpatient setting.  Specifically, this study determined that, "CPOE with CDSS could have prevented 73% of all errors and 76% of potentially harmful errors."
• Efficient health care provides the maximum benefit while keeping cost to a minimum.  This principle has the potential to be realized through health IT mechanisms such as the health information exchange (HIE) set up by Children's National Medical Center, the Children's IQ network. This HIE allows providers to access patient data immediately, shares important information between providers, and integrates electronically with the practice management system.  Efficiency of care delivery is crucial to providing quality care and can be observed through a balance between outcomes and inputs.  More information about efficiency can be found elsewhere in this module, in the section entitled, "How can health IT improve efficiency of care delivery."

Related Resources:

• Child Health Care Quality Toolbox (AHRQ)
• Emerging Health Information Technology for Children in Medicaid and SCHIP Programs (Kaiser Family Foundation) (PDF - 580KB)
• Using Telehealth to Improve Quality and Safety (AHRQ)
• Using Personal Health Records to Improve the Quality of Health Care for Children (American Academy of Pediatrics)
• Improving Health Outcomes for Children in Foster Care (The Children's Partnership)