Child Health Improvement through Computer Automation: The CHICA System

1
Child Health Improvement through Computer
Automation The CHICA System Paul G. Biondich,
1,2,3 Vibha Anand, 1,3 Aaron E. Carroll 1,2,3
Stephen M. Downs,1,2,3 1Indiana University School
of Medicine, 2Regenstrief Institute, Inc.
3Childrens Health Services Research Program
SYSTEM FEATURES/COMPONENTS
OVERVIEW
We present Child Health Improvement through
Computer Automation (CHICA), a pediatric
preventive care decision support system. CHICA
is designed to improve the quality and breadth of
topics addressed during routine child well care
visits. It delivers just in time
patient-relevant guidelines to physicians during
the clinical encounter and accurately captures
structured clinical data from all who interact
with the system. CHICA performs these tasks while
remaining sensitive to the workflow constraints
of a busy outpatient pediatric practice.

• Knowledge base of guideline rules Risk factors
  and physician reminders are encoded into the
  system using Arden Syntax, a national standard
  for the computer-interpretable representation of
  medical knowledge. Sources of this knowledge are
  widely accepted authoritative sources of
  pediatric preventive care AAPs Bright Futures
  and GAPS program, the US Preventive Task Force,
  and the CDC.
• Repository of patient data Having all relevant
  medical record data for patients allows the
  system to only generate reminders and questions
  that apply to a particular visit. This ensures
  that CHICA draws on the rich legacy of data
  already contained within the RMRS.
• Tailored Document Printing and Scanning Engine
  Allows all who interact with the system to use
  paper as a direct interface with the computer.
  Forms are dynamically generated and filled with
  patient specific data in real time, and are then
  scanned and optically interpreted by Optical
  Character Recognition (OCR) software. This gives
  CHICA a robust ability to capture structured
  clinical data.

BACKGROUND
Despite the acknowledged importance of preventive
care for children and the abundance of preventive
services guidelines, rates of preventive care
delivery are often inadequate.
Why? Computer alert and reminder systems
are an effective way to improve rates of
preventive services. However, these successes
have generally been limited to direct computer
interfaces. Unfortunately, for many outpatient
preventive services, a reminder at the time of
note writing or order entry is often too late, as
these events frequently take place after the
physician has completed the visit. Just in time
information delivery requires that a reminder be
delivered at the time the physician is making a
decision, and this is often while he or she is
conversing with a patient. This timeliness is
even more important in pediatric practice.

• Time limits constrain the number of guidelines
  that can be addressed during a clinic visit
• Significant amounts of time are required to
  assess which risk factors apply to a given
  patient and, therefore, which preventive services
  may not be appropriate.

REFERENCES
1 Downs SM, et al. Child Health Improvement
Program. 2 Anand V, et al. Child Health through
Computer Automation The CHICA System. Proc
MedInfo Symp 2004 (in press). 3 Biondich PG, et
al. Using Adaptive Turnaround Documents to
Capture Structured Clinical Data. Proc AMIA
Symp 2003 56- 60.
Figure 1 CHICAs Technical and Workflow Diagram
HOW IT WORKS
Patient is registered into the clinic using the
electronic appointment system. This information
passes to the Regenstrief central data
repository This registration reaches CHICA, which
triggers it to acquire clinical and demographic
data relating to that patient from the RMRS using
HL7. CHICA generates a PreScreening Form (PSF)
which allows parents and teens to identify
pertinent risk factors. It also captures vital
signs from personnel. The PSF is scanned by the
clinic data is extracted from the form using
OCR. CHICA generates a Physician Worksheet (PWS)
which presents clinicians with tailored guideline
recommendations and places to record their
actions. The PWS is scanned by the clinic data
is once again extracted from form. All of the
data recorded for this patient visit is sent back
to RMRS using HL7.
ACKNOWLEDGEMENTS
This work was supported, in part, by the Robert
Wood Johnson Foundation (043628), the Riley
Memorial Association, and Clarian Health
Partners (Clarian Health Values Fund, VFR
123). Dr. Biondich was supported in part by the
National Library of Medicine (T15 LM-7117-5).
Childrens Health Services Research