AMBULATORY PEDIATRICS Volume 4, Number 1 64 Copyright  2004 by Ambulatory Pediatric Association January–February 2004 Information Technology: Its Importance to Child Safety Kevin B. Johnson, MD, MS; Coda L. Davison, FACHE, BA, MPA KEY WORDS: adoption; barriers; children; computers; infor- mation technology Ambulatory Pediatrics 2004;4:64 72 Opportunity is missed by most people because it is dressed in overalls and looks like work. —Thomas A. Edison (1847–1931) T here is understandable concern about the safety of the United States health care system. According to the Institute of Medicine, 1,2 today’s health care environment suffers from 4 threats to the delivery of safe care. First, care providers must make decisions that consider and optimally utilize the complex array of sci- entific discovery and technologic innovation in medicine, a feat that experts agree is not possible for the unaided human being. 1 Second, providers manage an increasing number of patients who have rare and chronic conditions and their comorbidities. Appropriate management requires the coordination of care among multiple disciplines throughout the care continuum. Third, disparities and dis- organization in our health care system lead to inconsistent use of best practices. For example, despite evidence sup- porting the importance of managing patient contacts (ap- pointments, follow-up, and urgent care) and empowering patients (through counseling, education, and feedback), these types of interventions are inconsistently available to patients. Fourth, within the health care environment, there are very few opportunities for feedback that might im- prove care delivery. Data about patient complaints, phar- macy error prevention, and other quality measures rarely are provided to care providers until punitive action is threatened. The report by the Institute of Medicine on quality chasm 1 clearly states that information technology has an essential role to play in health care quality improvement. Indeed, one can readily appreciate the value of informa- tion technology in ameliorating the above threats to pa- tient safety. Unsafe practices may result from acts of ei- From the Departments of Biomedical Informatics and Pediatrics (Dr Johnson), Vanderbilt University Medical Center, Nashville, Tenn; and Division of Research (Mr Davison), Johns Hopkins Uni- versity School of Medicine, Baltimore, Md. Address correspondence to Kevin B. Johnson, MD, MS, Associ- ate Professor, Biomedical Informatics, Pediatrics, Vanderbilt Uni- versity Medical Center, 402 Eskind Biomedical Library, Nashville, TN 37232 (e-mail: kevin.johnson@vanderbilt.edu). Received for publication July 1, 2003; accepted October 19, 2003. ther commission or omission. As described above, poor access to information, poor communication, poor coordi- nation, inadequate medical knowledge, or other factors may cause these acts. The Figure outlines a conceptual model that describes how these processes combine to en- sure safe delivery of care. This review will characterize those technologies that have established or potential effects that impact the con- ceptual model described above. Each area will be de- scribed in some detail, followed by a discussion about research opportunities that may improve the development or adoption of these innovations. METHODS Resources for this review were obtained using three ap- proaches. First, a clinical librarian conducted a search us- ing Pubmed (http://www.pubmed.gov), with key words, safety management, risk management, office management, medication errors, and adverse events. The search was repeated including the terms infant, adolescent, childhood, pediatric, and paediatric. We considered articles relevant if they addressed a technology that had the potential to impact the safe delivery of care (using the conceptual model in Figure) or to improve safety, defined as freedom from accidental injury 2 and including technologies that could prevent both errors of omission (failure to admin- ister a vaccine at the appropriate time) and commission (prescribing a drug to which a patient is allergic). Rele- vant articles were flagged, and related articles was se- lected to broaden the search. Next, we reviewed the known sources of evidence-based practice parameters (in- cluding the Cochrane database and the Agency for Health- care Research and Quality practice parameter and evi- dence-based medicine reports) for information about in- formation technology of value to pediatrics. Finally, we examined reference lists of pertinent articles to uncover additional references of interest to this study. References were categorized by key words and sorted on the basis of setting (inpatient vs outpatient; rural vs urban; large prac- tice site vs small practice site) and type of research (the- oretical vs clinical trial or description). Literature reviews were excluded, although they were reviewed and used to strengthen points and validate the research agenda where applicable. RESULTS The search led to five technologies that had the greatest potential to improve safety: ● Care provider order entry with decision support.