Pediatrics is a whole different kind of care compared with that for adults. Just as it requires specialized medical knowledge, it also needs specialized healthcare information technology.
Tracy Warren is cofounder and CEO of Astarte Medical, a vendor of pediatric digital tools. Healthcare IT News sat down with Warren to take a deep dive into pediatrics and technology, discussing steps to make sure clinical staff is using the best data, the pace of technology innovation in pediatrics care, how health IT can curb the all-time high in premature births in the U.S., and best practices clinical care teams can use to prevent lapses and medical errors in the neonatal intensive care unit.
Q. Data and the way it is applied in clinical settings is helping to improve care. But there are the challenges with the quality of data and how it is presented. What steps can be taken to make sure clinical staff is using the best, most useful data?
A. What’s interesting about the shift to AI and machine learning is people are skipping over the fact that data quality from the EHR actually is a rate-limiting factor. Because EHRs are billing systems, not designed to support patient care, patient care data is documented in customized flow-sheet rows in multiple locations inconsistently, and often wrought with typographical errors or omissions.
Additionally, much of actual patient assessment and ordering is unstructured free text, making data quality highly variable and difficult to interpret with existing natural language processing solutions. This can result in companies needing clinical specialists to interpret, translate and transform.
With the advent of EHR-integrated technologies, there is a second set of eyes on EHR data, and, for those solutions that provide real-time access to data, a quality-monitoring system can exist, enabling clinical teams to be alerted to inconsistencies and gaps in data. From there, teams can make adjustments and raise the quality of data while improving processes to reduce variability.
Q. Some in the industry say innovation in pediatrics care has been slow. What is your opinion? And if slow, what do you think has held back this part of healthcare from embracing new technology?
A. As a former venture investor, it has long been held that “you can’t make a return in pediatrics because it’s a small market.” The FDA and other organizations have worked hard to accelerate innovation by reducing regulatory burden, streamlining processes, and creating financial incentives to pursue pediatric or rare disease pathways.
However, few if any investors actively support investments in pediatrics, limiting innovation and negatively impacting patient outcomes.
Children are more medically complex than ever before, with chronic diseases and conditions on the rise, yet technologies to support clinical providers, patients and their families are lagging or not keeping pace.
Large companies in the medical device and health IT space are pressured to focus on large adult populations, inhibiting the market to offer end-to-end solutions for our children. Finally, reimbursement in the pediatrics space also has created budget challenges for hospitals offering these services.
Medicaid and payers need to align in support of the health of our children or the weight of these challenges may have a ripple effect downstream.
Q. The March of Dimes released a report highlighting an all-time high in premature births in the U.S. How does this tax resources in the neonatal care unit and what can be done via healthcare information technology to improve the delivery of care?
A. Not only are preterm birth rates climbing – driven by a combination of poor access to prenatal care, poorer health of mothers and increasing age of mothers – the resources to support these critical infants were decimated by COVID-19. The pandemic drove many professionals out of the industry, with most units reporting nursing shortages limiting the ability to fill NICU beds.
The healthcare industry long has relied on human resources to deliver care, but this is no longer viable. The system needs to start with a whiteboard on how care can be optimally delivered with the fewest number of resources. In the NICU, revisit staffing ratios and remove mundane administrative activities from the clinical team that can best be served by technology and automation.
Leveraging the substantial investment many providers have made in their EHR to drive operational efficiencies will not be easy, but it is possible and can help the existing NICU capacity support a greater number of infants.
Q. In a fast-paced NICU setting, communication is critical, particularly as it relates to a baby’s vitals. From your experience, what are some best practices clinical care teams should be using to prevent lapses and medical errors?
A. Access to information is paramount in any ICU setting, and medical teams have been able to improve communication in multiple ways. First, a unit-wide surveillance or monitoring system can offer a “war room” like feature to monitoring complex patients, highlighting those at risk by automating criteria to efficiently direct resources based on key vitals.
Second, we can break down data silos by offering a comprehensive, longitudinal view of a patient, liberating data from the EHR. This can enable better compliance practice guidelines, ensuring effective and consistent communication across the multidisciplinary teams that exist in the NICU.
Finally, alert features have been used in the past, but need to be careful not to create fatigue with the clinical team, to avoid alert fatigue and further negative impact on clinical ordering and workflow.
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